Escalation of Care for Late Preterm Infants During the Birth Hospitalization.

To compare neonatal intensive care unit (NICU) admission rates and length of stay (LOS) of late preterm infants (LPIs) born before and after opening a specialized care nursery (SCN) at our academic, pediatric tertiary care center with ∼4,500 total deliveries annually. Retrospective chart review of inborn LPIs (35(0/7)-36(6/7) weeks) who were asymptomatic or minimally symptomatic at birth and delivered 7 months before the opening of the SCN (pre-SCN) or 7 months subsequently (post-SCN). Infants were excluded for major congenital anomalies or other conditions requiring immediate NICU admission. The pre-SCN options for care were standard couplet care or NICU. The post-SCN options for care were standard couplet care, SCN, or NICU. Pre-SCN (n = 109), 73 (67%) infants received standard couplet care, while 36 (33%) infants were ever admitted/transferred to the NICU. Post-SCN (n = 112), 59 (53%) infants received standard couplet care, while 20 (18%) were ever admitted/transferred to the NICU. A total of 33 (29%) infants were admitted/transferred to the SCN and avoided a NICU stay. Median LOS for all infants was 3 days. The frequency of LPIs admitted/transferred to the NICU decreased by ∼50% after the opening of the SCN. LOS did not differ by birth cohort, but did differ significantly by location of care (standard couplet care < SCN < NICU).

The rate of maternal and perinatal complications increases after 39 weeks' gestation in both unselected and complicated pregnancies. The aim of this study was to synthesize quantitatively the available evidence on the effect of elective induction of labor at 39 weeks on the risk of Cesarean section, and on maternal and perinatal outcomes. PubMed, US Registry of Clinical Trials, SCOPUS and CENTRAL databases were searched from inception to August 2018. Additionally, the references of retrieved articles were searched. Eligible studies were randomized controlled trials of singleton uncomplicated pregnancies in which participants were randomized between 39 + 0 and 39 + 6 gestational weeks to either induction of labor or expectant management. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias Tool. The overall quality of evidence was assessed according to the GRADE guideline. Primary outcomes included Cesarean section, maternal death and admission to the neonatal intensive care unit (NICU). Secondary outcomes included operative delivery, Grade-3/4 perineal laceration, postpartum hemorrhage, maternal infection, hypertensive disease of pregnancy, maternal thrombotic events, length of maternal hospital stay, neonatal death, need for neonatal respiratory support, cerebral palsy, length of stay in NICU and length of neonatal hospital stay. Pooled risk ratios (RRs) were calculated using random-effects models. The meta-analysis included five studies (7261 cases). Induction of labor was associated with a decreased risk for Cesarean section (moderate quality of evidence; RR 0.86 (95% CI, 0.78-0.94); I2 = 0.1%), maternal hypertension (moderate quality of evidence; RR 0.65 (95% CI, 0.57-0.75); I2 = 0%) and neonatal respiratory support (moderate quality of evidence; RR 0.73 (95% CI, 0.58-0.95); I2 = 0%). Neonates born after induction weighed, on average, 81 g (95% CI, 63-100 g) less than those born after expectant management. No significant effects were found for the other outcomes with the available data. The main limitation of our analysis was that the majority of data were derived from a single large study. A second limitation arose from the open-label design of the studies, which may theoretically have affected the readiness of the attending clinician to resort to Cesarean section. Elective induction of labor in uncomplicated singleton pregnancy at 39 weeks' gestation is not associated with maternal or perinatal complications and may reduce the need for Cesarean section, risk of hypertensive disease of pregnancy and need for neonatal respiratory support. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Prevalence and Morbidity of Late Preterm Infants: Current Status in a Medical Center of Northern Taiwan

The focus of this article is on the transition of late preterm infants from hospital to home. The current state of literature related to mortality, morbidities, emergency department visits, and rehospitalization underscores the vulnerability of late preterm infants following discharge from hospital. Universal provision of postpartum care to late preterm infants is viewed as an environmental support intended to facilitate transition of these vulnerable infants from hospital to home. Gaps in provision of postpartum care of late preterm infants are situated within the discussion of guidelines and models of postpartum care (home vs clinic) of late preterm infants.

Underuse Versus Overuse of Neonatal Intensive Care: What Is the Right Amount?

