Providing Appropriate Placement for Late Preterm Infants During Birth Admission

Purpose:
At a community hospital with 1800 deliveries a year and a level 2 NICU, Late Preterm Infants (LPI) charts were reviewed to determine the success of our current standard, (birth weight greater than 2200grams), for LPIs to remain mother-baby couplets and receive normal newborn care.

Background/Significance:
LPIs are born between 34.0 and 36.6 weeks gestation. While greater than 2200 grams at birth is an evidence based number, LPIs are under-recognized as premature and at risk for complications such as respiratory distress, apnea, bradycardia, sepsis, hypoglycemia, thermal instability, feeding difficulty, hyperbilirubinemia and readmission to the hospital within 30 days. If treated as term newborns, opportunities for early intervention are lost and financial and emotional costs can be high.

Methods:
The worksheet for testing change was used to organize. A chart review of all LPIs born at Kent was conducted for a trial period of three months. Results were shared with the multidisciplinary Perinatal Committee and were found to be compelling but not significant because of the small population (39 LDIs total, 8%). Discussion included determining to use gestational age as documented by the attending OB. Chart review continued retro- and prospectively for 2010. Data was separated by weeks gestation, 34.0-34.6, "34 weekers", 35-35.6, and 36.0-36.6, and sorted by admission to NICU, to mom-baby (MBU) and then home, or MBU then NICU. Simple totals and percentages were rendered by Excel program.

Results:
Annual results showed that 97% of 34 weekers were admitted to NICU (35/36). Three of these LPIs went to MBU as mom-baby couplets and were later admitted to NICU. Only one had an unremarkable birth admission (in relation to this study). 82% of the 35 weekers were admitted to NICU (31/38). Five of these infants were first admitted to MBU and then to NICU. Seven had unremarkable stays and were covered by normal newborn pathways. 55% of the 36 week infant group was admitted to NICU (36/66); twelve of these infants went to MBU prior to admission to NICU. Thirty had unremarkable birth admissions with normal newborn pathways.

Conclusions and Implications for Practice:
The results clearly show that at this facility, 34 week LPIs should be admitted to NICU for monitoring during transition. This study supports existing literature recommending separate order sets and closer monitoring of LPIs, and discharge teaching designed to meet their unique needs.