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Greve S, Bruns N, Dathe AK, Schuendeln MM, Felderhoff-Mueser U, Stein A. Effects of an early transfer from incubator to a warming crib in very low birthweight preterm infants. BMC Pediatr 2024; 24:319. [PMID: 38724933 PMCID: PMC11080167 DOI: 10.1186/s12887-024-04795-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
PURPOSE Very low birth weight infants are cared for postnatally in the incubator because of adverse consequences of hypothermia. Data on the optimal weight of transfer to a warming crib are rare. The aim of this study was to determine the course of temperature and body weight during a standardized transfer to a warming crib at a set weight. METHODS Prospective intervention study in very low birthweight infants who were transferred from the incubator to a warming crib at a current weight between 1500 g and 1650 g. RESULTS No infant had to be transferred back to an incubator. Length of hospital stay was equal compared to a historical cohort from the two years directly before the intervention. The intervention group showed an increase in the volume fed orally on the day after transfer to the warming crib, although this did not translate into an earlier discontinuation of gavage feedings. Compared to the historical group, infants in the intervention group could be transferred to an unheated crib at an earlier postmenstrual age and weight. CONCLUSIONS Early transfer from the incubator to a warming crib between 1500 g and 1650 g is feasible and not associated with adverse short-term events or outcomes. TRIAL REGISTRATION DRKS-IDDRKS00031832.
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Affiliation(s)
- Sandra Greve
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, Universitätsmedizin Essen, University of Duisburg-Essen, North-Rhine Westphalia, 45122, Essen, Germany.
| | - Nora Bruns
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, Universitätsmedizin Essen, University of Duisburg-Essen, North-Rhine Westphalia, 45122, Essen, Germany
| | - Anne-Kathrin Dathe
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, Universitätsmedizin Essen, University of Duisburg-Essen, North-Rhine Westphalia, 45122, Essen, Germany
- Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences, Jena, Germany
| | - Michael M Schuendeln
- Department of Paediatrics III, Department of Pediatric Hematology and Oncology, Universitätsmedizin Essen, University of Duisburg-Essen, North-Rhine Westphalia, 45122, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, Universitätsmedizin Essen, University of Duisburg-Essen, North-Rhine Westphalia, 45122, Essen, Germany
| | - Anja Stein
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, Universitätsmedizin Essen, University of Duisburg-Essen, North-Rhine Westphalia, 45122, Essen, Germany
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Body Weight Gain Status during the Incubator Weaning Process in Very Low Birth Weight Premature Infants. CHILDREN 2022; 9:children9070985. [PMID: 35883969 PMCID: PMC9323975 DOI: 10.3390/children9070985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/19/2022] [Accepted: 06/28/2022] [Indexed: 12/01/2022]
Abstract
Incubator care is essential for premature infants during early hospitalization. As the infants’ conditions improve, incubator weaning becomes necessary. This retrospective study aimed to evaluate the effect of body weight gain and status of intake-calorie gain on the incubator weaning process for very low birth weight (VLBW) premature infants. The study included 127 VLBW premature neonates. We analyzed data on clinical characteristics potentially associated with the weaning period and the end-weaning body weight (EWBW), including body weight gain status, intake-calorie gain status, and disease conditions. The neonates were weaned from the incubators at a mean postmenstrual age (PMA) of 35.1 ± 1.3 weeks; postnatal days, 37.7 ± 18.2 days; and body weight, 1882.8 ± 157.1 g. The total weaning period was 3.5 ± 3.1 days. Regarding the weaning period, there was a strong positive relationship only in the end-weaning PMA and the daily body weight within 3 days before incubator weaning. Further, regarding the factors associated with EWBW, only the end-weaning PMA and necrotizing enterocolitis had a significant positive impact. Body weight gain and the status of intake-calorie gain showed no association with either the weaning period or the EWBW and, thus, were not related to the incubator weaning process.
