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Earlier Incubator-Crib Transfer Safe for Preemies

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Babies born at a gestational age of 30-35 weeks can be safely transferred from the incubator to an open crib once they reach 1600 grams weight. This early weaning in turn leads to early discharge home, Italian physicians report in the September issue of Pediatrics.

“Traditional incubator weaning regimens have advocated weight cutoff values between 1800 and 2000 g,” write Dr. Enrico Zecca and colleagues at University Hospital “A. Gemelli,” of the Catholic University of the Sacred Heart, Rome. “However, weaning to an open crib at lower weights may result in earlier discharge, which facilitates family bonding and prevents overcrowding.”

The group conducted a randomized trial to see if the overall length of stay (LOS) would be significantly shortened for preterm infants transferred to an open crib at 1600 g, without increasing the risk of adverse outcomes: i.e., lower growth velocity, breastfeeding failure, return to an incubator, or hospital readmission during the first week after discharge.

The study included 94 babies born at more than 26 weeks gestation and weighing less than 1600 grams at birth. Only 1 of the infants in each group had a gestational age of <28 weeks at birth. The others were born between 30 and 35 weeks. Half of them were transferred from an incubator to an open crib at 1600 g (early transition group) while the others were transferred at 1800 g (standard transition group). To help with thermal stability, the investigators explain, “After transition to an open crib, infants were assisted with 24 C environmental temperature and 40% relative humidity and were dressed in a woolen hat, booties, 2 vests, and a cotton wrap.” No infants required transfer back to the incubator. The time spent in an open crib was 6 days in each group, and the lengths of stay were 23.5 days and 33 days (p=0.0002) in the early transition group and standard transition group, respectively. As expected, weights at discharge were significantly lower in the early group (1842 g) than in the standard group (2067 g). Nonetheless, there were no significant differences between the two groups in the follow-up week after discharge. Growth velocity was 14 versus 16 g/kg/d in the early transition group and standard transition group, respectively, and mean amounts of breastfeeding were 43% and 46%. None of the infants required emergency department visits, and just one in the standard transition group required hospital readmission, for a UTI. “Our study demonstrated that weaning moderately preterm infants from an incubator to an open crib at weights as low as 1600 g significantly reduced LOS without apparent adverse effects,” Dr. Zecca and colleagues conclude. Reference:
Early Weaning From Incubator and Early Discharge of Preterm Infants: Randomized Clinical Trial

Pediatrics 2010; 126:e.