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 *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html