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

• Type of Material: Article
• Authors: Seetha Shankaran, Wayne State University; Edward F. Bell, University of Iowa; Abbot R. Laptook, Brown University; Shampa Saha, RTI International; Nancy S. Newman, Case Western Reserve University; S. Nadya J. Kazzi, Wayne State University; John Barks, University of Michigan; Barbara Stoll, Emory University; Rebecca Bara, Wayne State University; Jenna Gabrio, RTI International; Kirsten Childs, Wayne State University; Abhik Das, RTI International; Rosemary D. Higgins, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Waldemar A. Carlo, University of Alabama Birmingham; Pablo J. Sanchez, Ohio State University; David Carlton, Emory University; Lara Pavageau, University of Texas Southwestern; William F. Malcolm, Duke University; Carl T. D'Angio, University of Rochester; Robin K. Ohls, University of New Mexico; Brenda B. Poindexter, Cincinnati Childrens Hospital Medical Center; Gregory M. Sokol, Indiana University; Krisa P. Van Meurs, Stanford University; Tarah T. Colaizy, University of Iowa; Ayman Khmour, Childrens Mercy Hospital; Karen M. Puopolo, Childrens Hospital of Philadelphia; Meena Garg, University of California Los Angeles; Michele C. Walsh, Case Western Reserve University
• Language: English
• Date: 2019-01-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jpeds.2018.08.079
• Title of Journal or Parent Work: Journal of Pediatrics
• ISSN: 0022-3476
• Volume: 204
• Start Page: 96
• End Page: +
• Grant/Funding Information: The National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) provided grant support for the Neonatal Research Network’s Trial on Incubator Weaning of Moderately Preterm Infants (NCT02160002) through cooperative agreements.
• Keywords: Pediatrics; PREMATURE-INFANTS; DISCHARGE; WEIGHT; Science & Technology; Life Sciences & Biomedicine; COTS; POSTNATAL-GROWTH VELOCITY; OUTCOMES; ENERGY-EXPENDITURE; MULTICENTER
• Research Categories: Health Sciences, Medicine and Surgery; Statistics; Environmental Sciences

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.