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hrovedo

Managing care for late preterm infants?

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Just wanted to ask about managing care of late preterm infants. Does your hospital automatically admit late preterm infants to your NICU/Special Care Nursery?  If not, how is their care managed? 

I am a staff nurse at a Level 2E Special Care Nursery (SCN) and we are looking to change how we manage care for late preterm infants. We are interested in learning how other hospitals care for this special population. We currently admit all infants <36 weeks to our unit. Infants >/=35 weeks are observed in the SCN for 24 hours. If the infant is feeding well and glucose checks are within normal limits for 24 hours, they are transferred to Postpartum to room in with mom and stay with mom until discharge. 

Thank you for your help!

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We have different practice in our unit may be due to the load of work and high rate of deliveries in our hospital which may reach to 700_ 900 deliveries per month we are just keeping them with mother and monitoring RBS if the weight is below 2.5 kg

Other wise we are not admitting them unless only if there is poor feeding unable to suck ,respiratory distress ,hypoglycemia or any significant problem

 

Some 

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Hi there,

we have the same policy - the concept being to prove themselves before they move to postpartum unit where there is less surveillance.

 

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We for maternity ward stay for infants at 35+0 wks and onwards. I don't know the exact NICU admission rate for 35+0 -- 35+6 infants but the majority stays only at the maternity ward for ~4-6 days, until feeding works and till we know there is no signif jaundice. The midwifes usually add a followup visit after another few days to check weight, jaundice, feeding etc, and then the family only goes to the regular well-baby-clinics (as any other infant)

But, we need to support (from the NICU) with planning etc, sometimes we invest relatively much time to make this work. But we feel that non-separation and "non-medicalization" of this group of infants works best in the maternity ward.

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In collaboration with my long-time colleague, Dr. Richard J Schanler  we monitored the oral feeding performance of Late Preterm Infants (LPT) at his hospital using the Oral Feeding Skill (OFS) scale we developed a few years ago (1). The OFS scale helps differentiate between infant oral feeding skills and endurance (2). As mentioned above, depending upon individual hospital policies, LPT may be transferred to different levels of care. However, due to their relatively short hospital stay, it remains at times difficult to identify  those that may be at risk for oral feeding issues. In our study, we observed that assessing the OFS maturity levels of LPTs  at their first oral feeding can help identify these at-risk infants early on. We speculated that provision of evidence-based efficacious interventions that improve OFS may shorten hospital stay and decrease future re-admission. 

(1). Lau C, Bhat J, Potak D, Schanler RJ. Oral Feeding Skills of Late Preterm Infants are correlated with Hospital Length of Stay. J Ped Moth Care 2015; 1:102; (2). Lau C, Smith EO. A novel approach to assess oral feeding kills of preterm infants  Neonatology 2011;100:64-70 (doi: 10.1159/000321987)

Lau et al'15 (LPT).pdf

Lau & Smith '11.pdf

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In our FMC we have three levels of newborn care, the 35wks+0d ~ 36wks+6d stay for one day (24hrs) in the level II (being with a BW of > or = to 2000 grams). During that time their vitals are being monitored (on a pulse oximeter: saturation and HR), blood sugar, levels bili. Next day if oral feeding and vitals show no issues, they are moved to mom. Moms are discharged 4thday after birth if NVD and 7th day if CS. All babies would receive a check up before discharge and would make reservations for their 1 month followup check.

In Canada I was in a level III unit which had a section as a step down, only 35 weekrs were kept in the NICU for 6hrs under observation by the pediatrician (under Obs) in the step down section, if the newborn could control its temp. and showed no issues on feeding and bl. sugar levels, would be moved to mom. If any issue appears, the Pediatrician would consult the NICU for management or NICU admission. 36weekrs kept with mom from birth.

I have the same concept as @tarekand @Stefan Johansson "Non-separation and non-medicalization"  of this population, especially that we actually very rarely need to admit these babies to the NICU.

 

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The large delivery hospital we cover unfortunately does not have an intermediate level of care (at least not physically) so we admit many late preterm infants to our level III+ NICU.  <36 weeks or <2000g is an automatic admission (had previously been <35 weeks or <1800g but so many were subsequently transferred to NICU that it was felt to be safer and more efficient to take these babies into NICU and then send them out to the nursery later.)  The challenge is that for logistical and institutional/cultural reasons once these babies enter the NICU there is almost no hope of getting them back to mom prior to her discharge (particularly given the relatively short length of postpartum stay in the USA).

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We let Babys Born > 35 wks with their mothers making Sure temperature and blood Glucose are normal - sometimes an 34+6 got accidentaly through - there was an Level 1 (Germany - means Level 3 in most countrys ) Team on the same floor of course so we would have been able to act every time - if you can rely on the nurses / midwifes you can trust the Babys 35 weeks or more most of them will make it! 10 years in a northern Germany tertiary Center made me believe in this 

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18 hours ago, frohlocke said:

if you can rely on the nurses / midwifes

This is the crucial point.  Very little of the care of the late preterm infant (particularly the older ones at 35-36 weeks) who does not have RDS is medical.  These babies need good nursing care to maintain thermoregulation and euglycemia.  In the US, many post-partum nursing units have one RN to 4-5 mothers AND their babies, making the staffing more like 10:1.  It is in this context that I see many programs in the US move more and more of these babies into an ICU setting.

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The clinical issues raised by late preterms may be better addressed as suggested by Jain & Raju (editorial attached):

"The focus on the late preterm infant seems to have uncovered two other understudied gestational age groups, one on each side of the late preterm spectrum: studies related to “moderate preterm” and “early term” births,4 further highlighted our lack of understanding of consequences of early birth, even if it is by 2 to 3 weeks and the importance of maintaining the gestational maturational continuum."

Jain&Raju'13 editorial (LPT).pdf

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