Kay Hoover and I obtained a pre-publication abstract of the Meier article
which, as Laurie pointed out, we quote in The Breastfeeding Atlas. I've had
private discussions about this study with Nancy Hurst, one of the other
authors, and a researcher I really respect.  I believe the article will be
in the Spring issue of JHL.  I was interested  to see their work which
demonstrates increased volumes of milk obtained by preemies nursing through
nipple shields.  It replicates my own observations.  Many preterm babies can
suck; they just don't suck real well. Their intake can often be quite
compromised.  They are sent home around here as early as 35 weeks gest. age,
and parents often believe that they can be managed the same way as term
nursing infants.  Short term use of shields seems to be a useful way to
transition them to oral feeds, and to insure they get more intake early on
when still very weak, plagued with tone problems, and sleepy.  For some
reason, the shield (newborn small size) keeps them more stimulated and also
seems to somehow improve their intra-oral stability.  Meier's study didn't
find any particular problem taking them away, and I usually don't either.  A
caveat here is that I track all my shield-using babies, and I know how they
are doing at any given point.

It would be ridiculous to chose to use a tool like a shield without a
specific rationale for doing so.   You have to ask:  What is wrong with the
baby?  Why can't the baby feed normally (i.e. why can't it breastfeed?) Will
a shield be a good tool to help transition THAT baby back to normal feeding?
Have you chosen the right size shield for the size of the baby and the
mother?  Are you monitoring to see if you've guessed correctly?  Does the
milk supply need special protection?

You don't hang a picture with a sledge hammer, or unlock the door with a
chain saw.  The right tool for the job is a maxim of any trade.  Shields are
tools with specific uses and specific indications.  Any tool can be
dangerous if improperly used.  People who are charged with caring for
vulnerable populations must take responsibility to personally learn about
how specific tools function and then they are ethically obligated to use
them appropriately or not at all.

I think we are planning to talk about the Livingston and Amir mastitis
articles from Sept. JHL in the next installment of the Journal Club, but I
hope the nipple shield article also gets picked for Journal Club, as I think
the research is quite interesting.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.lactnews.com

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