Discharge after weaning to Crib

[JThieman]

We just changed our weaning practices in our nicu. We used to wean the isolette to 80 degrees, take them out and monitor for 48 hours (wouldn't discharge until they met the 48 hour mark). We just changed to weaning the isolette to 74 degrees and are undecided on how long we should hold them after that for observation. They are weaned much lower so we feel that 24 hours would be sufficient but I would love to know what you all do.

[jennylee321]

Again this would be very dependent on the baby. If it's an ex 23-33 weeker they would really be out of there incubator for far longer than 48 hrs right? The incubator wouldn't be there last challenge, they'd still be working on feeding and growing for a while before discharge.

If it's s near term or term baby I'd be happy if there first few temps were in normal range to discharge them. For example, term babies who were just on photo, they have no reason to maintain there temp just fine.

[itsybitsy]

Whoa, you went DOWN to 74F?! We only go to 28C (~82F), for at least 24 hours. We can go lower if the baby is hot, but if not, we leave it at 28C. We also start weaning at 33 weeks and about 4 pounds. Once they meet that criteria, we wean to a crib. So in our unit, they rarely even have a chance to even be close to discharge when we wean, as we also don't start feeding until 34-35 weeks, cue based. However, there are those rare times you get that extreme IUGR kid that goes home before reaching 4 pounds and is 37 weeks. Those are the few exceptions that may have to wait. But not longer than 24 hours.

If it's s near term or term baby I'd be happy if there first few temps were in normal range to discharge them. For example, term babies who were just on photo, they have no reason to maintain there temp just fine.

Why are term babies in isolates, given that their weight is sufficient?

[NICU Guy, BSN, RN]

Once they reach 1500g, we put clothes on them and switch to air temp. Over the next 5 days we lower the air temp to 28C. If they have gained weight (and maintained their temp) each of those five days they are moved to crib.

If they are small enough to need an isolette after birth, then they are nowhere near discharge criteria. Discharge is based on the baby taking full feeds by bottle and consistently gaining weight. We don't start bottle feeding until they are 34 weeks Corrected Gestational Age.

[jennylee321]

Whoa, you went DOWN to 74F?! We only go to 28C (~82F), for at least 24 hours. We can go lower if the baby is hot, but if not, we leave it at 28C. We also start weaning at 33 weeks and about 4 pounds. Once they meet that criteria, we wean to a crib. So in our unit, they rarely even have a chance to even be close to discharge when we wean, as we also don't start feeding until 34-35 weeks, cue based. However, there are those rare times you get that extreme IUGR kid that goes home before reaching 4 pounds and is 37 weeks. Those are the few exceptions that may have to wait. But not longer than 24 hours.

Why are term babies in isolates, given that their weight is sufficient?

Don't have overbed warmers

[vintage_RN, BSN, RN]

We rarely have term babies in isolettes, unless they are very sick then they are in giraffes. If they are just here for photo/sugar issues they are in a cot.

[Elizabeth777, BSN, RN]

Wow, 74 does seem pretty low! We go down to 27C before we move to cribs.