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Weaning of moderately preterm infants from the incubator to the crib
A randomized clinical trial
Shankaran, S., Bell, E. F., Laptook, A. R., Saha, S., Newman, N. S., Kazzi, S. N. J., Barks, J., Stoll, B. J., Bara, R., Gabrio, J., Childs, K., Das, A., Higgins, R. D., Carlo, W. A., Sanchez, P. J., Carlton, D. P., Pavageau, L., Malcolm, W. F., D'Angio, C. T., ... Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (2019). Weaning of moderately preterm infants from the incubator to the crib: A randomized clinical trial. The Journal of Pediatrics, 204, 96-102.e4. https://doi.org/10.1016/j.jpeds.2018.08.079
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.
