Original Article

Journal of Perinatology (2009) 29, 570–574; doi:10.1038/jp.2009.54; published online 21 May 2009

Incubator weaning in preterm infants and associated practice variation

R Schneiderman1, S Kirkby1, W Turenne1 and J Greenspan2

  1. 1Alere (formerly ParadigmHealth), Marietta, GA, USA
  2. 2Thomas Jefferson University and Nemours/A.I. duPont Hospital for Children, Philadelphia, PA, USA

Correspondence: Dr R Schneiderman, Alere, 1850 Parkway Place, 6th Floor, Marietta, GA 30067, USA. E-mail: roy.schneiderman@alere.com

Received 20 October 2008; Revised 22 February 2009; Accepted 21 March 2009; Published online 21 May 2009.

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Abstract

Objective:

 

To evaluate the relationship of weight of preterm infants when first placed into an open crib with days to full oral feedings, growth velocity and length of stay (LOS), and to identify unwarranted variation in incubator weaning after adjusting for severity indices.

Study Design:

 

A retrospective study using the ParadigmHealth neonatal database from 2003 to 2006 reviewed incubator weaning to an open crib in appropriate-for–gestational-age (AGA) infants from 22 to Unfortunately we are unable to provide accessible alternative text for this. If you require assistance to access this image, please contact help@nature.com or the author weeks gestation. Primary outcome measurements included days to full oral (PO) feeding, weight gain from open crib to discharge and length of stay. Models were severity adjusted. To understand hospital practice variation, we also used a regression model to estimate the weight at open crib for the top 10 volume hospitals.

Result:

 

In all 2908 infants met the inclusion criteria for the study. Their mean weight at open crib was 1850  g. On average every additional 100 g an infant weighed at the open crib was associated with increased time to full PO feeding by 0.8 days, decreased weight gained per day by 1 gram and increased LOS by 0.9 days. For the top 10 volume hospitals, severity variables alone accounted for 9% of the variation in weight at open crib, whereas the hospital in which the baby was treated accounted for an additional 19% of the variation.

Conclusion:

 

Even after controlling for severity, significant practice variation exists in weaning to an open crib, leading to potential delays in achieving full-volume oral feeds, decreased growth velocity and prolonged LOS.

Keywords:

thermoregulation, length of stay, open crib

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