Search

Weighing

Authors 

Kalbér A, Kühn T, Oude-Reimer M, Frauenfelder O, Camba F, Ceccatelli M, Hankes-Drielsma I, Jørgensen E, Silva E

User group

Healthcare professionals, neonatal units, and hospitals

Statement of standard

The procedure of weighing an infant is individualised to minimise stress and adapted to the clinical condition and may be carried out alongside or by the parents.

Rationale

Weighing is carried out regularly to monitor weight and nutritional status. The optimal frequency is unknown and, in practice, is variable. Daily weighing may be used as a routine procedure. The procedure of weighing an infant is particularly stressful for very preterm or ill infants, and should be adapted to the individual situation of the infant taking into account direct therapeutic benefit (e.g. fluid and nutritional management). The manner in which the procedure is conducted may adversely affect the infant’s physiologic and behavioural stability.

Infants may be weighed using two different methods: using an integrated scale within the incubator (when the infant is very preterm or ill) or using a free standing scale when the infant is stable enough to handle the transfer.

Swaddling or using bedding materials (e.g. a snuggle or nest) during weighing provides more sustained support during the transfer to the scale, the infant’s hands may be positioned to be accessible to the mouth to assist in self-regulation. This is consoling and inhibits heat loss, behavioural disorganisation, and physiologic distress. (1,2) The transfer to the scale should be gentle and slow, with due regard to the immature vestibular system of the infant. The environment should provide for temperature stability as well as developmentally supportive experiences regarding to excessive sounds and bright light.

Benefits

Short-term benefits

  • Improved comfort of the infant (1)
  • Improved physiological stability and motor organisation with reduced arousal during the procedure (1)
  • Minimised energy expenditure (3)
  • Reduced hypothermia (2)
  • Increased parental awareness of behavioural cues and improved participation in daily care (4–6)

Long-term benefits

  • Increased parental awareness of behavioural cues and improved participation in daily care (7)
  • Improved healthy brain structure/developmental benefits (4,8)

Components of the standard

Component Grading of evidence Indicator of meeting the standard
For parents and family    
1. Parents are informed by healthcare professionals about the possibility of active participation in the weighing of their infant (swaddling, holding while transferred, providing containment on a scale), how to recognise behavioural signs of discomfort during weighing, and how to react accordingly. (4,5,9,10) A (Moderate quality)
B (Moderate quality)
Parent feedback, patient information sheet
       
For healthcare professionals    
2. A unit guideline on weighing (handling, transfer, frequency) is adhered to by all healthcare professionals. B (High quality) Guideline
       
3. Training on weighing (handling, transfer, frequency) and infant behaviour during weighing is attended by all responsible healthcare professionals. (11–13) A (Moderate quality)
B (High quality)
Training documentation
       
4. Weighing is performed not as a fix standard routine but done on an individual basis. (11) A (Moderate quality)
B (High quality)
Audit report
       
For neonatal unit    
5. A unit guideline on the procedure of weighing an infant is available and regularly updated. B (High quality) Guideline
       
For hospital    
6. Training on weighing an infant and infant behaviour during weighing is ensured. B (High quality) Training documentation
       
7. Appropriate material for swaddling and nesting is available. (14) (see TEG Care procedures) A (Moderate quality)
B (High quality)
Audit report
       
8. Modern bed/incubator built-in- scales are provided for the most vulnerable infants. (15) A (Moderate quality)
B (Moderate quality)
Audit report
       
For health service    
N/A      
       

Where to go

Further development Grading of evidence
For parents and family  
  • Parents are involved as primary caregivers who learn to perform weighing by themselves. (13,16,17)
A (High quality)
B (High quality)
For healthcare professionals  
  • Accept parents as primary caregivers and guide and support during care practices. (13,16,17)
B (High quality)
For neonatal unit  
N/A  
For hospital  
N/A  
For health service  
N/A  
   

Getting started

Initial steps
For parents and family
  • Parents are verbally informed by healthcare professionals about the possibility to actively participate in weighing their infant (swaddling, holding while transferred, providing containment on a scale), how to recognise the behavioural signs of discomfort during weighing, and how to react accordingly.
For healthcare professionals
  • Encourage parents to actively participate in a weighing procedure.
  • Attend training on weighing and infant behaviour during weighing.
For neonatal unit
  • Perform an individual approach of weighing to the special needs of the individual infant.
  • Develop and implement a unit guideline on the procedure of weighing an infant.
  • Develop information material on parental active participation in weighing their infant for parents.
For hospital
  • Support healthcare professionals to participate in training on weighing and infant behaviour during weighing.
For health service
N/A
 

