Hi Kris,
Sounds like this little guy is close, but does not have the energy to
get all the available milk at breast yet.
Have you tried the Lact-aid (as opposed to the sns) at breast?  How does
he do with the sns? Is there any change in his ability to sustain
nutritive sucking with the sns vs without it?  Sometimes in this sort of
situation where the fit between nipple and mouth is close, it takes
awhile before the baby can get all the milk that is available.  A very
asymmetrical latch can help if that is the issue.
If the baby is still a bit low on energy, sometimes pushing him with
breast compressions or a syringe and tube can be helpful.  Have mom
start breast compressions as soon as his nutritive sucking pattern
diminishes, then switch breasts when that no longer works.  If
compressions don't get him swallowing again, try having mom introduce a
5-fr feeding tube when he stops swallowing, and give small boluses of
milk from an attached syringe to "jump start" him.  This is my favorite
technique to use with otherwise healthy babies who've lost a lot of
weight and seem to stall after a few minutes at breast.  Of course the
usual cautions apply: make sure mom learns how to recognize and respect
a respiratory pause, etc.
If mom can have MER's, I don't think that oxytocin will make a difference.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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