>  I have a question about the nipple from Enfamil that has a green cap 
> and labeled " slow flow" nipple...
> Would these be appropriate to use with paced bottle feeding techniques when a
> non latching infant needs to be supplemented and other alternative methods have
> not been successful . I did do a lactnet search with no results, if anyone has a
> used them, please share your thoughts. thanks Germaine Lambergs
> 

I'm posting a response for my colleague Lisa Sandora who is not on Lactnet currently... (Karen G)
 
We have done a bottle nipple trial with almost all disposable hospital nipples as well as many of the commercially available bottle nipples.  The study was done with a Classic breast pump to determine which bottle nipples had flow rates comparable to the flow rate from the breast during the first week of lactation.  We wanted to find a bottle nipple that would not negatively influence the baby's feeding skills and facilitate transition to breast if the baby is supplemented for medical reasons.  Although the flow rate of the Enfamil green ring nipple was slower by a few mls compared to the newborn (blue ring) and  the Similac newborn, some of the nipples did not flow at all (quality of disposable nipples isn't so great) and, when Karen Gromada and I did some preliminary videotaping with real babies, we found that the flow may still be too fast.  Some of the LCs in our hospital have gotten more positive feedback about babies being able to handle the flow rate better than with the newborn nipples, but this is not enough to base whether or not they are truly acceptable or safe. 
 
Karen and I will be presenting our results from the flow rate trial at ILCA this coming week and plan to submit those results for publication as well.  We are also in the early stages of a phase two trial with babies both on the post partum unit as well as NICU.  That will begin this fall. We are interested to see what we find when we assess infants' feeding performance using the hospital disposable bottles and some of the commercial bottles that we have identified as being slower flow.
 
Hope that this helps.  We will have more to share as our study continues.
 
Lisa Sandora, MA, CCC-SLP, IBCLC
Lactation Consultant
Speech-Language Pathologist

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