PEDIATRICS Vol. 108 No. 2 August 2001, pp. 395-401
A Clinical Comparison of Radiant Warmer and Incubator Care for Preterm Infants From Birth to 1800 Grams
Received Aug 30, 2000; accepted Feb 5, 2001.
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From the * Neonatal Unit, Paediatrics and Child Health,
Middlemore Hospital and the University of Auckland; and Objective. The objective of this
study was to compare radiant warmer and incubator care for preterm
infants from birth with respect to temperature control and weight gain.
Methods. Sixty preterm infants <33 weeks' gestation were
randomized at birth to radiant warmer or incubator care. The initial
goal was to maintain abdominal temperature at 36.8°C in both groups and axillary temperature at 36.8 to 37.3°C; air servocontrol was used
for incubator infants. Infants in both groups received added humidity
for 5 days if their weight was <1000 g and for 3 days if they weighed
between 1000 and 1249 g. During a 3-hour period on days 1 to 7, recordings of abdominal, forehead, and foot temperatures were obtained.
The percentage of the recording time during which the abdominal
temperature was in the target range of between 36°C and 37.5°C was
determined as an indicator of temperature control. Weight gain from
birth to 1800 g was compared. Secondary outcomes included fluid
balance and clinical events.
Results. There were 30 infants in each group; 48 were
<1500 g (of whom 17 were <1000 g). There were no significant
differences in birth weight, gestation, gender, or illness severity
scores in the 2 groups. Significant differences in temperature control
were noted on day 1. Although admission temperatures were similar,
lower abdominal temperatures were noted in the first 2 hours of life in
the incubator group (medians were 36.6°C and 35.9°C in the radiant
warmer and incubator groups, respectively). Similarly, mean abdominal
temperatures during the 3-hour recording on day 1 were lower in the
incubator group, and infants in this group spent a significantly
greater percentage of the recording time with temperatures outside the
target range (17.3% compared with 0.88%). Other temperature
recordings from the forehead and foot were not significantly different
in the groups. Fluid intakes were higher for infants under radiant
warmer on days 2, 3, and 4, and the difference amounted to a mean of
12.8 mL/kg/d. Maximum sodium levels in the first week were similar in
the 2 groups. Mean weight gain was 17.4 g/kg/d for the radiant warmer
group and 17.1 g/kg/d for the incubator group; days to regain birth weight and length of hospital stay were not significantly different. Greater numbers of infants in the radiant warmer group required phototherapy, and adverse events (which included death, necrotizing enterocolitis, chronic lung disease, grade 3 or 4 intraventricular hemorrhage, periventricular leukomalacia, or retinopathy requiring laser treatment) were less frequent in the radiant warmer group (1 infant compared with 8 in the incubator group; relative risk 0.1; 95%
confidence intervals: 0.01-0.82).
Conclusions. This study has shown differences in abdominal
temperatures on day 1 and outcome, although the latter finding should
be viewed with caution because of the sample size. The results indicate benefits for the initial use of the radiant warmer after birth. Although fluid requirements were higher in the radiant warmer group for
days 2 through 4, the increased fluid volumes were given without
apparent adverse effect.
Fisher & Paykel Healthcare, Auckland, New Zealand.
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