Multidisciplinary guidelines for the care of late preterm infants

Abstract

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.