Kristen, even though these babies are 35 weeks these near term babies can  be 
very challenging.  From the description of the feeding pattern of the  little 
girl; not doing well with cup, bottle and breast, she may need the pg  
feedings for a while this is not a bad strategy.  Once she is gaining  better and 
getting closer to her due date, she could turn this around.  
I am very discouraged at the push to get babies out of the hospital even  
though they are not feeding well.  Defining feeding well: means all  feedings 
from the breast.  Since babies can be forced feed with a bottle  makes it appear 
from the hospital stand point that the baby is feeding fine and  can go home 
and maybe learn to breastfeed.  The statistics for a baby like  this to go on 
and be exclusively breastfeed is poor.
I'm reviewing the literature for a talk I found it interesting on the use  of 
cups and paladais babies gained well, paced themselves better, no drop in  
oxygen saturation, transitions better to the breast, and the person feeding the  
babies were watching the babies more therefore more interaction.
I would encourage this mom to stay with pg feedings for this little girl,  
continue to offer the breast with the pg feedings and after.  If the baby  boy 
is discharged first give mom reassurance that this is a good step and to  bring 
baby brother for visits to nursery when she comes in to feed the  girl.  I 
would encourage her to have the girl supplemented with a cup when  she is able 
to handle po feeds when not taking the breast.  I would also  keep the shield 
handy with observation of feedings along with pre and  post weights to 
determine her intakes.
Am interested in what others will respond.  Good luck.
Ann Perry, RN IBCLC
Boston, MA

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