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Ceasing or gradually reducing incubator humidity after 7 days for extremely preterm infants: a randomised clinical
Gillion Noreiks1, Deanne August2,3, Melissa Lai2,4
1Grantley Stable Neonatal Unit (GSNU), Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia. gill.noreiks@health.qld.gov.au.
Insights
Stopping incubator humidification abruptly or gradually after 7 days showed no significant difference in temperature instability or electrolyte imbalances for extremely preterm infants. Current practices for weaning humidity lack evidence-based support, suggesting no benefit in prolonged use beyond day 7.
Area of Science:
- Neonatalogy
- Pediatrics
- Clinical Trials
Background:
- Incubator humidification is standard for extremely preterm infants (EPTI) to manage transepidermal water loss and thermoregulation.
- Weaning practices for incubator humidification are inconsistent globally, with limited evidence to guide specific protocols.
Purpose of the Study:
- To compare the effects of two methods of discontinuing incubator humidification on temperature instability and electrolyte balance in EPTI.
- To assess the impact on skin injury in EPTI.
Main Methods:
- A randomized clinical trial involving 140 EPTI (born < 28 weeks GA) at a quaternary hospital in Queensland, Australia.
- Two groups: immediate cessation of humidity on day 8 vs. gradual reduction over 7 days.
- Primary outcome: temperature instability (hypo/hyperthermia); Secondary outcomes: hyponatremia, hypernatremia, and skin injury.
Main Results:
- No statistically significant differences were observed between the groups for hyperthermia (77% vs. 73%), hypothermia (53% vs. 37%), hyponatremia, hypernatremia, or skin injury (63% vs. 67%).
- While hypothermia rates were numerically higher in the immediate cessation group, the difference was not statistically significant (P=0.09).
Conclusions:
- Discontinuing incubator humidification either abruptly or gradually after 7 days of life does not impact temperature stability or serum sodium levels in EPTI.
- There is no apparent benefit to continuing incubator humidification beyond the first week of life for this population.
Abstract:
The purpose of this study is to compare the effects of two different ways of stopping incubator humidification on episodes of hypothermia, hyperthermia, hyponatraemia, hypernatraemia, or skin injury. The design is a single site, two-armed, parallel, randomised, clinical trial conducted between April 2019 and March 2022. The setting was a quaternary referral and teaching hospital in Queensland, Australia. There were 140 extremely preterm infants, born < 28 weeks gestational age (GA). Intervention groups were (1) cease humidity: incubator humidification turned from 80% to off at 00.01am on day 8 of life (n = 70); or (2) gradually reduce humidity: incubator humidification reduced by 5% at 00:01 of each day from day 8 until ceased on day 14 (n = 70). The primary outcome was episodes of temperature instability: defined as either hypothermia < 36.5 °C or hyperthermia > 37.5 °C. Secondary outcomes included episodes of hyponatraemia: hypernatraemia or skin injury. One hundred forty infants were enrolled, 70 in each group. No statistically significant differences for any outcomes. Hyperthermia: 77% (n = 54) in the cease group and 73% (n = 51) in the gradual reduction group (P = 0.70). Hypothermia: 53% (n = 37) in the cease group and 37% (n = 26) in the gradual reduction group (P = 0.09). The number of hyponatraemic events was similar for both groups (P = 0.73), as for hypernatraemic events (P = 0.3). Skin injury in week 2 of life: 63% in the cease group and 67% in the gradual reduction group (P = 0.72).
Conclusions:
Ceasing or gradually reducing incubator humidification after day 7 of life had no effect on the number of episodes of hypothermia or hyperthermia in this cohort of extremely preterm infants (EPTI). There was also no effect on the number of episodes of hyponatraemia or hypernatraemia.
Trial Registration:
ANZCTR.org.au (Australia New Zealand Clinical Trials Registry). ACTRN 1261 9000 266167 Registered 21/2/2019.
What Is Known:
• Incubator humidification is a widely accepted and routine practice in the management of EPTI as it influences transepidermal water loss (TEWL) and supports thermoregulation. However, weaning practices remain varied and inconsistent across the globe. • There remains a paucity of data to inform specific evidenced-based humidification practices.
What Is New:
• Ceasing or gradually reducing incubator humidification after 7 days had no effect on temperature stability, serum sodium levels, or frequency of skin injury in this cohort of EPTI between day 8 and day 14. • There is no apparent benefit in prolonging incubator humidity beyond day 7 of life in these EPTI.
