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At what weight should preterm infants be transferred from incubator to open cot?
  1. Abdul Razak1,2
  1. 1Department of Pediatrics, Princess Nourah Bint Abdulrahman University, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
  2. 2Department of Pediatrics, McMaster Childrens Hospital, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Abdul Razak, Division of Neonatology, Department of Pediatrics, Princess Nourah Bint Abdulrahman University, King Abdullah bin Abdulaziz University hospital, Riyadh 13412, Saudi Arabia; razakmdpaed{at}gmail.com; arazak{at}npmmcmaster.ca

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Scenario

A preterm infant born at 28 weeks’ gestation is 5 weeks old, weighs 1600 g and nursed in an incubator. During the round, the medical team instructs the nurse to transfer the infant to open cot. The nurse in charge is concerned that weaning the infant from incubator to cot at this weight might affect the temperature stability, weight gain and may delay the discharge of the infant. The third-year paediatric resident offers to review the literature and report the findings to the multidisciplinary team.

Structured clinical question

In a medically stable preterm infant with a birth weight of less than 1600 g, not on any respiratory support, nursed in incubator (patient), whether transferring the infant from incubator to unheated open cot at a lower weight (<1700 g) (intervention) compared with a higher weight (>1700 g) (comparison) will affect the temperature stability, weight gain and length of hospital stay of the infant (outcomes)?

Search

Study selection

Randomised or quasirandomised clinical trials, systematic reviews and observational studies comparing two or more different weights for transferring the infant from incubator to cot were included. Included studies should report one or more outcomes mentioned above in the question. Descriptive studies, conference abstracts, letter to the editor and case series were excluded.

Search strategy

PubMed and Cochrane CENTRAL databases were searched from inception to 4 December 2018 for following terms: ((neonate) OR (preterm) OR (premature) OR (infant) OR (low birth weight)) AND ((weaning) OR (transfer) OR (discontinue)) AND ((incubator) OR (cot)). The search returned 118 abstracts (PubMed: 105 records and Cochrane CENTRAL: 13 records). The references of the included studies were also searched. The list of studies excluded following a detailed review, including the reasons for exclusion, are provided in online supplementary file 1. Three systematic reviews,1–3 five randomised controlled trials4–8 and three observational studies9–11 were identified for …

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