Background Home care of late preterm infants (LPIs) can be challenging for mothers after hospital discharge because they are more vulnerable than full-term infants and experience higher hospital admission rates. Purpose This study aims to determine the effect of a thorough and collaborative discharge education program offered by a nurse to mothers of LPIs. The program focuses on the mother’s preparedness (self-efficacy and readiness) to care for their LPIs at home after discharge from the neonatal intensive care unit. Methods A quasi-experimental design will be applied in a large, accredited referral NICU in Jordan. Two groups of mothers will be enrolled using convenience sampling. The experimental group will receive the designed pre-discharge education, and the comparison group will receive routine discharge instructions for LPI care at home. The outcome will measure a mother’s self-efficacy and readiness to care for their LPI at home. Data will be compared within and between the groups before and after the intervention. An independent and paired sample t-test will be used for analysis. Results/Discussion This study will be conducted on the notion that educating mothers is a principal role for neonatal nurses and helps improve the quality of healthcare services provided to parents of vulnerable infants. Implications for Nursing The study findings will provide insight into national and global neonatal nursing practices through a thorough discharge education program for mothers with LPIs. Conclusion Publishing a research protocol encourages research transparency and allows the exchange of methodological insights and feedback between academic and clinical communities.

Of the 500 000 premature babies born each year in the United States, nearly 75%—or 375 000—of them are born at 34 0/7 through 36 6/7 weeks of gestational age (GA). These infants are referred to as ‘late preterm infants' (LPI) by many who publish research and commentaries about their care, including the consensus panel at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).1 Late preterm infants are physiologically and metabolically immature at the time of birth, often lacking the self-regulatory ability to respond appropriately to the extra-uterine environment. Despite their appearance as small but ‘normal' babies, LPIs have higher rates of morbidity and mortality than their term counterparts, not only during birth hospitalization, but also throughout the first year after birth and beyond.2 In some hospitals, LPIs account for up to 20% of admissions to the NICU, and LPIs are more likely to be re-hospitalized within the first 2 weeks of discharge.3, 4, 5 The morbidity rate approximately doubles for every week below 38 weeks gestational age that a baby is born (38 weeks: 3.3% 37 weeks: 5.9% 36 weeks: 12.4% 35 weeks: 25% 34 weeks: 51.2%).6 Because of these inherent risks, LPIs require increased surveillance and monitoring of the mother–infant dyad to direct their healthcare needs. The level and intensity of care provided should be based on ongoing assessment of the infant's physiological status and availability of services and personnel within the birthing facility, so that any needed interventions can occur quickly to prevent permanent consequences. With appropriate awareness of potential risks, the care of many LPIs can be managed in the postpartum setting, and the Multidisciplinary Guidelines for the Care of Late Preterm Infants are focused on these infants. However, some infants may require transfer to a higher level of care for suitable management and monitoring. A multidisciplinary approach to caring for the LPI is recommended. Care should be implemented and coordinated by clinicians within their scope of practice and should be family-centered, developmentally supportive, and within the context of the family's culture and preferences. Communication should occur and education should be provided in ways that are appropriate for individual family needs, including families with limited or no English proficiency or health literacy. Care standards should always be of the highest quality but may require different methods of implementation.

BackgroundRespiratory distress syndrome (RDS) is one of the leading causes of early neonatal morbidity and mortality in late preterm infants (LPIs) worldwide. This matched cohort study aimed to assess how the antenatal dexamethasone use affect the respiratory distress (RD) proportion in preterm newborns between 34 0/7 weeks and 36 6/7 weeks of gestation.MethodsThis was a prospective cohort study on 78 women with singleton pregnancy who were in threatened preterm birth and had not received prior dexamethasone, who were admitted between 34 0/7 weeks and 36 6/7 weeks at Hue University of Medicine and Pharmacy Hospital from June 2018 to May 2020. The matched control group without dexamethasone use included 78 pregnant women diagnosed with threatened late preterm births who were at similar gestational ages and estimated fetal weights as the treatment group. The treatment group received 6 mg intramuscular dexamethasone every 12 h for a total of 4 doses or until delivery. Primary outcome was the rate of neonatal RD. Secondary neonatal outcomes included the need for respiratory support, neonatal intensive care unit (NICU) admission, hypoglycemia, necrotizing enterocolitis, intraventricular hemorrhage, and neonatal death. Statistical analyses were performed by using SPSS software, version 26.0.ResultsThe proportion of RD in LPI was significantly lower in the treatment group than in the matched control group (10.3% vs. 23.1%, respectively), adjusted Odds Ratio [aOR] 0.29; 95% confidence interval [CI] 0.10 – 0.83 and p = 0.021. Neonatal hypoglycemia was more common in the dexamethasone group than in the matched group (25.6% vs. 12.8%, respectively; aOR, 2.59; 95% CI, 1.06 – 6.33; p = 0.037). There were no significant between-groups differences in the incidence of respiratory support, NICU admission or length of hospital stay.ConclusionsAdministration of antenatal dexamethasone to women at risk for late preterm birth could help to lower the proportion of respiratory distress in late preterm infants.

