The SNS might not be the right intervention for this little guy. If he 
has respiratory issues, increasing the milk flow will only increase the 
demand on his aerobic capacity.
I'd try using the breast for dessert. Mom can give most of the bottle 
using careful pacing, then put the baby to the breast to get full. She 
can then pump to get the milk for the next bottle. If she cannot manage 
to pump, then she can take a bottle out of her freezer stock, and then 
pump once the baby is satisfied to help maintain her supply.

Most former premies transition to exclusive breastfeeding gradually. 
Just because he can't breastfeed all his feedings now does not mean that 
he won't do it soon. If she can possibly see a skilled private practice 
IBCLC or the hospital LC who has helped her so much already, they might 
be able to help more.
Catherine Watson Genna, IBCLC  NYC

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