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Key messages

  • Incubators are not required for the entire length of the baby's special care nursery (SCN) stay.
  • Evaluating when is the right time to transition a preterm infant to an open cot is an essential skill for staff in the SCN.
  • Achieving temperature stability is important in optimising body growth and development in a premature infant.

Please note that all guidance is currently under review and some may be out of date. We recommend that you also refer to more contemporaneous evidence in the interim.

Evaluating when is the right time to transition a preterm infant to an open cot is an essential skill for staff in the special care nursery (SCN).

Incubators are designed to minimise heat loss and provide a neutral thermal environment requiring minimal metabolic effort by the baby to maintain thermoregulation.

Temperature maintenance for premature infants

Achieving temperature stability is important in optimising body growth and development in the premature infant.

Premature and low birthweight infants both have:

  • sparse brown fat available for heat production
  • small liver with limited glycogen stores for energy and heat production
  • large surface area to body mass posing a huge potential for heat loss
  • immature response of the central nervous system to cold stress.

Cold stress can lead to:

  • feeding intolerance
  • respiratory and metabolic acidosis
  • hypoglycaemia
  • hypoxia. 

Nursing assessment

Use the following assessments to determine if infants may be ready to move from the incubator to the cot:

  • Infant weight:
    • infants weighing 1,500 g or more are candidates
    • regained birth weight
    • for extremely preterm infants consistent weight gain is an additional indicator
  • Incubator settings:
    • the incubator should be in manual mode
    • stable body temperature (36.5-37.4C per axilla) with the incubator set in the lower range of the neutral thermal environment (NTE) for previous 24 hours with the infant clothed
  • Physiologically stable:
    • the infant must be systemically well and physiologically stable; no apnoea or bradycardia requiring stimulation
  • Feeding:
    • the infant should be tolerating feeds 
  • Monitoring:
    • on transfer from incubator to open cot check temperature per axilla:
      • hourly for four hours
      • then three- to six-hourly before feeds
  • Parent education:
    • The ambient room temperature in most nurseries is frequently slighter warmer than the home and will influence the amount of clothing and blankets the baby requires on transfer to an open cot compared with at home
    • Perhaps the most important role is to educate the parents about actions to reduce the risk of SIDS including:
      • placing the baby on his/her back to sleep
      • breastfeeding the baby
      • maintaining a non-smoking environment
      • preventing overheating
      • putting the baby's feet to the foot of the cot
  • Failure of transition:
    • failure to maintain axillary temperature in accepted range
    • increased apnoea/bradycardia
    • vomiting / weight loss
    • if infant returns to the incubator the temperature should be at that last tolerated prior to transfer

More information

References

  • Open and Closed Care, Ducker. T and Todd. R, Journal of Neonatal Nursing Vol 6 No 6, 2000.
  • Transition from incubator to waterbed: a care study approach, Harvey. M, Journal of Neonatal Nursing Vol 6 No 6, 2000, p 185 - 188.
  • Kenner. C, Rockwern Amlung. S and Applewhite Flandemeyer. A (1998), Protocols in Neonatal Nursing, W.B Saunders Company Philadelphia.
  • Merenstein. G and Gardner. S (1998), Handbook of Neonatal Intensive Care 4th ed., Mosby St Louis.
  • Transition of pre-term infant to an open crib, Meier. P, Bliss-Holtz. J, Lund. C., AWHONN Voice Vol 1 No 10 1993 pg 10.
  • Neonatology Clinical Guidelines, 2011, King Edward Memorial/Princess Margaret Hospitals, Perth

Get in touch

Centre of Clinical Excellence - Women and Children
Safer Care Victoria

Version history

First published: May 2016

Last web updated: October 2018

Review by: May 2019

UNCONTROLLED WHEN DOWNLOADED

Page last updated: 17 Feb 2021

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