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Vidal Santos S, Souza Ramos FR, Costa R, da Cunha Batalha LM. Evidências sobre prevenção de lesões de pele em recém-nascidos: revisão integrativa. ESTIMA 2019. [DOI: 10.30886/estima.v17.787_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo: identificar estratégias para a prevenção de lesões de pele em recém-nascidos (RN) hospitalizados, publicadas em periódicos científicos no período de 2013 a 2018. Método: revisão integrativa de literatura realizada em dois momentos de busca em bases de dados, sendo selecionados 37 estudos publicados entre os anos de 2013 e 2018. Resultados: termorregulação, uso de antisséptico, uso de emolientes e limpeza do coto umbilical foram as recomendações mais encontradas. Entre as práticas baseadas em evidência, destacam-se as que previnem o risco de hipotermia, como o uso de saco de polietileno e o contato pele a pele, que respaldam a assistência e que garantem segurança no cuidado do paciente neonatal. Conclusão: a prevenção de lesões de pele é um tema relevante, entretanto, existe escassez de evidências robustas para sustentar, com segurança, as práticas de cuidados com o RN. Observa-se ainda que as evidências são insuficientes para englobar o universo do tema, demonstrando que o cuidado com a pele é um tema que demanda investimentos e mais pesquisas.
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Vidal Santos S, Souza Ramos FR, Costa R, da Cunha Batalha LM. Evidence on prevention of skin lesions in newborns: integrative review. ESTIMA 2019. [DOI: 10.30886/estima.v17.787_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: To identify strategies for the prevention of skin lesions in hospitalized newborns (NBs), published in scientific journals from 2013 to 2018. Method: Integrative literature review performed in two moments of database search, selecting 37 studies published between 2013 and 2018. Results: Thermoregulation, use of antiseptic, use of emollients and cleaning of the umbilical stump were the most commonly found recommendations. Among the evidence-based practices, we highlight those that prevent the risk of hypothermia, such as the use of a polyethylene bag and skin-to-skin contact, which support the assistance and ensure safety in the care of the neonatal patient. Conclusion: The prevention of skin lesions is a relevant topic. However, there is a scarcity of robust evidence to safely sustain NB care practices. It is also observed that the evidence is insufficient to encompass the universe of the theme, demonstrating that skin care is a theme that requires investment and more research.
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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] [Abstract] [Key Words] [MESH Headings] [Grants] [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
| | - S Nadya J Kazzi
- Department of Pediatrics, Wayne State University, Detroit, MI
| | - 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, MD
| | - 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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Dinkel D, Hanson C, Koehler K, Berry AA, Kyvelidou A, Bice M, Wallen J, Bagenda D, Jana L, Pressler J. An overview of assessment methodology for obesity-related variables in infants at risk. Nutr Health 2018; 24:47-59. [PMID: 28944717 DOI: 10.1177/0260106017732268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The first 2 years of a child's life are a particularly critical time period for obesity prevention. AIM An increasing amount of research across the world is aimed at understanding factors that impact early childhood obesity and developing interventions that target these factors effectively. With this growing interest, new and interdisciplinary research teams are developing to meet this research need. Due to rapid growth velocity during this phase of the lifespan, typical assessments used in older populations may not be valid or applicable in infants, and investigators need to be aware of the pros and cons of specific methodological strategies. METHODS This paper provides an overview of methodology available to assess obesity-related factors in the areas of anthropometry and body composition, nutrient intake, and energy expenditure in infants aged 0-2 years. RESULTS Gold standard measures for body composition, such as dual-energy X-ray absorptiometry (DXA) or other imaging techniques, are costly, require highly trained personnel, and are limited for research application. Nutrient intake methodology primarily includes surveys and questionnaires completed via parent proxy report. In terms of energy expenditure, methods of calorimetry are expensive and may not differentiate between different activities. Questionnaires or physical activity sensors offer another way of energy expenditure assessment. However, questionnaires have a certain recall bias, while the sensors require further validation. CONCLUSIONS Overall, in addition to understanding the pros and cons of each assessment tool, researchers should take into consideration the experience of the interdisciplinary team of investigators, as well as the cost and availability of measures at their institution.
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Affiliation(s)
- Danae Dinkel
- 1 School of Health and Kinesiology, University of Nebraska at Omaha, USA
| | - Corrine Hanson
- 2 Medical Nutrition Education, University of Nebraska Medical Center, USA
| | - Karsten Koehler
- 3 Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, USA
| | - Ann Anderson Berry
- 4 Division of Newborn Medicine, University of Nebraska Medical Center, Department of Pediatrics, USA
| | | | - Matthew Bice
- 6 Department of Kinesiology and Sport Sciences, University of Nebraska Kearney, USA
| | - Jill Wallen
- 7 Department of Growth and Development, University of Nebraska Medical Center, USA
| | - Danstan Bagenda
- 8 Department of Anesthesiology, University of Nebraska Medical Center, USA
| | - Laura Jana
- 9 College of Health and Human Development, Penn State University, USA
| | - Jana Pressler
- 10 College of Nursing, University of Nebraska Medical Center, USA
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