Related Experiment Video
Updated: Jun 23, 2026
Recapitulating Suckling-to-Weaning Transition In Vitro using Fetal Intestinal Organoids
Published on: November 15, 2019
Incubator weaning in preterm infants and associated practice variation
R Schneiderman1, S Kirkby, W Turenne
1Alere (formerly ParadigmHealth), Marietta, GA, USA. roy.schneiderman@alere.com
Insights
Preterm infant weight at open crib significantly impacts feeding, growth, and hospital stay. Significant practice variations exist, even after accounting for infant health, affecting outcomes.
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.
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 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.
