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Discussion

Daily Weights?

I am looking into evidence surrounding the need for daily weights in the NICU. We currently have orders for daily weights on all NICU patients (unless clinically contraindicated such as oscillating pt's or pt's with chest tubes, etc.). I'm working with a committee who is trying to implement more relationship-based care and we'd like to move to weights 3-times a week or alternate days as our baseline weighing policy and then only order daily weights on high risk patients who need them. Anyone have a policy like this in place? Or can point me towards evidence? I'm having a hard time finding anything - thank you!

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    I'll be frank: I don't think you'll find evidence that daily weights are contraindicated in NICU patients (besides those too unstable). I can't ever see someone actually studying that, let alone doing a RCT on it. I don't see any advantage to a researcher doing a project on it (what would be the hypothesis of advantage of non-daily weights?)...

    Most NICUs do daily weights so that we can keep close track of growth rate- gaining too much (usually fluid retention, but obesity too in the older ones), gaining too little (preemies need their enteral nutrition weight adjusted, for example), and things like false weights- in that the scale was off or the nurse did not weigh appropriately and have a false number one night. It's absolutely imperative for fresh micropreemies (some units weigh them every 12 hours) so that we can get an idea of their fluid balance and shifting electrolytes.

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    • Experts

    I agree with babyNP -- it's not a study I would expect to find.

    If I were interested in exploring the question -- and had unlimited time, money, etc. -- I would plan a series of studies.

    1. Documenting the use of the data obtained by the weights and the usefulness of the data -- broken down by chronological age, gestational age, birthweight, current weight, current physician status and stability

    I would use that first study to develop a framework for the consideration of the possible benefits of weights

    2. Then I would document the potential harms of weights (thermal stress, respiratory stress, neuro stress, etc.). I would combine that with the results of the first study to develop a framework for consideration of the risks/benefits to the baby arising from weights

    3. I would also document the amount of nursing time etc. used and any other potential disadvantages/costs of the weighing procedure.

    Putting all that together, you'd have a framework for considering the costs/risks/benefits of weights. You could then begin to look at whether or not there were certain types of babies who would benefit from being weight more often and other groups that might be weighted less often.

    I am pretty sure no one has done that.

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    We only do daily weights on gainers/growers, kids on diuretics, heart kids. Any kid under a kilo gets weighed every 3rd day unless otherwise ordered. Some kids don't get weighed until stable such as oscillator, cooling, nitric. It really kind of relies on unit preference. And we do have bed Scales in all beds and warmers.

    I have to disagree about fresh micronates needing weighed every 12 hours. Research has shown that the less you bother these kids, the better the outcome, especially in the first 72-96 hours.

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    What is your rationale for not doing daily weights?

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    Our attendings and nutritionists don't feel they are necessary. You know there is insensible loss and we give increased daily fluids to compensate for this and follow labs every 12 hours. And you use their dry weight for calculations anyways, so they are happy with leaving them alone.

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    Actually, studies are happening right now around this very topic and it's because of the burgeoning field of Developmental Care philosophy and avoiding unnecessary trauma. I know it seems like weights aren't trauma but we're re-evaluating that and really, it's noxious stimuli. Besides the most important value from a nutritional standing is OFC. Weekly weight, OFC and length is likely to become standard of care for feeder/growers within a few years.

    We do nightly weights and OFC and length weekly. We also do nightly blood pressures on every single baby. Luckily, we have one NNP who is extremely focused on developmental care and I've gotten her to sign off on decreasing frequency of BPS and weights on appropriate kiddos.

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    • Experts

    This is why any warmer or isolette manufactured in the past 5 or so years has a built in scale. Unless a child is on ECMO (and sometimes we weigh those kids too...) or is a comfort care, babies should be weighed at least every other day. As a NNP provider in the NICU, I rely on frequent weights in order to fight against the growth curve slump by making adjustments to total calories, fluids, electrolyte components, etc on a daily basis. We've seen that every baby loses weight...and that by stopping that weight loss tumble, we can discharge healthy babies that are actually ON the growth curve instead of way below.

    I don't think doing a simple bed scale weight should be any more "harmful" than a diaper change. Micros are more likely in my opinion... to get a head bleed from inappropriately titrated fluid balances than a simple lift, zero and hold weight check.

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