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

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.

Body Weight Gain Status during the Incubator Weaning Process in Very Low Birth Weight Premature Infants

“…For instance, a review by Razak indicated that infants transferred to open cots at a weight lower than 1600 g gained more weight and grew better [9]. The adequacy of transferring infants to open cots at around 1500-2000 g has also been suggested in many studies [4,5,7,8,[10][11][12]. All the above evidence implies that weaning preterm neonates from incubators at different weight levels is feasible, based on their stable condition at the decision of weaning and a stage of dynamic equilibrium in changes of their physiological parameters (e.g., daily calorie changes and daily body weight changes).…”

“…As an indicator of maturity, the body weight status has widely been proven to reflect a neonates growth velocity and adaptation to its environments [ 6 ]. Further, it also serves as an important indicator of the following factors: successful weaning from the incubator to the crib [ 4 ], the length of hospital stays [ 7 , 8 ], and the discharge weight [ 4 , 7 ]. Therefore, most of the relevant research has compared weaning infants of different weight ranges to determine if there were any positive or negative effects of weight on weaning in these vulnerable neonates.…”

“…As earlier mentioned, the role of the body weight “gain” status, which reflects the stability of daily weight changes in the incubator weaning process, has been comparatively understudied compared to body weight status. The most current studies principally considered body weight gain as an outcome after successful transfer from incubators [ 4 , 6 , 10 , 13 ] with the follow-up period varying among the studies. Zecca et al [ 7 ] compared infants who were weaned from incubators at 1600 g and 1800 g and found that there was no difference in weight gain for over 1 week after transfer.…”

“…This prevents abrupt incubator weaning decisions that may lead to the worsening of outcomes. For instance, the clothing test [4], a common Children 2022, 9, 985 2 of 10 maneuver, reflects the early adaptability of premature newborns to the environmental temperature. By keeping the body temperature relatively stable to detect if there are abnormal physiological changes, the clothing test serves as a meaningful indicator for safe and successful weaning of the neonate from the incubator.…”

Effects of Hammock Positioning on Clinical Parameters in Preterm Infants Admitted to a Neonatal Intensive Care Unit: A Systematic Review

“…4,8,23 However these clinical markers can be modified with other resources, such as, for example, a heated cradle, antipyretic and blood pressure regulating medications, among others. [36][37][38][39] Rev Paul Pediatr. 2021;39:e2019399…”