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Shankaran S, Bell EF, Laptook AR, Saha S, Newman NS, Kazzi SNJ, Barks J, Stoll BJ, Bara R, Gabrio J, Childs K, Das A, Higgins RD, Carlo WA, Sánchez PJ, Carlton DP, Pavageau L, Malcolm WF, D’Angio CT, Ohls RK, Poindexter BB, Sokol GM, Van Meurs KP, Colaizy TT, Khmour A, Puopolo KM, Garg M, Walsh MC. Weaning of Moderately Preterm Infants from the Incubator to the Crib: A Randomized Clinical Trial. J Pediatr 2019; 204:96-102.e4. [PMID: 30337189 PMCID: PMC6326364 DOI: 10.1016/j.jpeds.2018.08.079] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/03/2018] [Accepted: 08/30/2018] [Indexed: 11/28/2022]
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.gov: NCT02160002.
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Affiliation(s)
| | - Edward F. Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Abbot R. Laptook
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI
| | - Shampa Saha
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | - Nancy S. Newman
- Department of Pediatrics, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH
| | | | - John Barks
- Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Barbara J. Stoll
- Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX
| | - Rebecca Bara
- Department of Pediatrics, Wayne State University, Detroit, MI
| | - Jenna Gabrio
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | - Kirsten Childs
- Department of Pediatrics, Wayne State University, Detroit, MI
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville
| | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Waldemar A. Carlo
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL
| | - Pablo J. Sánchez
- Department of Pediatrics, Nationwide Children’s Hospital, Ohio State University College of Medicine, Columbus, OH
| | - David P. Carlton
- Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Lara Pavageau
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Carl T. D’Angio
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Robin K. Ohls
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Brenda B. Poindexter
- Department of Pediatrics, Perinatal Institute, Cincinnati Children’s Hospital, Cincinnati, OH
| | - Gregory M. Sokol
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Krisa P. Van Meurs
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA
| | | | - Ayman Khmour
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO
| | - Karen M. Puopolo
- Department of Pediatrics, The Children’s Hospital of Philadelphia and The University of Pennsylvania, Philadelphia, PA
| | - Meena Garg
- Department of Pediatrics, University of California, Los Angeles, CA
| | - Michele C. Walsh
- Department of Pediatrics, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH
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