Advancing the Evidence Base in the Care of Term and Late Preterm Infants.

Comprehensive care for late preterm infants: fostering integrated follow-up

Routine postnatal chest x-ray and intensive care admission are unnecessary for a majority of infants with congenital lung malformations

To assess the need for respiratory support in late preterm infants treated with sustained lung inflation (SLI) at birth. In this controlled trial, we randomly assigned infants born at 34(+0) to 36(+6) weeks of gestation to receive SLI (25 cmH2O for 15 s) at birth, followed by continuous positive airway pressure (CPAP) or assistance according to the recommendations of the American Academy of Pediatrics. The primary outcome was the need for any type of respiratory support. The secondary outcomes included neonatal intensive care unit (NICU) admission for respiratory distress and length of stay. The risk ratios (RRs) and 95% confidence intervals (CIs) of the outcomes were calculated for the SLI group in reference to the control group. A total of 185 infants were enrolled: 93 in the SLI group and 92 in the control group. No difference was found in the need for any type of respiratory support between the infants treated with SLI and the control group (10.6 vs 8.7%, RR 1.24, 95% CI 0.51 to 2.99). The NICU admission for respiratory distress and the length of stay did not differ between the groups. Providing SLI at birth in late preterm infants does not affect their need for respiratory support.

A Baby Weigh Station: Continuum of Care for Late Preterm Breastfeeding Infants

Background Late preterm infants (LPIs) account for most preterm births and are at high risk of developing prematurity-related morbidities. Due to the increasing rate of cesarean section delivery, it is expected that more LPIs with respiratory complications will be admitted to neonatal intensive care units (NICU). Objectives To assess the rate of NICU admission and respiratory complications among LPIs and to compare their outcomes based on the mode of delivery. Patients and Methods The list of all LPIs who were admitted in the period 2015–2020 was reviewed. Data collected about demographic characteristics, delivery information, NICU admission, respiratory complications, respiratory support, length of stay, and readmission. Infants were classified according to their mode of delivery into: vaginal delivery group (VD) and cesarean section group (CS). Results Out of 2236 LPIs included, 321 (14%) were born at 34-week gestation, 1137 (51%) were males. 1243 (56%) were admitted to NICU. The CS group comprised 77% (1719) while the VD group 23% (517). Compared to the VD group, infants in the CS group had a higher rate of NICU admission (57.1% vs. 50.7%, P = 0.006), respiratory distress syndrome (RDS) (22% vs. 17%, P = 0.000), and transient tachypnea of newborn (TTN) (17% vs. 11%, P = 0.019). Also, more babies in the CS group received CPAP (36.2% vs. 24.6%, P = 0.000) and surfactant therapy (6.6% vs. 4.6%, P = 0.02). After logistic regression analysis, CS remains an independent factor for NICU admission (OR 1.3, 95% confidence intervals [CI] 1.1–1.6, P = 0.01), respiratory complications (OR 1.6, 95% CI 1.2–2.2, P = 0.001), CPAP requirement (OR 1.6, 95% CI 1.3–2, P = 0.000), and a longer length of stay &gt; 3 days (OR 1.5, 95% CI 1.2–1.8, P = 0.000). Conclusion The rate of CS delivery among late preterm gestation is very high and alarming. CS delivery of LPI increases the rate of NICU admission, respiratory complications, and the need for respiratory support.

Indications for delivery and short-term neonatal outcomes in late preterm as compared with term births