Anne,
I hope you have read Mary Grace Lanese's (et. al) study in JOGNN regarding
the improved breastfeeding continuation rates when babies were transitioned
to breast from gavage rather than bottles.   We have had the same experience
in our NICU.

Re: transitioning premies to the breast
While cup feeding works well for babies close to term, I think our neonatal
occupational therapist (NDT and SI certified) would drop dead if we tried to
transition premies  with a cup because it does nothing to teach correct jaw
and suckling action in preparation for breastfeeding.  Note: we don't use
bottles either unless mom is not available and has requested it.

Re: Indwelling naso-gastric tubes and breast feeding.
A couple of years ago, I stuck a gavage tube down my own nose and taped it
down for a day to see how miserable it was to eat with it in place.  It was
just awful going down and coming back up.  But while it was indwelling ----
it tickled,......that's about it, and I have a fully developed gag reflex.
Personally I think nasal oxygen cannulas interfere more with breastfeeding
because they create a barrier under the baby's nose.  That problem is solved
pretty well by using a clutch hold, but I am always grateful when the baby
can maintain oxygen saturation without supplemental oxygen.

Nystatin for over a month?  What for?

Re: fortification of EBM revisited
I am not a neonatologist or a neonatal dietician, BUT, after 30 years as an
NICU nurse, I can say  that routine long-bone studies on premature babies
fed totally on unfortified breast milk HAVE shown evidence of rickets.   My
question is: Just because a baby does not have clinically obvious rickets,
does that mean there isn't a problem?  Are long-bone studies done on premies
in Zimbabwe? Just curious.
I'm not necessarily in favor of fortifying breast milk if it is not
necessary, but I am definitely in favor of reducing any incidence of
nutritional deficiencies from whatever cause when it is possible.
Deanne

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