Dear Dawn,
I'd recommend several of Paula Meier's studies on breastfeeding preterm
infants.  One that comes to my mind is the study "Nipple Shields for Preterm
Infants: Effect on Milk Transfer and Duration of Breastfeeding" which was
published in Journal of Human Lactation, Vol. 16, No. 2, pp. 106-114.  Is a
nipple shield being used to effectively enhance transfer of milk?
Secondly, are they measuring volume of intake at the breast?  Use of the
BabyWeigh Scale to accurately measure volume of intake and then supplementing
accordingly will demonstrate to the physicians that this baby will have
adequate intake.  And, perhaps adequate volume is being transferred, but no
one knows it because it's not being accurately and validly measured.
Thirdly, research demonstrates that preterm infants coordinate
suck/swallow/breathing patterns at an earlier gestational age when
breastfeeding as compared to bottlefeeding.  Another article that appeared in
Journal of Human Lactation 16(1), 2000 is "The Effect of Breast- and
Bottle-Feeding on Oxygen Saturation and Body Temperature in Preterm Infants"
by Chen, M.D. et. al.
Lastly, I'd capture the articles discussing the use of hindmilk for preterm
infants.  In fact, despite medical participation, you can indeed counsel mom
about pumping off her foremilk and offering hindmilk as a way to enhance
growth so that this baby thrives and can go home with his mom.  But, I'd also
recommend appropriate lactation follow-up, inclusive of consults and the
rental of a BabyWeigh Scale to optimize mom's ability to breastfeed.  It's
been my experience that without adequate follow-up, many moms of preterm
infants do not continue to breastfeed, but choose to pump and offer expressed
milk as a result of their appropriate concerns regarding adequate intake.
Even the most confident moms require the emotional support of an LC to carry
her along the path when she has lulls in the course of the early weeks home
with her infant.
Good-luck!
Sincerely,
Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services, Inc.
Geneva, Il

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