Weaning from an isolette

Once a baby is over 1600 grams we dress them in an outfit, hat, and blanket and put their isolette on air control. We have a chart that takes into account their age and weight and gives a neutral thermal environment temperature to start the air temp weans at. Some people don't use this chart, they just look at the air temps over the past few days and start there. We check the babe's axillary temp after an hour or 2 to ensure they aren't getting cold. We leave their temp probe on and keep track of their skin temp too. We wean the isolette temps based on the axillary temp we obtain with their cares. I usually wean by .2-.5 degrees celsius every 4-6 hours. After the air temp is at about 80 degrees farenheit and the baby is holding their temperature, we put them in a basinet. This process takes a week to a shift, depending on the baby.

We have a specific protocol--once the baby is over 1500 grams, and not having any changes such as just off IV fluids or just starting feeds, anything that could cause weight loss on its own, then they are dressed in clothes and a blanket and the isolette temp is turned down to 29.5 C. The baby is checked for a shift to a couple of days like that, and then put into a crib if he maintains his temp adequately. He should be dressed and covered with a blanket during this time!

Dawn

We start weaning once the infant reaches 1800 grams. We decrease 0.5-1 degree Celsius each assessment to 27 degrees. The infant starts out dressed in a onesie or sleeper and a hat. We swaddle them once the isolette temp is down to 29 degrees.

We swaddle all of our kids on NTE at my full-time job.

I've worked agency at more than one NICU that doesn't swaddle until they're put in an open crib.

We start weaning once the baby reaches 1700 grams, dressed w/ a paper cloth,hats on, and swaddled well inside the isollette with temp. control off, port holes open for three hours.If the baby maintains his body temp. within that span of time, wean them out and put them into a cot with additional blanket on.

At 1250 grams, our kids in isolettes are changed from "skin temp control" to air temp control and are dressed and wrapped like they were in open cribs. Air temp control initial setting is whatever the temp in the isolette was when they were on skin control. Then air temp setting is weaned by 0.5 degrees an hour until stable. We usually leave babies in the isolette at the lowest setting until they are taking PO feeds pretty well and are on a steady weight gain trend. We have found that even though they can maintain their temps out of the isolette, it sometimes burns too many calories and/or makes them not able to PO feed as well. So they may be dressed and wrapped and in an isolette at the lowest setting (I think it's 27 degrees C.) for a while. NOTE: Don't ever leave a kid in an isolette that is turned off; there is no air circulation in it.

What is your protocol for weaning an infant from an isolette? We usually wrap infant as if in open crib, t-shirt, hat, booties, blankets...and proceed to turn isolette temp down based on infants temp taken every couple of hours. Once air temp has reached 78 degrees, we expect that the infant will be able to maintain its temp in an open crib. However, we have some nurses who turn the isolette down, but do not wrap the infant at all. What do you do at your hospital?

To the nurses that just keep turning the isolette down, I would say this:

The big difference between the isolette and the open crib is the air flow....an isolette turned completely down would be colder than an open crib...b/c the heat from the regular HVAC system of the hospital can't get to it.

The infant needs to be clothed, wrapped and swaddled...b/c most likely, that is the way the parents would keep it when it gets home.