Sources

  1. Neu M, Browne JV. Infant physiologic and behavioral organization during swaddled versus unswaddled weighing. J Perinatol Off J Calif Perinat Assoc. 1997 Jun;17(3):193–8.
  2. World Health Organization. Thermal protection of the newborn: a practical guide [Internet]. WHO. [cited 2018 Jun 12]. Available from: http://www.who.int/maternal_child_adolescent/documents/ws42097th/en/
  3. Trauma-Informed Care in the NICU [Internet]. Springer Publishing. [cited 2018 Jun 12]. Available from: http://www.springerpub.com/trauma-informed-care-in-the-nicu.html/
  4. Milgrom J, Newnham C, Anderson PJ, Doyle LW, Gemmill AW, Lee K, et al. Early sensitivity training for parents of preterm infants: impact on the developing brain. Pediatr Res. 2010 Mar;67(3):330–5.
  5. Hall SL, Hynan MT, Phillips R, Lassen S, Craig JW, Goyer E, et al. The neonatal intensive parenting unit: an introduction. J Perinatol Off J Calif Perinat Assoc. 2017 Dec;37(12):1259–64.
  6. Craig JW, Glick C, Phillips R, Hall SL, Smith J, Browne J. Recommendations for involving the family in developmental care of the NICU baby. J Perinatol. 2015 Dec;35(Suppl 1):S5–8.
  7. Melnyk BM, Feinstein NF, Alpert-Gillis L, Fairbanks E, Crean HF, Sinkin RA, et al. Reducing premature infants’ length of stay and improving parents’ mental health outcomes with the Creating Opportunities for Parent Empowerment (COPE) neonatal intensive care unit program: a randomized, controlled trial. Pediatrics. 2006 Nov;118(5):e1414-1427.
  8. Ariagno RL, Thoman EB, Boeddiker MA, Kugener B, Constantinou JC, Mirmiran M, et al. Developmental care does not alter sleep and development of premature infants. Pediatrics. 1997 Dec;100(6):E9.
  9. Feeley N, Zelkowitz P, Westreich R, Dunkley D. The evidence base for the cues program for mothers of very low birth weight infants: an innovative approach to reduce anxiety and support sensitive interaction. J Perinat Educ. 2011;20(3):142–53.
  10. Steinhardt A, Hinner P, Kühn T, Roehr CC, Rüdiger M, Reichert J. Influences of a dedicated parental training program on parent-child interaction in preterm infants. Early Hum Dev. 2015 Mar;91(3):205–10.
  11. Valizadeh L, Asadollahi M, Mostafa Gharebaghi M, Gholami F. The congruence of nurses’ performance with developmental care standards in neonatal intensive care units. J Caring Sci. 2013 Mar;2(1):61–71.
  12. Hasanpour M, Farashi F, Mohammadizadeh M, Abdeyazdan Z. The Impact of a Neonatal Sleep Care Training Program on Nurses’ Knowledge and Performance in Neonatal Intensive Care Units. Iran J Nurs Midwifery Res. 2017 Jun;22(3):215–8.
  13. American Academy of Pediatrics, Institute for Family-Centred Care. Policy Statement. Organizational principles to guide and define the child health care system and/or improve the health of all children [Internet]. 2003 [cited 2018 Jun 11]. Available from: http://pediatrics.aappublications.org/content/pediatrics/112/3/691.full.pdf
  14. Toso BRG de O, Viera CS, Valter JM, Delatore S, Barreto GMS. Validation of newborn positioning protocol in Intensive Care Unit. Rev Bras Enferm. 2015 Dec;68(6):1147–53.
  15. Erasmus MC : Dräger Caleo Couveuse (e-module) [Internet]. [cited 2018 Jun 11]. Available from: https://www.erasmusmc.nl/cs-eduplaza/voor-medewerkers/index/drager
  16. Bracht M, Kandankery A, Nodwell S, Stade B. Cultural differences and parental responses to the preterm infant at risk: strategies for supporting families. Neonatal Netw NN. 2002 Oct;21(6):31–8.
  17. Staff Education and Support [Internet]. Family Integrated Care. [cited 2018 Jun 11]. Available from: http://familyintegratedcare.com/implementing-ficare/program-development/staff-education-and-support/

November 2018 / 1st edition / next revision: 2023

Recommended citation

EFCNI, Kalbér A, Kühn T et al., European Standards of Care for Newborn Health: Weighing. 2018.

For the purpose of evaluation, we would be grateful if you could send us details on your profession and country. This information is optional, anonymous and the data processed will exclusively be used for the aforementioned purpose, in line with Article 6, Para. 1 lit. a GDPR (General Data Protection Regulation).

Thank you for your support!