Hi Andrea,
A few things spring out at my from your post:
1. pneumonia, nicu -- was baby born with symptoms and chest xray evidence or
did this occur a few days later -- could be aspiration from a
suck/swallow/breathe disorder.
2. exclusively bf for 6 days until it was advised to give bottle due to
ineffective feeding --
again, did baby become sick once the milk supply increased? Again I am
thinking aspiration or suck/swallow/breathe disorder.
3. Inadequate wt gain -- I'm assuming mom has a good supply, has protected
her supply. So why is baby feeding inefficiently? I'm still thinking
suck/swallow/breathing  issues.
4. Aversive behavior, arching, fussing when positioned at breast -- possibly
he can breath when positioned for bottle feeding but not for bf, and/or he
can rest and release the bottle for swallowing/breathing, and restart
easily. But with bf, it is very difficult to frequently rest, release the
breast and get started back again.
5. "days when he just doesn't feel good" -- he still has issues that are not
resolved.
6. You saw alert baby with normal suck who would not latch. I am still
thinking his issues are during feeding. Have you been able to observe a
bottle feed, he would likely still have s/s you would notice during and
after the feeding. Have you questioned mom more about what s/s he had when
he got pneumonia (history) and exactly what he does when he does accomplish
a latch and/or short bf.
I guess you can see the direction I would be exploring. I hope this helps
you.
Laurie Wheeler RN MN IBCLC
Mississippi USA

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome