Hi Jaye-
I didn't see in your post any mention of how this babe does at breast using
a nipple shield, so was wondering if this has been tried.
 We seem to get lots of multiple births ( six set of twins in the last two
weeks) and In the last couple of years I've gotten to work with 2 sets of
quads and 5 sets of triplets ( mainly all NICU premies)
 One thing that has worked very well for me with these little guys is
transitioning to breast and using a nipple shield until the bucal pads
develope better along with muscle tone. They have seemed to be less
tachypnic and diaphoretic at breast if lightly swaddled or nested tightly
against mom to improve their organizational state. Lights low, no rocking
or talking as they try and organize. Sometimes I start with the small
shield for the first nursing or two but try and quickly progress per babes
abilities to the regular shield. Since the shield fills the oral cavity
better at this time ( babe's mouth is often unable to draw and maintain the
breast in the mouth easily ) they tend to tire less quickly and succeed
sooner. I also have mom go pump for a couple of minutes ( or manually
induce letdown) before the nursing session. Another nice thing about a
shield is that these babes are often overwhelmed easily with mom;'s let
down. ( generally a premies suckle pattern is a burst of suckling, a long
burst of breathing, rest, burst of suckling, etc. verses the suck,suck,
pause of a term infant.) Because of this breasthing pattern, they seem to
panic if too fast a flow hits their throat so the shield seems to let them
organize better.
Paula Meier has published and spoke alot about this area as have others.
 I do agree that the babe also needs to see an OT/PT who specializes in
premies/newborns. Sweating and shutting down early during feeds with no
medical condition indicates a highly overwhelmed baby.
Good Luck-
Lisa

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