Incubator weaning in preterm infants and associated practice variation

Area of Science:

• Neonatal care
• Pediatric outcomes research
• Health services research

Background:

• Open cribs are used for preterm infants transitioning from incubators.
• Infant weight at this transition may influence clinical outcomes.
• Variations in clinical practice may affect patient care and resource utilization.

Purpose of the Study:

• To assess the relationship between preterm infant weight at open crib placement and key outcomes.
• To identify variations in incubator weaning practices among hospitals.
• To adjust for infant severity when evaluating these relationships and variations.

Main Methods:

• Retrospective analysis of 2908 appropriate-for-gestational-age preterm infants (2003-2006).
• Data sourced from the ParadigmHealth neonatal database.
• Primary outcomes: days to full oral feeding, weight gain, and length of stay (LOS); regression models used for analysis.

Main Results:

• Mean infant weight at open crib was 1850g.
• Each 100g increase in weight at open crib correlated with 0.8 days longer to full oral feeding, 1g/day less weight gain, and 0.9 days longer LOS.
• Hospital practice accounted for 19% of the variation in weight at open crib, beyond infant severity (9%).

Conclusions:

• Significant, unexplained variation in incubator weaning practices exists among hospitals.
• These practice variations, independent of infant severity, can negatively impact feeding, growth, and LOS.
• Standardizing weaning protocols may improve preterm infant outcomes.