No research here, but just a few comments, based on my experience with 
adopted babies who have been born prematurely or with serious healthy issues 
(like my Julia, who was born with a congenital diaphragmatic hernia, and was 
six months old when I adopted her).

The specialty formulas, like Nutramigen, can be a problem, because of the 
horribly vile taste.  Many babies will still take it, but there are some who 
will avoid it, even at a very young age, or even be gagged by the taste of 
it.  Also, I have seen where an assumption is made that a baby needs a fast 
flowing nipple when the baby actually has a good suck and would be much more 
comfortable with a nipple that allowed him to suck well, without getting a 
big gulp of milk deal with.

I didn't see anything that mentioned supplementation at the breast.  Has 
this been considered?  It can be such an advantage to keep the baby who 
needs supplementation, at the breast, rather that giving bottles, that I 
don't understand why it is not thought of sooner, in many cases, except 
maybe that there aren't alot professionals who have much experience with it. 
  The Lact-Aid is definitely the best choice, for anyone who expects to need 
long-term supplementation, but the SNS would do, in a case like this.  I 
would start with the smallest tubing, with both tubes open, so it can vent 
properly and flow can be regulated easily.  Unless the baby has a really 
weak suck, the smallest tubing would probably be fine.  In fact, for a baby 
who has a halfway decent suck, I think the medium tubing flows too much, and 
too easily, unless the opposite tube is closed, but then the flow is very 
difficult to control.  There are some high calorie formulas that won't flow 
well through the smallest tubing.  However, ebm flows faster than the 
standard 20 cal per oz formulas, so I would think that ebm with something 
added to it would flow through the small tubing.

I hope this mom and baby get through this period where the neo is pushing 
fast growth quickly, and are able to get to exclusive breastfeeding soon!

Darillyn

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