Thoughts on warming milk in the NICU

Specialties NICU

Published

I am looking to you all for your honest thoughts.

We have been looking at the Medela Waterless Warmers for our unit and for the most part, thought they were fine. We decided to be fiscally responsible and trial the Penguin warmer just to see how we liked it and do a cost comparison so we could determine what we could and couldn't afford seeing as both require purchases of liners (Medela's are 100 to case for approx $3.00 per liner and the Penguin comes 300 to a case and I think about $1.10 to $1.20 per liner).

We were leaning towards Medela because it's waterless even though we LOVED how well the Penguin worked and it was very quiet (Medela's had a loud hum to it). I just learned today while doing some research as I have to make up my mind that the high heat required by Medela's system (heater coil and fan) blows hot air (150 to 170 degrees) directly on top of the bottle has the potential for introducing harmful chemicals to the baby's feeding. If I am not mistaken I believe that 120°F is considered highly suspect for causing extractables. I also know that the top of the bottle is always hotter than the bottom when coming out of the Medela unit, which means there is no way that this unit can be the warming the bottles to the same temperature throughout. YIKES! I guess I never considered the implications of blowing hot air on top of plastic and the fact that the unit is pulling air, from our hospital, into the system and blowing airborne germs around the feeding.

My staff is 75/25 split on who likes what (most prefer the Penguin) but I want to know what you all are using and how many of these things are you ordering? What about the liners - how many do you order?

Specializes in NICU, PICU, PACU.

We will be putting in our revised protocol for breastmilk feedings. Once it is a standard of care for our institution and is in a protocol then we are able to make it a charge item. We have done this with our UAC/PICC kits, our biosensors, neolinks/inline suction, disposable ISC probes, things of that natures. We just have to have documentation that it is part of our routine care. Insurance companies often want to see the documentation that it is something that is used in our standards. We also can charge for eggcrates, positioning items, and that such as we have it in our skin protocols and developmental protocols.

We are a large teaching hospital with up to 60 if pushed.

Specializes in Nurse Scientist-Research.

JayHawkFan;

Another local respected unit uses the penguin heaters. The staff in our unit was not given any chance to comment other than when we trialed the Medela warmers. Of course we were thrilled to have ANYTHING vs. nothing. I understand the potential drawbacks of the medela warmers, but given our choices (none), we were excited to get anything at all.

Specializes in CDI Supervisor; Formerly NICU.
Can I ask a really dumb question? I'm a postpartum nurse who gets floated to NICU. All I've ever seen used to heat a bottle of breast milk or formula is a large Styrofoam cup of hot water. Yes, there is the possibility of a spill, but that hardly ever happens. The NICU has practical places that are good for placing the cup-and-bottle arrangement that are stable and wouldn't allow damage or a big mess if something did spill.

It's low tech and much less expensive. No hot spots. The cups are disposable. If the bottle is placed in the cup before baby gets changed and has vitals done, it's ready at just the right time.

This is how we heat bottles for the fussy ones on postpartum, too, although most just get room temperature milk.

I'm confused about why such expensive units need to be purchased. This is a serious inquiry, not a joke or a criticism.

Thanks in advance.

I agree, we also just use hot water (in one of those pink ice/water buckets). I don't see the point in spending hundreds of dollars for these things.

I agree, we also just use hot water (in one of those pink ice/water buckets). I don't see the point in spending hundreds of dollars for these things.

I know the gripe against the foam cups, but the liners for these warmers are also disposable. I wonder how biodegradable they are. Six or more of those a day would certainly add up.

As for the infection control issues, if the cups are tossed after 24 hrs. and the water level is kept low enough, I don't see that being a problem either. It hasn't been in the NICU where I get floated. I could see using special warmers for the really fragile babies, but for more stable kids and the feeders and growers, they seem like an unnecessary expense.

I should mention that we have faucets where the water can get really hot. For all but the biggest babies, we transfer the milk (breast or formula) into the little graduated feeder bottles. They heat up nicely in 10-15 minutes and I can't think of a single problem that has come from this low-tech option other than the occasional spill. But, as I said earlier, each crib pod has a good place to set the warming bottle where it is not likely to get jostled, and if it did, it wouldn't do any damage.

It does sound like the Penguin warmers are a lot better than the Medelas. I'm just for keeping things simple and inexpensive unless there's a compelling reason to do otherwise.

Specializes in NICU, PICU, PACU.

Our purchase was prompted by an outbreak of Legionairre's in our hot water tanks. We use the warmers to warm sterile water for our micronates too. It is great for refridged formulas and no more water by the bedside to spill on to the keyboards and other things on our counters.

We used cups and those pink plastic things, but ID wanted us to throw them out once a day since there is a risk of bacterial growth unless you were wiping them with red wipes...who wants to float food in something that had been wiped out with those wipes?

Like I said, we use it as a charge item and recoup some of the cost.

I agree totally with keeping things simple but must say, there is a lot of science behind these things and while I "think" I know a lot about them, it really is impressive to listen to all the research and science that has been put into them. I have a feeling that in no time flat, JCAHO will be looking as mandating everyone have a warmer for standardizing everything, but who knows. I am thrilled we will have the Penguin in our unit.

Specializes in NICU.

We recently switched to the warmers. We used to use plastic cups with warm water to heat the milk, which I personally never had a problem with, nor ever spilt (which is saying a lot for me, bcause I can be very clumsy). Sure the warmers are fancy, but they don't warm the milk up any faster than the cups of water. We have at least one warmer for every two bed spaces (42 bed unit). Our nutrition department thaws and mixes all of our breatmilk, so defrosting it is not an issue (they only have one, so they still use the cup method mostly). I just wish we would have spent the money on something else... we could really use new computer work stations, because ours are litterally falling apart.

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