Weight at Weaning of Preterm Infants from Incubator to Bassinet: A Randomized Clinical Trial

Abstract

Objective To evaluate thermal responses, weight gain, and resting energy expenditure (REE) in preterm infants weaned from an infant incubator to a warming bassinet after reaching a body weight of either 1,500 or 1,600 g, respectively.

Methods Preterm infants weighing ≤ 1,500 g were randomly allocated for weaning from a convective incubator after reaching 1,500 g body weight (study group) or 1,600 g (controls). Postweaning body temperature was recorded at short intervals. REE was measured before and after weaning, while the weight gain was calculated daily.

Results All 21 enrolled infants were weaned successfully to a bassinet (room temperature). REE inside the incubator and in the warming bassinette was similar between infants weaned at 1,500 g and at 1,600 g (2.9 ± 6.8 vs. 1.1 ± 4.8 kcal/kg/d, respectively (p = 0.7). REE increased slightly after weaning in both groups. Weight gain and days from randomization to discharge did not differ between groups.

Conclusion Weaning very low birth weight infants from an incubator to a warming bassinet at a body weight of 1,500 g is feasible and has no significant deleterious effects on weight gain and REE. The many benefits provided by such greater accessibility to premature infants are discussed.

Keywords

metabolic rate - indirect calorimetry - incubator - weaning

Registration Number

NCT01083303

• References

• 1 Thomas K. Thermoregulation in neonates. Neonatal Netw 1994; 13 (2) 15-22
• 2 Silverman WA, Fertig JW, Berger AP. The influence of the thermal environment upon the survival of newly born premature infants. Pediatrics 1958; 22 (5) 876-886
• 3 New K, Flenady V, Davies MW. Transfer of preterm infants from incubator to open cot at lower versus higher body weight. Cochrane Database Syst Rev 2008; (1) CD004214
• 4 Schneiderman R, Kirkby S, Turenne W, Greenspan J. Incubator weaning in preterm infants and associated practice variation. J Perinatol 2009; 29 (8) 570-574
• 5 New K, Bogossian F, East C, Davies MW. Practice variation in the transfer of premature infants from incubators to open cots in Australian and New Zealand neonatal nurseries: results of an electronic survey. Int J Nurs Stud 2010; 47 (6) 678-687
• 6 Sutter TW, Phan D, Pierchala CE, Rishel W. Weaning of premature infants from the incubator to an open crib. J Perinatol 1988; 8 (3) 193-198
• 7 Heimler R, Sumners JE, Grausz JP, Kien CL, Glaspey JC. Thermal environment change in growing premature infants: effect on general somatic growth and subcutaneous fat accumulation. Pediatrics 1981; 68 (1) 82-86
• 8 Zecca E, Corsello M, Priolo F, Tiberi E, Barone G, Romagnoli C. Early weaning from incubator and early discharge of preterm infants: randomized clinical trial. Pediatrics 2010; 126 (3) e651-e656
• 9 New K, Flint A, Bogossian F, East C, Davies MW. Transferring preterm infants from incubators to open cots at 1600.  g: a multicentre randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2012; 97 (2) F88-F92
• 10 West CR, Williams M, Weston PJ. Feasibility and safety of early transfer of premature infants from incubators to cots: a pilot study. J Paediatr Child Health 2005; 41 (12) 659-662
• 11 Medoff-Cooper B. Transition of the preterm infant to an open crib. J Obstet Gynecol Neonatal Nurs 1994; 23 (4) 329-335
• 12 Lubetzky R, Vaisman N, Mimouni FB, Dollberg S. Energy expenditure in human milk- versus formula-fed preterm infants. J Pediatr 2003; 143 (6) 750-753
