Incubator weaning in preterm infants and associated practice variation.
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Schneiderman
R
R
Alere (formerly ParadigmHealth), Marietta, GA, USA. roy.schneiderman@alere.com
Kirkby
S
S
Turenne
W
W
Greenspan
J
J
D001903:Bottle Feeding; D001942:Breast Feeding; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007186:Incubators, Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D019102:Infant, Very Low Birth Weight; D008297:Male; D010818:Practice Patterns, Physicians'; D015300:Ventilator Weaning; D015430:Weight Gain