Preemie Nipples

Specialties NICU

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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?

Specializes in NICU.
Our unit recently had an overhaul regarding preemie nipples - we dumped them, based on the theory that if an infant can't accommodate a term nipple, he's not ready to PO feed yet.

In some ways I agree with this, in some ways I don't.

We've had some extremely IUGR babies who are 2 pounds but 36 weeks gestation, PO ad lib, on high calorie formula, using preemie sized nipples (back when we had them), gaining weight and doing fine. Their mouths are just too small for the term nipple, but they are otherwise mature enough to PO feed.

Then we'll have some kids who are fine with the size of term nipples, but they need the slow-flow ones labeled premature, and with these they do absolutely fine PO feeding and are usually switched to regular flow before discharge.

I guess that I feel this way because we've had so many kids not PO feed during that 32-40 week gestational period, and then when you try and PO feed them later they are totally averted and it's like we've missed the window to teach them to eat. So if we can use a preemie sized nipple or a slow-flow one, why not?

But I do understand what you're saying, for the most part it's true. There are just cases here and there where excpetions could be made.

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Specializes in NICU, PICU, educator.

Dawn...I had to laugh...sometimes I feel like taking the top off the bottle,dumping it on the cloth and saying...there, we're done now :chuckle

We rarely use the preemie nipples...we may start some kids on them, but they don't stay on them long. Our OT department doesn't like them...they don't help them build up the muscles in the cheeks, etc.

We don't cup feed at all, we will on occasion finger feed, but I agree...how is a finger like a nipple? Duh :uhoh21:

We have had moms that want an IV in there kids too...and some of them were NURSES! Our attendings will not bow to them. Hello, why poke a kid a zillion times, then he gets staph epi sepsis and is there even longer? Geez. Also, we will not NG a full term BF kid. We tell them moms that they can BF while they are there, we will finger feed or bottle feed. We usually have the moms do a fingerfeed too, or the dads so that they can see that sometimes the kids don't do as well.

I think as a parent, I would do what I had to do to get my baby home!

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OMG I just cannot believe this! Most of our 25-26 weekers are on the vent, and even those who aren't aren't stable enough respiratory wise to PO feed. Plus, whatever happened to the fact that babies don't develop the suck-swallow-breathe reflex until 32 weeks?!?! This is just so wrong, and such a huge risk for aspiration pneumonia.

I don't blame you for wanting to move! Good luck at your new place!!

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.

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Dawn...I had to laugh...sometimes I feel like taking the top off the bottle,dumping it on the cloth and saying...there, we're done now :chuckle

ME TOO!!! After 20 minutes and only maybe 5 cc's, most of which is on the cloth anyway, I just want to pour it down the NG tube or dump it on the cloth. I can SOOOO relate!

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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?

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Specializes in NICU.
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.

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Specializes in IV Therapy, newborn, MotherBaby.

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

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Specializes in NICU.

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.

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Specializes in Newborn ICU, Trauma ICU, Burn ICU, Peds.

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

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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.

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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?

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Specializes in NICU.
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).

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