Transfer of preterm infants from incubator to open cot: a review of contemporary practice, a randomised controlled trial and systematic review.

New, Karen (2011). Transfer of preterm infants from incubator to open cot: a review of contemporary practice, a randomised controlled trial and systematic review. PhD Thesis, School of Nursing and Midwifery, The University of Queensland.

       
Attached Files (Some files may be inaccessible until you login with your UQ eSpace credentials)
Name Description MIMEType Size Downloads
s4147608_phd_finalthesis.pdf s4147608_phd_finalthesis.pdf Click to show the corresponding preview/stream application/pdf 5.19MB 17
Author New, Karen
Thesis Title Transfer of preterm infants from incubator to open cot: a review of contemporary practice, a randomised controlled trial and systematic review.
School, Centre or Institute School of Nursing and Midwifery
Institution The University of Queensland
Publication date 2011-11
Thesis type PhD Thesis
Supervisor Fiona Bogossian
Chris East
Total pages 225
Total colour pages 2
Total black and white pages 223
Language eng
Subjects 111003 Clinical Nursing: Secondary (Acute Care)
Abstract/Summary Background While the neonatal unit and incubator environment are essential for preterm infant survival, at some stage, the infant is required to maintain a normal body temperature without the assistance of a heated incubator. Successfully transitioning from an incubator to an unheated open cot by maintaining a normal body temperature and having continued weight gain are key criteria the infant must achieve in order to be discharged from hospital. The literature reports various practices for transferring infants from incubators to open cots, but does not specifically address how, or to what extent, practices vary. Additionally, an extensive literature search could not determine why a weight of 1800 g has traditionally been used as a criterion for transferring preterm infants to unheated open cots. Other limited data suggests that preterm infants could be transferred at body weights lower than 1800 g. Aims These studies aimed to systematically summarise the evidence for transferring preterm infants to open cots; to describe current practice in public hospital high dependency neonatal units within Australia and New Zealand; and to determine the effects on temperature stability and weight gain when transferring lower weight (1600 g) preterm infants (compared with higher weight, 1800 g) to unheated open cots. Research Design Quantitative research methods were used to meet the aims in three phases of research. Phase 1 involved conducting a Cochrane Systematic Review to collate findings from randomised and quasirandomised controlled trials on the transfer of preterm infants from incubators to unheated open cots at lower body weights compared to higher body weights. Phase 1 provided background information and data on practices and other proposed strategies for transfer to open cots, and assisted in developing a survey sent to neonatal units in Australia and New Zealand (Phase 2). Phase 3 used the information and data from Phase 1 to inform and design a multi-centred, randomised controlled trial. The results of Phase 3 were used to update and draw conclusions for the Cochrane Systematic Review (Phase 1). Results While many common practices for transferring premature infants to unheated open cots exist in Australian and New Zealand neonatal nurseries, these practices vary considerably. Only one variable, nursing infants clothed (p = 0.011), showed significant practice variation between viii Australian and New Zealand public hospital high dependency neonatal units. Between neonatal intensive care and special care baby units, practice variations were significant for weight range (p = 0.005), evidence-based practice (p = 0.004), historical nursery practice (p = 0.029) and incubator air control mode (p = 0.001). Differences in these variables existed between nurseries in metropolitan and rural locations. Processes and practices undertaken similarly in both Australia and New Zealand included use of incubator air control mode, current weight criterion, thermal challenging, singlewalled incubators, and use of heated mattress systems. The randomised controlled trial demonstrated that medically stable, preterm infants can be transferred to unheated open cots at a weight of 1600 g without significant adverse effects on temperature stability or weight gain. Average daily weight gain in the 1600 g group was 17.07 (SD 4.5) g/kg/day compared to in the 1800 g group, 13.97 (SD4.7) g/kg/day (p=<0.001). Over the first 72 hours, more infants in the 1800 g group had temperatures <36.4°C when compared to the 1600 g group (p=0.03). From post-transfer to discharge, the 1600 g group had more temperatures >37.1°C (p=0.02). The update of the Cochrane Systematic Review incorporated the results of two new trials. Pooled results revealed preterm infants transferred from incubators to unheated open cots at lower body weights had: significantly greater daily weight gain (pooled mean difference (MD) 2.66; 95% confidence interval (CI) 1.37, 3.95); no greater need for an overhead heater for temperature maintenance (pooled RR 1.43; 95% CI 0.35, 1.18); and no greater probability to return to an incubator for failure to maintain temperature stability (pooled RR 1.78; 95% CI 0.77, 4.08). Conclusions Medically stable preterm infants can be transferred to unheated open cots at a lower body weight of 1600 g without adverse effects on temperature stability or weight gain. Earlier transfer, however, does not necessarily result in earlier discharge.
Keyword survey, body temperature regulation, incubator, open cot, open crib, weaning
Additional Notes colour - p 22, 191 landscape - pages 50-53; 86-89; 198-199

 
Citation counts: Google Scholar Search Google Scholar
Access Statistics: 182 Abstract Views, 17 File Downloads  -  Detailed Statistics
Created: Fri, 23 Mar 2012, 07:56:50 EST by Ms Karen New on behalf of Library - Information Access Service