Just to clarify (because this policy is so far outside what my own 
multiple NICU experiences were as a preemie mom and also unlike any 
other NICU policy I've since encountered).  Is this NICU's protocol to 
supplement an at-breast feed that lasts LONGER than 20 minutes, or 
shorter?  If it's to cut off and supplement after 20 minutes at breast, 
that's not completely uncommon because (the belief is that) preemies use 
so much energy to feed that going longer at the breast will wind up 
making the feed actually use more calories than are taken in.  However, 
bottle feeding also uses calories, so if they're stopping an at-breast 
feed just to finish off with a bottle that's a poor policy.  If they are 
stopping the at-breast feed and then doing a bolus with NG tube, that's 
more in line with how most NICUs I've experienced handle feeds.

Now, if they're forcing supplements because baby's not taking a full 20 
minutes at the breast, then I'd encourage the mom to assert her desire 
for pre- and -post feeding weights to illustrate that baby is taking in 
the required cc's at the breast.  Overfeeding a preemie is just going to 
overwhelm the immature GI system and s/he'll use extra energy in dealing 
with the overfeed.

Theresa Belville (NICU mama X 2, LLL Leader since 2001, and IBCLC 
candidate in 2011)

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