I work in a 29 bed NICU in Minneapolis; our program sounds very much
like the one that Kathy Boggs has recently described.  We have struggled
with the push to shorten length of stay and yet maintain both our high
rate of initiation and rate that babies are sent home exclusively
breastfeeding.

The "standard" now is to try to get babies home in their 35th week of
life.  We have had success getting many babies exclusively breastfeeding
by that point, and some stay longer for other medical reasons and this
allows more time to get them breastfeeding.  For those who remain too
sleepy or weak to be exclusively breastfed by the middle of their 35th
weak, we have compromised by "testing" them with one bottle with a slow
flow nipple; if they have trouble with this, they gain extra time to
work on breastfeeding.  For babies who can feed this way supplementally,
they are discharged.  We were concerned about sending moms home with
pumping, bottles, often nipple shields (sometimes multiples!) and only
phone support, if they had the energy to seek it.

We submitted a proposal for a specialized clinic just for NICU
graduates, were approved and now see these families back.  It is
wonderful to see how another week or two makes all the difference, and
we can advise the mothers on discontinuing nipple shields, bottles and
pumping, in order to reach their goals.

Grace Doolittle RNC, IBCLC
Minneapolis, MN  USA

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