Cindy - this sounds such a tough one, going on and on, so easy for everyone
to get discouraged and give up.  I think the weight-watching is a GOOD idea
- a bit demoralising for the mum, yes, but the purpose of all this is to
FEED the baby, and the weight going on (I like it when they're gaining
3Og/day) demonstrates that the baby is being fed!  I've also seen babies who
LOOK as if they're sucking beautifully, but can't be (low urine/stool
output, minimal weight gain). I've also seen babies who will only apparently
suck well when the milk is "flowing" - at other times they just flutter
and/or doze.  It seems that when the baby is under-weight he may not have
the strength to suckle well.  I would concentrate on building this baby's
weight up by ANY means and if this takes MORE formula for a time I would go
for that.  When he's bigger and stronger his suck may improve and in the
meantime his nutritional status is not being compromised.  However, it IS
possible to build up the breastmilk supply simultaneously - this takes
DRAINAGE.  When the baby has finished breastfeeding (with or without the
SNS), what happens when mother attempts to pump or hand express the breasts
IMMEDIATELY afterwards?  I'd just bet there's milk left behind in the
breasts.  If she can be persuaded to drain the breasts AFTER breastfeeding
REALLY well (even obtaining 5 - 10 ml to start with would be good) this
achieves two things - some of the supplement can be EBM  - 10 ml expressed
after 6 feeds in 24 hours equals 60 ml - AND, what's even more important,
VERY good drainage will stimulate increasing breastmilk production. It's all
very time-consuming - breastfeeding, THEN pumping - but it really does seem
to work if the mother can be persuaded to make the effort.  I ask the mum to
keep a chart showing breastfeeds, supplements (EBM and/or formula), when she
pumps and how much obtained. (You can see the motivation here, if she only
pumps three times in 24 hours she wont have much success, if she will go for
it 7 times she'll start noticing changes within about 4 - 5 days). When the
baby becomes stronger and starts to breastfeed more efficiently the
supplements taken reduce and the amount of EBM that can be pumped after
feeding reduces - but the baby by this time is usually gaining well.  I am
very cautious about reducing supplements too soon or too fast, otherwise the
baby's weight reflects a lowered intake and you're back to square one, weak
baby, inefficient breastfeeding, gradually reducing breastmilk supply again.

Keep us posted!  Dying to hear how this one finally turns out!  BEST wishes

Pamela, Zimbabwe