Sitting in a chair next to her bed in the maternity ward at Pennsylvania Hospital, Susan Ross swaddled her new baby in a cotton cloth and gently lifted a small stainless-steel cup to his lips. The cup was filled with her own breast milk, which she had pumped just hours before.
"We have this fancy international cup for you," said Ross, 36. "Not everybody could get that. You're special."
Slowly, Brandon opened his mouth and took two licks of breast milk from the long spout of the cup. Not much, but it was a start, said Tammy Arbeter, a lactation specialist who coached the parents in how to use the device.
Brandon is one of 300 newborns in the Philadelphia area who are being enrolled in a clinical trial aimed at determining whether a traditional Indian feeding cup, known as a paladai, can help American babies learn to breast-feed.
The trial, which also involves four other area hospitals, is being overseen by Vinod Bhutani, a pediatrician at Pennsylvania Hospital and professor at the University of Pennsylvania Medical School.
"I call this 'technology transfer in reverse,' " he said.
Originally used to burn oil during religious ceremonies in South India, the paladai also turned out to be a perfect infant feeding device, one that virtually every family had on hand. It is now being promoted in government-run Indian medical clinics and hospitals as an interim measure until a baby can breast-feed.
At the All India Institute of Medical Sciences in New Delhi, for instance, the paladai is used in the hospital's neonatal intensive-care unit for premature and low birth-weight babies who in the past might have been fed intravenously and then shifted to a bottle.
While the hope was always that women would eventually breast-feed their babies, often that final step didn't happen because the babies got hooked on the bottle.
But in India, bottles can be dangerous because poor sanitation often makes it difficult to keep them clean, thereby introducing the risk of exposure to infectious disease, said Dr. Vinod Kumar Paul, who heads the neonatal unit.
"The new mothers come in here to feed their own babies with the cup, using their own milk," said Paul as he showed off the hospital's program one day last fall. As he spoke, tapes of Indian ragas, a classical form of Indian music, played softly in the background while half a dozen tiny infants slept in high-tech bassinets attached to computer monitors.
The key to the paladai is its long, grooved spout. To get milk from the cup, the baby has to lick milk from the groove. The licking action mimics what a baby has to do to breast-feed, making it easy for a paladai-fed baby to transfer to the breast.
By contrast, the sucking action involved in bottle-feeding is quite different. And once babies become accustomed to bottles, they often don't want to give them up. Sucking from a bottle involves less work.
"We would like to prove here that we can move babies faster to the breast with the paladai than with the bottle," Bhutani said.
Although he was born in the United States, Bhutani is of Indian heritage and completed his medical training in the Indian city of Pune, near Bombay.
As part of a cooperative program between Penn and the All India Institute, he has helped train Indian medical personnel and provided access to state-of-the-art equipment, such as ventilators for newborns. In exchange, Indian doctors and nurses have introduced the Americans to some of the low-tech wonders of Indian medicine, including the paladai.
Besides testing the use of the paladai, Bhutani hopes to work with Temple University's Tyler School of Music to examine the impact of classical Indian music on babies in hospital nurseries. At the All India Institute, Paul has overseen a study indicating that newborns in the intensive-care unit eat and sleep much better with the music than without.
The multi-site study of the paladai is initially being conducted with healthy babies. The researchers want to see if they can teach parents to use the cup. They are also tracking how long it takes the babies to learn to breast-feed, how much weight they gain at one month, and any negative experiences.
If the paladai proves to be safe and effective, Bhutani plans to conduct a much larger study among 600 to 900 premature babies across the country.
The studies come at a time when breast-feeding is on the decline in the United States despite widespread agreement in the medical community that breast milk is far superior to formula for the first six months of life.
Only about 60 percent of American mothers are nursing their babies when they leave the hospital. After six months, the figure drops to 30 percent. The numbers lag behind the goal set by the U.S. Public Health Service, which aims to have 75 percent of new mothers breast-feeding by 2000.
Experts say that one reason for the current lag is that managed-care companies don't pay for women to stay in the hospital long enough to work out the kinks in breast-feeding.
Despite its seeming simplicity, breast-feeding requires a baby to make use of 63 different nerves and coordinate sucking, swallowing and breathing, Arbeter said. About 10 percent of all babies encounter problems doing this, she said. These are the babies who are being targeted in the current study.
The hope is that the paladai will help the babies breast-feed before their mothers get so discouraged that they give up even trying.
For Susan and David Ross, who live in Glenside, the paladai proved its mettle. After just two days on the cup, their son was able to begin breast-feeding. "I wanted him to get all the antibodies in breast milk," said Susan Ross, a nurse practitioner. "And I wanted the closeness of breast-feeding."