In our 84 bed NICU we have not had success with using a supplementing 
device at the breast for premies.  

We think it is because premies often have multiple problems with feeding 
including lack of stamina, difficulty with flow control, difficulty 
coordinating suck-swallow-breath, immature muscles that prevent a strong 
latch, to name a few.  A supplemental device at the breast can exacerbate 
their difficulties coordinating flow-control and suck-swallow-breath, while 
also breaking the seal that their otherwise weak muscles may have made at 
the breast, reducing their ability to produce the negative pressure needed 
to suckle effectively.  Additionally, at follow-up developmental clinics, 
there are many annecdotal reports of poor long-term feeding outcomes for 
premies that had early negative feeding experiences (i.e., experiences 
where they were "forced" to take more than they could reasonably handle at 
the breast). We want to avoid this kind of situation and try to set 
everyone up for success.

The best breastfeeding outcomes we have experienced with premies come from 
routine kangaroo care, maternal responsiveness to infant feeding cues, 
early and frequent time to explore/learn at the breast, use of an NG tube 
to provide the bulk of the required nutrition, and time.  A 20mm nipple 
shield can also provide good help with latch as the infant grows stronger 
and more coordinated.

I would be interested to hear if others find that the supplemental systems 
do work with premies.

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