Here in our preemie SCN we are initiating feeds at the breast and/ or with a
Haberman. Babies are "allowed" to keep their indwelling NGs as long as
necessary. The OT, neonatologist and myself are all opposed to any kind of
forced oral feeds. Absolutely no red nipples!

My background experience as a NICU nurse gives me a bit of credibility here but,
really, it is the  OT/ PT literature on infant suck that has helped the most. It
is crucially important to win these OTs over! They will support use of a
Haberman because it is dripless and has flow control. Babies can get habituated
to a Haberman but they do not, in our experience, get any tongue thrust etc.
Once they are ready to go home I move them to breast only. If they fuss about it
we use a preemie nipple shield as an intermediate step. If they are still
reluctant we go to a couple days of "skin feeds" which means breast only or
finger feeding. Much of this can be accomplished on an outpt. or home care
basis. Here you may have to get a case manager involved to get home visits
approved.

I don't fight with the OTs and Neonatologists about doing finger feeds on very
young preemies. Some battles aren't worth fighting, esp. when there is no
documented evidence that the results are better. I think it is important to
consider the knowledge that comes from each field. As an LC, I don't know it
all. As a team we do know an awful lot. Working together we can achieve the best
outcomes.

If there is a short term SCNer (like TTN or something) we keep them on IVs until
they can breastfeed. Period. No bottles. And we also will do cup feeds and SNS
feed in cases where each is indicated. But, for the preemies...the Haberman is
the rule.

Hope this helps.

Susan

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