Weaning of Moderately Preterm Infants from the Incubator to the Crib: A Randomized Clinical Trial
Seetha Shankaran, Edward F Bell, Abbot R Laptook, Shampa Saha, Nancy S Newman, S Nadya J Kazzi, John Barks, Barbara J Stoll, Rebecca Bara, Jenna Gabrio, Kirsten Childs, Abhik Das, Rosemary D Higgins, Waldemar A Carlo, Pablo J Sánchez, David P Carlton, Lara Pavageau, William F Malcolm, Carl T D'Angio, Robin K Ohls, Brenda B Poindexter, Gregory M Sokol, Krisa P Van Meurs, Tarah T Colaizy, Ayman Khmour, Karen M Puopolo, Meena Garg, Michele C Walsh, Eunice Kennedy Shriver National Institute of Child Health, and Human Development Neonatal Research Network, Richard A Polin, Martin Keszler, Angelita M Hensman, Elisa Vieira, Anna Marie Hibbs, Bonnie S Siner, William E Truog, Eugenia K Pallotto, Howard W Kilbride, Cheri Gauldin, Anne Holmes, Kathy Johnson, Kurt Schibler, Suhas G Kallapur, Cathy Grisby, Barbara Alexander, Estelle E Fischer, Lenora Jackson, Kristin Kirker, Jennifer Jennings, Sandra Wuertz, Greg Muthig, C Michael Cotten, Ronald N Goldberg, Theresa Roach, Joanne Finkle, Kimberley A Fisher, Matthew M Laughon, Carl L Bose, Janice Bernhardt, Cindy Clark, Stephen D Kicklighter, Ginger Rhodes-Ryan, Ellen C Hale, Yvonne Loggins, Diane I Bottcher, Stephanie Wilson Archer, Heidi Harmon, Dianne E Herron, Shirley I Wright-Coltart, Leif D Nelin, Sudarshan R Jadcherla, Patricia Luzader, Julie Gutentag, Courtney Park, Julie C Shadd, Margaret Sullivan, Jennifer L Grothause, Melanie Stein, Erna Clark, Rox Ann Sullivan, Dennis Wallace, Kristin M Zaterka-Baxter, Margaret Crawford, Jeanette O'Donnell Auman, David K Stevenson, Lou Ann Herfert, M Bethany Ball, Gabrielle T Goodlin, Melinda S Proud, R Jordan Williams, Namasivayam Ambalavanan, Monica V Collins, Shirley S Cosby, Teresa Chanlaw, Rachel Geller, Dan L Ellsbury, Jane E Brumbaugh, Karen J Johnson, Donia B Campbell, Jacky R Walker, Kristi Watterberg, Conra Backstrom Lacy, Sandy Sundquist Beauman, Carol Hartenberger, Haresh Kirpalani, Eric C Eichenwald, Sara B DeMauro, Noah Cook, Aasma S Chaudhary, Soraya Abbasi, Toni Mancini, Dara Cucinotta, Satyan Lakshminrusimha, Ronnie Guillet, Ann Marie Scorsone, Julianne Hunn, Rosemary Jensen, Holly I M Wadkins, Stephanie Guilford, Ashley Williams, Myra Wyckoff, Luc P Brion, Diana M Vasil, Lijun Chen, Lizette E Torres, Athina Pappas, Bogdan Panaitescu, Shelley Handel, Diane F White, Mary Christensen, Stephanie A Wiggins, Seetha Shankaran, Edward F Bell, Abbot R Laptook, Shampa Saha, Nancy S Newman, S Nadya J Kazzi, John Barks, Barbara J Stoll, Rebecca Bara, Jenna Gabrio, Kirsten Childs, Abhik Das, Rosemary D Higgins, Waldemar A Carlo, Pablo J Sánchez, David P Carlton, Lara Pavageau, William F Malcolm, Carl T D'Angio, Robin K Ohls, Brenda B Poindexter, Gregory M Sokol, Krisa P Van Meurs, Tarah T Colaizy, Ayman Khmour, Karen M Puopolo, Meena Garg, Michele C Walsh, Eunice Kennedy Shriver National Institute of Child Health, and Human Development Neonatal Research Network, Richard A Polin, Martin Keszler, Angelita M Hensman, Elisa Vieira, Anna Marie Hibbs, Bonnie S Siner, William E Truog, Eugenia K Pallotto, Howard W Kilbride, Cheri Gauldin, Anne Holmes, Kathy Johnson, Kurt Schibler, Suhas G Kallapur, Cathy Grisby, Barbara Alexander, Estelle E Fischer, Lenora Jackson, Kristin Kirker, Jennifer Jennings, Sandra Wuertz, Greg Muthig, C Michael Cotten, Ronald N Goldberg, Theresa Roach, Joanne Finkle, Kimberley A Fisher, Matthew M Laughon, Carl L Bose, Janice Bernhardt, Cindy Clark, Stephen D Kicklighter, Ginger Rhodes-Ryan, Ellen C Hale, Yvonne Loggins, Diane I Bottcher, Stephanie Wilson Archer, Heidi Harmon, Dianne E Herron, Shirley I Wright-Coltart, Leif D Nelin, Sudarshan R Jadcherla, Patricia Luzader, Julie Gutentag, Courtney Park, Julie C Shadd, Margaret Sullivan, Jennifer L Grothause, Melanie Stein, Erna Clark, Rox Ann Sullivan, Dennis Wallace, Kristin M Zaterka-Baxter, Margaret Crawford, Jeanette O'Donnell Auman, David K Stevenson, Lou Ann Herfert, M Bethany Ball, Gabrielle T Goodlin, Melinda S Proud, R Jordan Williams, Namasivayam Ambalavanan, Monica V Collins, Shirley S Cosby, Teresa Chanlaw, Rachel Geller, Dan L Ellsbury, Jane E Brumbaugh, Karen J Johnson, Donia B Campbell, Jacky R Walker, Kristi Watterberg, Conra Backstrom Lacy, Sandy Sundquist Beauman, Carol Hartenberger, Haresh Kirpalani, Eric C Eichenwald, Sara B DeMauro, Noah Cook, Aasma S Chaudhary, Soraya Abbasi, Toni Mancini, Dara Cucinotta, Satyan Lakshminrusimha, Ronnie Guillet, Ann Marie Scorsone, Julianne Hunn, Rosemary Jensen, Holly I M Wadkins, Stephanie Guilford, Ashley Williams, Myra Wyckoff, Luc P Brion, Diana M Vasil, Lijun Chen, Lizette E Torres, Athina Pappas, Bogdan Panaitescu, Shelley Handel, Diane F White, Mary Christensen, Stephanie A Wiggins
Abstract
Objective: To assess whether length of hospital stay is decreased among moderately preterm infants weaned from incubator to crib at a lower vs higher weight.
Study design: This trial was conducted in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants with gestational ages 29-33 weeks, birthweight <1600 g, and in an incubator were randomly assigned to a weaning weight of 1600 or 1800 g. Within 60 to 100 g of weaning weight, the incubator temperature was decreased by 1.0°C to 1.5°C every 24 hours until 28.0°C. The infants were weaned to the crib following stable temperature at 36.5°C to 37.4°C for 8 to 12 hours. Clothing and bedcoverings were standardized. The primary outcome was length of hospital stay from birth to discharge; secondary outcomes included length of stay and growth velocity from weaning to discharge. Adverse events were monitored.
Results: Of 1565 infants screened, 885 were eligible, and 366 enrolled-187 to the 1600-g and 179 to the 1800-g group. Maternal and neonatal characteristics did not differ among weight groups. Length of hospital stay was a median of 43 days in the lower and 41 days in the higher weight group (P = .12). Growth velocity from completion of weaning to discharge was higher in the lower weight group, 13.7 g/kg/day vs 12.8 g/kg/day (P = .005). Groups did not differ in adverse events.
Conclusions: Among moderately preterm neonates, weaning from incubator to crib at a lower weight did not decrease length of stay, but was safe and was accompanied by higher weight gain after weaning.
Trial registration: ClinicalTrials.gov: NCT02160002.
Keywords: incubator; moderately preterm infants; randomized controlled trial; temperature; weaning.
Copyright © 2018 Elsevier Inc. All rights reserved.
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Source: PubMed