[dawngloves]

My unit will not send a baby home until they can use a term nipple, but I see preemie nipples for sale all over? What are your guidelines? Do you send babies home using preemie nipples?

[Darchild77]

Our hospital sends babies home on premie nipples because for a lot of premies, the regular nipples are too big for their mouths and they gag on them or gag because the flow is too fast. But, yes a baby can gag if the nipple is to big for their mouths like the NUK nipple.

[dawngloves]

Our babies can go home @ 1800g. Never had one that was gagging because a term nipple was too big. If anything the flow is too fast from the preemie nipple and they will choke and brady.
How about Habermanns? We send the really bad gulpers home with those because they are so greedy they choke and gag even with a term nipple.

[fergus51]

We don't care how they are eating as long as it is by mouth. We have a lot of breastfeeding nazis who will even insist on cup feeding or finger feeding only. As long as they can buy the supplies in the community and the baby gets enough to eat, that's good enough for us.

[Gompers]

We don't really care what they're eating with, so long as they're eating. For preemies on the unit, if the free Similac nipples and nuks are too fast, we use Gerber slow flow nipples and nuks. We used to use the Gerber preemie bottles and nipples, which are a lot smaller, but it got to be too expensive. Now if babies have REALLY small mouths, we'll ask their parents to bring in a pack of those. Similac used to make a pink preemie nipple, and I have no idea why they stopped! Some people have said their red nipples are preemie, but I thought the red ones are high flow!

If the kids go home with slow flow or preemie nipples, we give the parents guidelines as to when to change them to the regular ones (less sloppy, no A&B's with feedings, good pacing, etc.) and they usually do just fine. Most of the kids who go home PO ad lib are using regular nipples anyway. It's the babies who go home with NGs that are still using preemie and slow flow ones, and they get home care visits from our RNs so they will transition them to regular nipples at home then.

[dawngloves]

That's an interesting point Fergus. We'll send home a bf'ing baby if they can take x amount in about half an hour, but cup or finger feeds have never come up. I wonder what the peds would think about that.

[dawngloves]

Originally Posted by Gompers

Similac used to make a pink preemie nipple, and I have no idea why they stopped! Some people have said their red nipples are preemie, but I thought the red ones are high flow!

I see them around the unit still. Old box maybe? They are way small! The red ones are both high flow and smaller so the little guys don't have to work so hard to eat.

[Gompers]

Originally Posted by dawngloves

I see them around the unit still. Old box maybe? They are way small! The red ones are both high flow and smaller so the little guys don't have to work so hard to eat.

I wish we had those pink ones! Are they slow flow as well? If they're still making them, I'll have to talk to management about that! We stopped supplying the red nipples years ago because they were way too fast and kids were choking. It's a constant debate with NICU nurses, it seems! Some like high flow because it's easier for the baby to eat, some like slow flow because it's less likely for the baby to choke and aspirate. Any kid I feed who is getting more milk OUTSIDE his mouth than INSIDE, I switch to a slow flow. It can be frustrating sometimes for them, but if the food is all over the bib/washcloth and not in the baby's stomach...

Most of our kids are on formulas mixed by our nutritionists, and they rarely give us a drop extra, so we need to get every CC down that baby!

The debate continues!

[fergus51]

Originally Posted by dawngloves

That's an interesting point Fergus. We'll send home a bf'ing baby if they can take x amount in about half an hour, but cup or finger feeds have never come up. I wonder what the peds would think about that.

Ours were apparently very resistant at first, until someone asked them if getting 50ccs from a bottle was more than 50ccs from a cup! I had to laugh at that one. As long as they take all their meals by mouth we can send em out

[dawngloves]

Gompers, you are one lucky RN to have someone mix your formulas!Drives me crazy when I have to make Neosure 29 or something crazy!
If we have a kid that was leaking like that we'd squeeze his cheeks and chin together for "support".
Can't remember the last time I used those pink nipples. Maybe for some IUGR kiddo.Remind me of when I fed baby rabbits!