[fergus51]

Originally Posted by nekhismom

In response to the lack of suck-swallow-breathe....we're told to just "pace" the kids. Just like we would pace older PO feeders. You know,tilt the nipple down or take the bottle out of the kids mouth to "cue" them to breathe. It's scary. We have several 26-26 wkrs on vents, but many of them are not. It's weird.
I don't feel comfortable PO feeding one that small. It's always preceeded by a prayer on my part.

Aren't they concerned about aspiration?

[Gompers]

Originally Posted by fergus51

Aren't they concerned about aspiration?

That's exactly my thought. There is absolutely no reason to PO feed a baby less than 32 weeks. The dangers by far outweigh the benefits. I can't imagine taking a 700 gram baby out of it's isolette and making it waste precious calories bottle feeding. I'm sorry I keep going on about this, but I've just never heard of this practice.

[Picksomething]

We don't even have premie nipples (red). We only use yellow. Sometimes the OT recommends a slow flow nipple.

[Mimi2RN]

This has been a very interesting thread. When we think our docs have some strange ideas, it makes me feel much better when I read about procedures and problems at other places!

We do nipple (using a red nipple), a couple of times a day when they get to 32-33 weeks. Then just when they are starting to get the idea, they have to come out of the box, which always seems to set them back. I think it's too much to to accomplish at one time. I would rather they stayed in the isolette another week or two, so they can use the calories to eat, not to keep warm.

[faithmd]

We never use premie nipples. The only three nipples we carry are the standard "regular" hole, the single hole and the orthodontic nipple.

[wynter]

I work in an nicu unit with many preemies. We have used premature nipples for years with premature infants with a decreased intra oral suck pressure,and they have all done well w\out any problems transitioning to a term nipple. Latey, an issue has been brought up that Premature nipples are not being used in the nicu anymore because they inhibit the infant's development. Based on that info, the O.T. stated that it was better for a infant to be tubed and bolused fed as opposed to the infant given the opportunity to po feed with a premature nipple. She stated she felt only standard term nipples should be offered. If you work or have worked in a nicu, please let me know your thoughts on this.

[Preemienurse23]

We have the red nipples, but our OT and several of the nurses dont like them because they flow so fast. I don't care much for them. Our similac regular (a clear ring) flows fast enough for me.

I do have a question.... We have a kid with a CDH, who is about 3-4 months old now (a very big kid!) and he is nippling once a day. What made me nervous was the fact that the kid is sitting there huffing a puffing on 4 L (sats in the 90's though) So I nippled him, and got 10 down him. He couldnt keep a seal formed long enough to get anything, most of what he got was what dripped from the nipple. How do your hospitals work with CDH kids?

[elizabells]

Originally Posted by Preemienurse23

How do your hospitals work with CDH kids?

Oh, feeding CDHers. The bane of my existence. Honestly, many of ours end up with G-tubes and Nissens. Sometimes we teach mom and dad to pass NGTs and send them home on gavage feeds. Once in a while they nipple like champs, but those are usually the ones who had uncomplicated courses all along (no ECMO).

[littleneoRN]

On our unit we use slow flow nipples on all preterm kids and some term kids. I think (can't remember exactly) that the medium flow nipple packages are labeled for something like 3-6 months of age. Slow flows are designed for newborns and preemies. They have to suck harder to transfer milk, which may cause them to expend some additional calories. But, the flow on a medium flow nipple is more than most kids can properly accomodate. So many of them end up bathing their bib or choking or both with the medium flow. But, if the kid is pretty coordinated but has a weak suck, we might try a medium flow nipple so they don't have to work so hard. Bonus for the slow flow is that it is closer to the amount of suction they will need to transfer milk when breastfeeding--so this will hopefully help them develop the strength of suck they will need to transition well between bottle and breast.

[concernedRN]

Originally Posted by wynter

I work in an nicu unit with many preemies. We have used premature nipples for years with premature infants with a decreased intra oral suck pressure,and they have all done well w\out any problems transitioning to a term nipple. Latey, an issue has been brought up that Premature nipples are not being used in the nicu anymore because they inhibit the infant's development. Based on that info, the O.T. stated that it was better for a infant to be tubed and bolused fed as opposed to the infant given the opportunity to po feed with a premature nipple. She stated she felt only standard term nipples should be offered. If you work or have worked in a nicu, please let me know your thoughts on this.

I am assuming by "preemie" nipple you mean the red fast flow nipple? If that is what you are referring to (and not the smaller pink slow flow nipple) then we did away with them many years ago! We had an RN committee that looked at all the articles and decided that it was not best for our preemie babies. The OT has never liked them, we hated to admit she was right :-) honestly, we have been so happy not using them and our babies are doing great. The OT still has slow-flow and Haberman nipples if a baby needs that. Does your OT have these also? In reference to being bolused of course we tube feed. If a baby can’t take a feed or finish a feed then we bolus the rest so the baby will get the full amount of calories. I thought everyone did this?