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Nurses' Perception of Milk Temperature at Delivery Compared to Actual Practice in the Neonatal Intensive Care Unit

Lawlor-Klean, Phyllis MS, RNC, APN/CNS; Lefaiver, Cheryl A. PhD, RN, CCRP; Wiesbrock, Jeanne MS, APN/CNS, IBCLC

Section Editor(s): Dowling, Donna

doi: 10.1097/ANC.0b013e3182a14cbd
Original Research

PURPOSE: The purposes of this study were to examine nurses' perception of feeding temperature practices and to compare the nurses' temperature estimation with the measured temperature of milk at the time of delivery to the infant.

DESIGN: A descriptive exploratory study was conducted in 3 level III neonatal intensive care units (NICUs).

SUBJECTS: A convenience sample of nurses from 3 level III NICUs in the Midwest. In addition, temperatures from bottle/syringe samples of formula/breast milk were measured and recorded.

METHODS: The Feeding Practices and Temperature Survey, a 10-item survey measuring nurses' perception of the effect of feeding temperature on infant condition, was distributed to subjects. Afterward for select feedings, researchers recorded the type of milk, delivery method, nurses' estimated temperature of the milk, and the measured infrared temperature of milk just before feeding delivery. To compare perception with actual practice patterns, the measured milk temperature was compared with the nurses' estimated temperature, standard room temperature, and body temperature using descriptive statistics of the survey responses and t test comparisons.

MAIN OUTCOME MEASURES/PRINCIPAL RESULTS: A total of 141 surveys were analyzed. More than 50% of respondents reported feeding temperature as clinically very significant. A range of 35.5°C to 37.2°C was reported as the ideal temperature of breast milk at delivery. Recordings of 419 temperatures were used for analysis. Measured milk temperature just before feeding ranged from 22°C to 46.4°C. The mean measured temperatures were 31.0°C (SD = 2.8°C) for warmed milk in a bottle and 30.5°C (SD = 2.5°C) for milk warmed in a syringe. The measured milk temperature and the nurse-estimated temperature were significantly lower than body temperature (P = 0.000) and significantly higher than room temperature (P = 0.000).

CONCLUSION: Current warming methods yield wide variation in milk temperature. Nurses' estimation of milk temperature was not consistent with measured temperature at the time of delivery. Future research is needed to establish guidelines for feeding temperature standardization assisting nurses to enhance evidence-based feeding practices.

Neonatal Intensive Care Unit, Advocate Children's Hospital–Oak Lawn (Ms Lawlor-Klean); Neonatal Intensive Care Unit, Advocate Children's Hospital-Park Ridge (Ms Wiesbrock); and Department of Nursing Science (Dr Lefaiver), Advocate Christ Medical Center, Oak Lawn, Illinois.

Correspondence: Phyllis Lawlor-Klean, MS, RNC, APN/CNS, Neonatal Intensive Care Unit, Advocate Children's Hospital, Oak Lawn, IL 60453 (

The study was conducted at 3 sites: Advocate Children's Hospital, Oak Lawn, Illinois; Advocate Children's Hospital, Park Ridge, Illinois; and Advocate Good Samaritan Hospital, Downers Grove, Illinois.

The authors thank Jennifer Perkins, MS, BSN, RNC, for being a coinvestigator; Amy Biedron, RN, Raji Jose, RN, Edy Pettinger, RN, Rose Slomiany, RN, Wendy Walczak, BSN, RN, Laura Waszak, RN, and Rosanna Welling-Trahey, BSN, MBA, RN, for assisting with data collection; the staff from the participating NICUs; and Read McCarty, Sandbox Medical, Pembroke, Massachusetts, for granting us permission to use the Feeding Preferences Survey.

Funding for this study was received from the Division of Nursing at Advocate Christ Medical Center and Advocate Children's Hospital-Oak Lawn.

The authors declare conflict of interest.

© 2013 by The National Association of Neonatal Nurses