To add to Barbara Wilson Clay's info on nipple shields, I am totally
convinced that they have preserved breastfeeding for many premature infants
in our NICU. I am currently working with two babies, both 33 weeks corrected
age, who have started breastfeeding in the last week or so. Neither has had a
bottle. Both mothers have latchable nipples and both babies are able to latch
without a shield. Neither, however, is able to maintain the latch.  Both
mothers also have abundant milk supplies.

The first baby, 33 weeks now, born at 30 weeks is able to take a whole
feeding from breast several times per day with the shield.  Mother has to
pump off 1 to 1.5 ounces first so infant can handle flow and, of course, the
nipple shield also helps slow the flow. This mother is absolutely thrilled
that breastfeeding is working for her. I know If we waited until this baby
had enough muscle strength to elongate the nipple to maintain a latch he
would have  many bottles and might never be able to make the transition to
breast.

The second infant is one week old with a corrected age of 32-33 weeks. He had
his first successful latch with a shield today. He had several bursts of
nutritive sucking before he tired.  Without the shield he did not receive
enough stimulation and never sucked. As he progresses we will perform test
wts to assess his intake and will then back down on the gavage feeds.

Several years ago we began to notice that many premies bf better with shields
but we were having trouble believing what we saw (since it went against
conventional wisdom) until Paula Meier published her research in JHL.  We've
also found that at corrected age of term or at, or slightly after discharge,
mothers are able to wean these babies from the shield.  I think this is not
so difficult because of the way infants breastfeed with a shield. Mom is
taught to position the baby exactly as she would without the shield, to wait
for a root and to pull the baby onto the breast. It seems these babies become
patterned to latch this way and make the transition when they are strong
enough.  We don't use consent forms, but follow these mothers and babies
closely.

Kathy Boggs, RN, IBCLC
Mountain View, CA

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