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J Pediatr. 2018 Oct 15. pii: S0022-3476(18)31253-8. doi: 10.1016/j.jpeds.2018.08.079. [Epub ahead of print]

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

Author information

1
Department of Pediatrics, Wayne State University, Detroit, MI. Electronic address: sshankar@med.wayne.edu.
2
Department of Pediatrics, University of Iowa, Iowa City, IA.
3
Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI.
4
Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC.
5
Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH.
6
Department of Pediatrics, Wayne State University, Detroit, MI.
7
Department of Pediatrics, University of Michigan, Ann Arbor, MI.
8
Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX.
9
Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD.
10
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
11
Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL.
12
Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH.
13
Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.
14
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
15
Department of Pediatrics, Duke University, Durham, NC.
16
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.
17
Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM.
18
Department of Pediatrics, Perinatal Institute, Cincinnati Children's Hospital, Cincinnati, OH.
19
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
20
Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA.
21
Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO.
22
Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania, Philadelphia, PA.
23
Department of Pediatrics, University of California, Los Angeles, CA.
24
Division of Neonatology, College of Physicians and Surgeons, Columbia University.
25
Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island.
26
Case Western Reserve University, Rainbow Babies & Children's Hospital.
27
Children's Mercy Hospital.
28
Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical Center, Good Samaritan Hospital.
29
Duke University School of Medicine, University Hospital, University of North Carolina, WakeMed Health and Hospitals, Duke Regional Hospital.
30
Emory University, Children's Healthcare of Atlanta, Grady Memorial Hospital, Emory University Hospital Midtown.
31
Eunice Kennedy Shriver National Institute of Child Health and Human Development.
32
Indiana University, University Hospital, Methodist Hospital, Riley Hospital for Children at Indiana University Health, Eskenazi Health.
33
Nationwide Children's Hospital, The Research Institute at Nationwide Children's Hospital, The Ohio State University Wexner Medical Center, The Ohio State College of Medicine, Center for Perinatal Research.
34
RTI International.
35
Stanford University, Lucile Packard Children's Hospital.
36
University of Alabama at Birmingham Health System, Children's Hospital of Alabama.
37
University of California-Los Angeles, Mattel Children's Hospital, Santa Monica Hospital, Los Robles Hospital and Medical Center, Olive View Medical Center.
38
University of Iowa and Mercy Medical Center.
39
University of New Mexico Health Sciences Center.
40
University of Pennsylvania, Hospital of the University of Pennsylvania, Pennsylvania Hospital, and Children's Hospital of Philadelphia.
41
University of Rochester Medical Center, Golisano Children's Hospital, University of Buffalo Women's and Children's Hospital of Buffalo.
42
University of Texas Southwestern Medical Center at Dallas, Parkland Health & Hospital System, Children's Medical Center Dallas.
43
Wayne State University, University of Michigan, Hutzel Women's Hospital, Children's Hospital of Michigan.

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.govNCT02160002.

KEYWORDS:

incubator; moderately preterm infants; randomized controlled trial; temperature; weaning

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