Kathy,

does this also apply to borderline premies?  The one I have a question about
is 4 days old, born at 36 weeks.  Very sleepy at the breast (mom is bottle
feeding & restarting breastfeeding - long story) and most feeds, feeds
better at night.  Would a nipple shield help this baby nurse better (saw him
nursing - I am glad this baby is also getting bottles).

Felicia Henry
Oxnard, CA

Felicia,
It doesn't apply as strongly with a borderline premie, although these babies
can have stamina issues as well.  If a 36 weeker is in our Intermediate Care
Nursery we try to establish breastfeeding before giving bottles and
supplement by gavage.  Occasionally a 36 weeker will be a gang busters
breastfeeder--more commonly they are sleepy with decreased stamina and may
not be consistent.  As mom's supply increases, nursing often improves, esp.
if we can keep bottles away.  I wouldn't be against trying a shield with a 36
week baby but if s/he can maintain a latch without it I would hold off. I
remind mom that her baby will only get bigger and stronger.  I also use
breast compression and have mom pump after most feedings to enhance supply.
We often have 36 weekers in our normal newborn nursery and they get an
automatic lactation consult because they are at high risk for poor intake at
the breast at first.  With early and consistent support and discharge follow
up (which sometimes involves short term supplementation (preferably with
mother's milk) these babies can do great. We don't use shields with them.  If
a 36 weeker ends up in a special care nursery in our hospital they are
usually smaller or sick.

Kathy Boggs, RN, IBCLC
Mountain View, CA

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