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.

Figures

Figure 1.
Figure 1.
NICHD NRN weaning algorithm: initiate at 1500–1540 or 1700–1740 g.
Figure 2.
Figure 2.
Flow of moderately preterm infants through a trial of incubator weaning at a lower weight vs a higher weight.
Figure 3.
Figure 3.
A, Infant axillary temperature during weaning from incubator to crib. B, Incubator temperature during weaning from incubator to the crib.

References

    1. Schneiderman R, Kirkby S, Turenne W, Greenspan J. Incubator weaning in preterm infants and associated practice variation. J Perinatol 2009;29:5704.
    1. Medoff-Cooper B Transition of the preterm infant to an open crib. J Obstet Gynecol Neonatal Nurs 1994;23:329–35.
    1. Sutter TW, Phan D, Pierchala CE, Rishel W. Weaning of premature infants from the incubator to an open crib. J Perinatol 1988;8:193–8.
    1. Gibson E, Medoff-Cooper B, Nuamah IF, Gerdes J, Kirkby S, Greenspan J. Accelerated discharge of low birth weight infants from neonatal intensive care: a randomized, controlled trial. The Early Discharge Study Group. J Perinatol 1998;18(6 Pt 2 Su):S17–23.
    1. New K, Flenady V, Davies MW. Transfer of preterm infants for incubator to open cot at lower versus higher body weight. Cochrane Database Syst Rev 2011;(9):CD004214 Review. doi:10.1002/14651858.CD004214.pub4.
    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;41:659–62.
    1. 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:e651–6.
    1. 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:F88–92.
    1. Whyte RK. Neonatal management and safe discharge of late and moderate preterm infants. Semin Fetal Neonatal Med 2012;17:153–8.
    1. American Academy of Pediatrics Committee on Fetus and Newborn. Hospital discharge of the high-risk neonate. Pediatrics 2008;122:111926.
    1. Patel AL, Engstrom JL, Meier PP, Kimura RE. Accuracy of methods for calculating postnatal growth velocity for extremely low birth weight infants. Pediatrics 2005;116:1466–73.
    1. Patel AL, Engstrom JL, Meier PP, Jegier BJ, Kimura RE. Calculating postnatal growth velocity in very low birth weight (VLBW) premature infants. J Perinatol 2009;29:618–22.
    1. Barone G, Corsello M, Papacci P, Priolo F, Romagnoli C, Zecca E. Feasibility of transferring intensive cared preterm infants from incubator to open crib at 1600 grams. Ital J Pediatr 2014;40:41. doi:10.1186/1824-7288-40-41.
    1. O’Brien K, Robson K, Bracht M, Cruz M, Lui K, Alvaro R, et al. Effectiveness of Family Integrated Care in neonatal intensive care units on infant and parent outcomes: a multicenter, multinational, cluster-randomised controlled trial. Lancet Child Adolesc Health 2018;2:245–54.
    1. Dollberg S, Mimouni FB, Weintraub V. Energy expenditure in infants weaned from a convective incubator. Am J Perinatol 2004;21:253–6.
    1. Lei TH, Lien R, Hsu JF, Chiang MC, Fu RH. Effect of body weight on temperature control and energy expenditure in preterm infants. Pediatr Neonatol 2010;51:178–81.
    1. Berger I, Marom R, Mimouni F, Kopelovich R, Dollberg S. Weight at weaning of preterm infants from incubator to bassinet: a randomized clinical trial. Am J Perinatol 2014;31:535–40.
    1. Heimler R, Sumners JE, Grausz JP, Kien CL, Glaspey JC. Thermal environment change in growing premature infants: effect on general somatic growth and subcutaneous fat accumulation. Pediatrics 1981;68:82–6.
    1. Walsh MC, Bell EF, Kandefer S, Saha S, Carlo WA, D’angio CT et al. Neonatal outcomes of moderately preterm infants compared to extremely preterm infants. Pediatr Res 2017;82:297–304.

Source: PubMed

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