Feasibility of transferring intensive cared preterm infants from incubator to open crib at 1600 grams

Giovanni Barone, Mirta Corsello, Patrizia Papacci, Francesca Priolo, Costantino Romagnoli, Enrico Zecca, Giovanni Barone, Mirta Corsello, Patrizia Papacci, Francesca Priolo, Costantino Romagnoli, Enrico Zecca

Abstract

Background: Ability to maintain a normal body temperature in an open crib is an important physiologic competency generally requested to discharge preterm infants from the hospital. The aim of this study is to assess the feasibility of an early weaning protocol from incubator in preterm newborns in a Neonatal Intensive Care Unit.

Methods: 101 infants with birth weight < 1600 g were included in this feasibility study. We compared 80 newborns successfully transferred from an incubator to open crib at 1600 g with 21 infants transferred at weight ≥ 1700 g. The primary outcome was to evaluate feasibility of the protocol and the reasons for the eventual delay. Secondary outcomes were the identification of factors that would increase the likelihood of early weaning, the impact of an earlier weaning on discharge timing, and the incidence of adverse outcomes. Newborns in the study period were then compared with an historical control group with similar characteristics.

Results: Early weaning was achieved in 79.2% of infants without significant adverse effects on temperature stability or weight gain. Delayed weaning was mainly due to the need of respiratory support. Gestational age affected the likelihood of early weaning (OR 1.7282 95% CI: 1.3071 - 2.2850). In the multivariate linear regression, early weaning reduced length of stay (LOS) by 25.8 days (p < 0.0001).

Conclusions: Preterm infants can be weaned successfully from an incubator to an open crib at weight as low as 1600 grams without significant adverse effect. Early weaning significantly reduces LOS in preterm newborns.

Figures

Figure 1
Figure 1
Distribution of gestational age in the early weaning (EW) and the delayed weaning group (DW).

References

    1. American Academy of Pediatrics. Committee on Fetus and Newborn. Hospital discharge of the high-risk neonate: proposed guidelines. Pediatrics. 2008;122(5):1119–1126. doi:10.1542/peds.2008-2174.
    1. New K, Flenady V, Davies MW. Transfer of preterm infants from incubator to open cot at lower versus higher body weight. Cochrane Database Syst Rev. 2011;9:CD004214.
    1. Schneiderman R, Kirkby S, Turenne W, Schneiderman R, Kirkby S, Turenne W, Greenspan J. Incubator weaning in preterm infants and associated practice variation. J Perinatol. 2009;29(8):570–574. doi: 10.1038/jp.2009.54.
    1. Zecca E, Corsello M, Priolo F, Zecca E, Corsello M, Priolo F, Tiberi E, Barone G, Romagnoli C. Early weaning from incubator and early discharge of preterm infants: randomized clinical trial. Pediatrics. 2010;126(3):e651–e656. doi: 10.1542/peds.2009-3005.
    1. New K, Flint A, Bogossian F, New K, Flint A, Bogossian F, East C, Davies MW. Transferring preterm infants from incubators to open cots at 1600 g: a multicentre randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2012;97(2):F88–F92. doi: 10.1136/adc.2011.213587.
    1. Lockwood C, Lemons J. Guidelines for Perinatal Care. 6. Elk Grove Village, IL: American Academy of Pediatrics; 2007. pp. 205–249.
    1. Patel AL, Engstrom JL, Meier PP, Patel AL, Engstrom JL, Meier PP, Kimura RE. Accuracy of methods for calculating postnatal growth velocity for extremely low birth weight infants. Pediatrics. 2005;116(6):1466–1473. doi: 10.1542/peds.2004-1699.
    1. Russell RB, Green NS, Steiner CA, Russell RB, Green NS, Steiner CA, Meikle S, Howse JL, Poschman K, Dias T, Potetz L, Davidoff MJ, Damus K, Petrini JR. Cost of hospitalization for preterm and low birth weight infants in the United States. Pediatrics. 2007;120(1):e1–e9. doi: 10.1542/peds.2006-2386.
    1. Forcada-Guex M, Pierrehumbert B, Borghini A, Forcada-Guex M, Pierrehumbert B, Borghini A, Moessinger A, Muller-Nix C. Early dyadic patterns of mother-infant interactions and outcomes of prematurity at 18 months. Pediatrics. 2006;118(1):e107–e114. doi: 10.1542/peds.2005-1145.
    1. Saenz P, Cerda M, Diaz JL, Sáenz P, Cerdá M, Díaz JL, Yi P, Gorba M, Boronat N, Barreto P, Vento M. Psychological stress of parents of preterm infants enrolled in an early discharge programme from the neonatal intensive care unit: a prospective randomised trial. Arch Dis Child Fetal Neonatal Ed. 2009;94(2):F98–F104. doi: 10.1136/adc.2007.135921.
    1. Lamarche-Vadel A, Blondel B, Truffer P, Lamarche-Vadel A, Blondel B, Truffer P, Burguet A, Cambonie G, Selton D, Arnaud C, Lardennois C, du Mazaubrun C, N'Guyen S, Mathis J, Bréart G, Kaminski M. EPIPAGE Study Group. Re-hospitalization in infants younger than 29 weeks’ gestation in the EPIPAGE cohort. Acta Paediatr. 2004;93(10):1340–1345. doi: 10.1080/08035250410032926.
    1. Picone S, Paolillo P, Franco F, Picone S, Paolillo P, Franco F, Di Lallo D. The appropriateness of early discharge of very low birth weight newborns. J Matern Fetal Neonatal Med. 2011;24 Suppl 1:138–143.
    1. Sutter TW, Phan D, Pierchala CE, Rishel W. Weaning of premature infants from the incubator to an open crib. J Perinatol. 1988;8(3):193–198.
    1. Medoff-Cooper B. Transition of the preterm infant to an open crib. J Obstet Gynecol Neonatal Nurs. 1994;23(4):329–335. doi: 10.1111/j.1552-6909.1994.tb01884.x.
    1. West CR, Williams M, Weston PJ. Feasibility and safety of early transfer of premature infants from incubators to cots: a pilot study. J Paediatr Child Health. 2005;41(12):659–662. doi: 10.1111/j.1440-1754.2005.00754.x.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel