We have found that supplementing premie and, even term infants who need it,
with the Haberman Feeder (Medela) works quite well. Because it has a silicone
teat which is long enough to encourage the infant to bring tongue forward, it
can help those babies who retract or tongue thrust, habits premies tend to
have. Most importantly the Haberman Nipple has a variable flow and is used
freuqently in our setting for small babies who are overwhelmed by the fast
flow of the formula company nipples. Babies that we see consistenly dropping
heart rates and oxygen saturation with faster flow nipples respond really
well to the Haberman since you can change the flow to meet the baby's needs
without frustrating the baby by removing the nipple from his mouth.  We
always have baby open wide before offering the nipple so s/he won't lose this
reflex so important for breastfeeding.  In our NICU and stepdown unit we try
to initiate breastfeeding before starting bottles.  We find that if babies
can establish breastfeeding starting at their earliest possible readiness
they later  can take some bottles if mom can't always be there.  Our major
method of  supplementation is by indwelling gavage tube. When baby begins to
fight this or needs to get out of the hospital we switch to supplementation
by bottle.  Hopefully by then, breastfeeding is established. In the best of
all worlds all NICU babies would be discharged on full breastfeeding.  Due to
the interference of nature and the NICU this is not always possible.  We also
have babies that supplement with the tube  at the breast, but of course this
requires mother to be present.  Building and maintaining milk supply and
teaching mom and babies mechanics of breastfeeding before bottles intervene
seem to make the most difference in establishing breastfeeding in our NICU.
We have gotten rid of red premie nipples...can't come up with any redeeming
value for them.  Some staff resist using the Haberman since it takes a little
more skill than the "regular" bottle...this from nurses who single handedly
manage ventilators and multiple drips.  I'm not above pointing this out to
them.  We have not tried cup feeding...could work well for awhile but at some
point I believe babies just need to suck when mom can't be there.  I'm
interested in hearing how others are supplementing in NICU.

Kathy Boggs, RN, IBCLC
Packard Children's Hospital at Stanford

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