Feasibility and safety of early transfer of premature infants from incubators to cots: A pilot study

Abstract

The results of this pilot study indicate the potential to transfer very low birthweight infants to an open unheated cot at a bodyweight of 1500 g. This study provides information for the design of future randomized controlled trials that are required to confirm the findings of this study before routine adoption of this intervention into clinical practice.

Incubator weaning in preterm infants and associated practice variation

“…A heterogeneous patient population in this small study showed increased growth at warmer incubator temperatures compared with a cooler environment. Our data support the recent study by West et al 10 and Berger et al's 11 preliminary data, which showed no decrease in weight gain following incubator wean to open crib. The ParadigmHealth database, as one of the largest data sets published on this topic, further shows the consequences in delaying appropriate incubator weaning, such as delayed oral feedings and prolonged length of hospitalization.…”

“…An appropriate starting point would be to develop standardized incubator weaning protocols based on physiological principles and evidence based medicine. Medoff-Cooper et al, 9 West et al, 10 Berger et al, 11 Meier,15 as well as the Association for Women's Health, Obstetric, and Neonatal Nursing (AWHONN) Research Utilization Project 16 support our data that successful incubator weaning can begin at infant weights approximating 1500 g. In addition, though this study evaluated infants less than 31-weeks GA, consideration to begin incubator weaning at 1500 g in a more mature GA patient population seems reasonable given their physiological stability in comparison with the study group.…”

“…Incubator use for preterm infants has a long history. [5][6][7][8] Several studies have shown the effectiveness of incubator weaning at weights as low as 1500 g. [9][10][11] Glass et al's 12 article in 1968 may have set an earlier precedent for incubator weaning. A heterogeneous patient population in this small study showed increased growth at warmer incubator temperatures compared with a cooler environment.…”

Transferring preterm infants from incubators to open cots at 1600 g: a multicentre randomised controlled trial

“…We identified one randomised9 and two quasi-randomised6 7 controlled trials and five observational studies3 8 12–14 assessing transferring preterm infants to standard open cots. Sutter and colleagues7 showed that preterm infants could be safely transferred to open cots at 1700 g but only for infants with birth weights >1000 g. However, they expressed caution in interpreting the results, due to the small number of infants with birth weights <1000 g (n=12).…”

“…There was evidence from two quasi-randomised studies suggesting that transfer to an open cot may safely occur at weights ≥16006 or ≥1700 g 7. More recent studies suggest potential transfer at 1500 g8 and at 1600 g 9…”