Paula Meier, Nancy Hurst and others did research with premies and nipple
shields, looking at milk intake.  It's in JHL from about a year ago(May2000).
 It showed a nearly fivefold increase in milk intake for the baby when a
nipple shield was used.  My experience has been that, when the shield is
used, babies stay at the breast until satiated, and that they do not require
supplementation after these feedings.  Preterm infants feed by compression,
not suckling, so that the shield seems to increase the surface area that is
compressed, therefore getting helping them to get milk.    Premies aren't
able to pull the nipple into proper position for feeding, so that the form of
the shield also helps them do this.  One of our dads called them "training
wheels" for breastfeeding.  We teach the mothers to try without the shield
when the baby can pull the nipple about three quarters up the shield, and
most mothers are able to breastfeed without the shield by 38-40 weeks
gestation.  If the baby is able to well soften mother's breast, we do not
have her pump.  We do not see an association with low milk supply and nipple
shields.  We use the Medela small  shields--we've tried Avent and Hollister
too, to be fair, but they are far too large to fit a premie's mouth without
making them gag.  It, of course, would be nicer to have the breastfeed
without the shield, but the repeated positive reinforcement of having the
baby actually FEED at the breast is well worth it.  Mothers either laugh or
cry when the baby feeds for the first time, successfully, because they are SO
happy.  The alternative is putting baby to bare breast, where he would have a
few sucks and fall asleep, even with prodding and breast compression. Then,
of course, this is followed up, in many cases, by a bottlefeeding where the
baby seemingly "gulps" down the volume.  That makes a lot of mothers feel
pretty bad and doesn't look good for breastfeeding.  No wonder many mothers
of premies decide to bottlefeed!  Also, remember the more interventions you
try to do with a premie, the less likely he will participate.  With the
nipple shield, premies don't seem to need much prodding to continue
nursing--very good for baby and mother.  And breastFEEDING can begin earlier
and more easily for the mother and baby.
                                                                     Maureen
Allen RN, BSN, IBCLC

Lactation Consultant
                                                                     Neonatal
Intensive Care Unit
                                                                     Brigham
and Women's Hospital
                                                                     Boston,
MA

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