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

Abstract

BackgroundAbility 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.Methods101 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.ResultsEarly 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).ConclusionsPreterm 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.

Weaning of Moderately Preterm Infants from the Incubator to the Crib: A Randomized Clinical Trial

“…3 Prospective studies of infants with birth weights of <1600 g from New Zealand and Italy have demonstrated the feasibility and safety of early weaning from incubators to cribs. 6,13 Families have more access to infants cared for in cribs with the ability to promote skin-to-skin care and breastfeeding, as noted in a recent Family Integrated Care model. 14…”

At what weight should preterm infants be transferred from incubator to open cot?

“…The evidence from all the trials suggests that weaning at a lower body weight from incubator to cot is safe and does not affect temperature stability and weight gain. Infants weaned at a lower body weight grew significantly better than infants weaned at a higher weight 3 6 7 10. Besides, the proportion of infants returning to an incubator because of temperature instability did not differ if weaned at a lower body weight compared with a higher body weight.…”

“…The list of studies excluded following a detailed review, including the reasons for exclusion, are provided in online supplementary file 1. Three systematic reviews,1–3 five randomised controlled trials4–8 and three observational studies9–11 were identified for inclusion (figure 1).…”

“…The population in this trial4 was slightly older (gestational age ~32 weeks) compared with the randomised trials,6 7 which failed to show reduced length of hospital stay (gestational age ~30–31 weeks). Similarly, an observational study10 identified infants length of stay is shorter if weaned from incubator to cot at a lower body weight; however, the study groups differ for baseline prognostic factors and hence should be interpreted with caution.…”

Tempo de permanência do curativo do cateter central de inserção periférica em neonatos

“…Quanto ao tipo de infusão da terapia, a politerapia teve correlação positiva com o maior tempo de curativo de CCIP (µ=0,798; p=0,0010). A politerapia é muito frequente nas unidades de tratamento intensivo, considerando a gravidade do neonato e maior necessidade de suporte medicamentos (Costa et al, 2016 (Barone et al, 2014;Costa, Tonete, Parada, 2017;Gray, Flenady, 2011;Kaleshi et al, 2017;New et al, 2012 (Fernández, Antolín-Rodríguez, 2018).…”