• 13 Weintraub V, Mimouni FB, Dollberg S. Changes in energy expenditure in preterm infants during weaning: a randomized comparison of two weaning methods from an incubator. Pediatr Res 2007; 61 (3) 341-344
• 14 Dollberg S, Mimouni FB, Weintraub V. Energy expenditure in infants weaned from a convective incubator. Am J Perinatol 2004; 21 (5) 253-256
• 15 Jéquier E, Felber JP. Indirect calorimetry. Baillieres Clin Endocrinol Metab 1987; 1 (4) 911-935
• 16 Bauer K, Pasel K, Uhrig C, Sperling P, Versmold H. Comparison of face mask, head hood, and canopy for breath sampling in flow-through indirect calorimetry to measure oxygen consumption and carbon dioxide production of preterm infants < 1500 grams. Pediatr Res 1997; 41 (1) 139-144
• 17 Olhager E, Forsum E. Total energy expenditure, body composition and weight gain in moderately preterm and full-term infants at term postconceptional age. Acta Paediatr 2003; 92 (11) 1327-1334
• 18 Bauer K, Laurenz M, Ketteler J, Versmold H. Longitudinal study of energy expenditure in preterm neonates <30 weeks' gestation during the first three postnatal weeks. J Pediatr 2003; 142 (4) 390-396
• 19 Berger I, Weintraub V, Dollberg S, Kopolovitz R, Mandel D. Energy expenditure for breastfeeding and bottle-feeding preterm infants. Pediatrics 2009; 124 (6) e1149-e1152
• 20 Gray PH, Paterson S, Finch G, Hayes M. Cot-nursing using a heated, water-filled mattress and incubator care: a randomized clinical trial. Acta Paediatr 2004; 93 (3) 350-355
• 21 Sarman I. Thermal responses and heart rates of low-birth-weight premature babies during daily care on a heated, water-filled mattress. Acta Paediatr 1992; 81 (1) 15-20
• 22 Green-Abate C, Tafari N, Rao MR, Yu K, Clemens JD. Comparison of heated water-filled mattress and space-heated room with infant incubator in providing warmth to low birthweight newborns. Int J Epidemiol 1994; 23 (6) 1226-1233
• 23 Sarman I, Tunell R. Providing warmth for preterm babies by a heated, water filled mattress. Arch Dis Child 1989; 64 (1 Spec No): 29-33
• 24 Glass L, Silverman WA, Sinclair JC. Effect of the thermal environment on cold resistance and growth of small infants after the first week of life. Pediatrics 1968; 41 (6) 1033-1046
• 25 Day RL, Caliguiri L, Kamenski C, Ehrlich F. Body temperature and survival of premature infants. Pediatrics 1964; 34: 171-181
• 26 Gibson E, Medoff-Cooper B, Nuamah IF, Gerdes J, Kirkby S, Greenspan J. The Early Discharge Study Group. Accelerated discharge of low birth weight infants from neonatal intensive care: a randomized, controlled trial. J Perinatol 1998; 18 (6 Pt 2 Su) S17-S23
• 27 Brück K. Which environmental temperature does the premature infant prefer?. Pediatrics 1968; 41 (6) 1027-1030
• 28 Shields-Poë D, Pinelli J. Variables associated with parental stress in neonatal intensive care units. Neonatal Netw 1997; 16 (1) 29-37
• 29 Benini F, Magnavita V, Lago P, Arslan E, Pisan P. Evaluation of noise in the neonatal intensive care unit. Am J Perinatol 1996; 13 (1) 37-41
• 30 MacRae Dell K. Fluid, electrolytes, and acid-base homeostasis. In: Martin RJ, Fanaroff AA, Walsh MC, , eds. Neonatal Perinatal Medicine, Diseases of the Fetus and Infant. 9th ed. St. Louis, MO: Mosby; 2010. :674. Vol. 1, Chap. 36
• 31 Lei TH, Lien R, Hsu JF, Chiang MC, Fu RH. Effect of body weight on temperature control and energy expenditure in preterm infants. Pediatr Neonatol 2010; 51 (3) 178-181