Center Neonatal Intensive Care Unit Research Articles

Provider Networks in the Neonatal Intensive Care Unit Associate with Length of Stay.

We strive to understand care coordination structures of multidisciplinary teams and to evaluate their effect on post-surgical length of stay (PSLOS) in the Neonatal Intensive Care Unit (NICU). Electronic health record (EHR) data were extracted for 18 neonates, who underwent gastrostomy tube placement surgery at the Vanderbilt University Medical Center NICU. Based on providers' interactions with the EHR (e.g. viewing, documenting, ordering), provider-provider relations were learned and used to build patient-specific provider networks representing the care coordination structure. We quantified the networks using standard network analysis metrics (e.g., in-degree, out-degree, betweenness centrality, and closeness centrality). Coordination structure effectiveness was measured as the association between the network metrics and PSLOS, as modeled by a proportional-odds, logistical regression model. The 18 provider networks exhibited various team compositions and various levels of structural complexity. Providers, whose patients had lower PSLOS, tended to disperse patient-related information to more colleagues within their network than those, who treated higher PSLOS patients (P = 0.0294). In the NICU, improved dissemination of information may be linked to reduced PSLOS. EHR data provides an efficient, accessible, and resource-friendly way to study care coordination using network analysis tools. This novel methodology offers an objective way to identify key performance and safety indicators of care coordination and to study dissemination of patient-related information within care provider networks and its effect on care. Findings should guide improvements in the EHR system design to facilitate effective clinical communications among providers.

Effect of Fat Emulsion Hang Time Changes on Central Line-associated Bloodstream Infection Rates and Risk Factor Analysis in a Single Center Neonatal Intensive Care Unit

Effect of Fat Emulsion Hang Time Changes on Central Line-associated Bloodstream Infection Rates and Risk Factor Analysis in a Single Center Neonatal Intensive Care Unit

Evaluation of a Remote Telemedicine Screening System for Severe Retinopathy of Prematurity.

To evaluate the validity of remote telemedicine screening for retinopathy of prematurity (ROP) in a population of at-risk preterm infants in Iowa and South Dakota. The medical records for all preterm infants screened for ROP at neonatal intensive care units (NICUs) in Sioux City, Iowa, and Sioux Falls, South Dakota, from September 1, 2017, to July 31, 2018, were retrospectively reviewed. The RetCam Shuttle (Natus Medical Inc., Pleasanton, CA) was used to capture retinal images, which were posted on a secure server for evaluation by a pediatric ophthalmologist. Infants with suspected ROP approaching the criteria for treatment with anti-vascular endothelial growth factor (VEGF) medications were transferred to the Children's Hospital and Medical Center NICU in Omaha, Nebraska, where a comprehensive examination was performed and treatment was administered when indicated. The remaining infants received an outpatient comprehensive examination by one of two pediatric ophthalmologists within 2 weeks of discharge. A total of 124 telemedicine examinations were performed on 35 infants during the study period. Remote telemedicine screening for referral-warranted ROP using the RetCam Shuttle had a sensitivity of 100%, specificity of 97%, positive predictive value of 66.7%, and negative predictive value of 100%. Of the three infants transferred for referral-warranted ROP, two required treatment with anti-VEGF medications. Good outcomes were noted in all cases, and no patients progressed beyond stage 3 ROP. Telemedicine screening reliably detected referral-warranted ROP in at-risk premature infants at two remote sites, with no poor outcomes during the 11-month period. These results demonstrate the validity and utility of remote telemedicine screening for ROP. [J Pediatr Ophthalmol Strabismus. 2019;56(3):157-161.].

2333. Practice of Endotracheal Tube Suction Catheter Flushes With Polymyxin in Extremely Low Birthweight Neonates

BackgroundAerosolized or powdered forms of polymyxin have been used as prophylaxis for ventilator associated infections in adults. In 2015, Children’s National Medical Center neonatal intensive care unit (NICU) protocol recommended that neonates <1,000 g receive polymyxin endotracheal tube suction catheter flushes with the goal to reduce acquired respiratory infection. The objective of this study was to describe the clinical characteristics and outcomes of patients who received polymyxin endotracheal tube flushes compared with those who received saline.MethodsA retrospective cohort study of infants weighing <1,000 g ventilated for >48 hours in the NICU, January 1, 2015–June 30, 2016 was performed. Data were collected from an internal NICU database, medication billing data, and through chart review of the electronic health record. Demographics, antibiotic treatment days, ventilator days, length of stay, mortality, and microbiologic culture data were compared between patients receiving polymyxin and saline using chi-squared for binary and t-test for continuous variables.ResultsOf the 71 patients included, 38 received polymyxin and 33 received saline. Mean gestational age at birth was 24.1 weeks (23.9 polymyxin vs. 24.2 saline, P = 0.06); median age on admission 4 days (3 vs 12, P = 0.019); median admission weight 700 g (640 vs. 800, P = 0.002); 52% were male (58% vs. 45% group). Median antibiotic days was 52 (77 vs. 41, P = 0.056), median ventilator days 39 (43.5 vs. 33, P = 0.06). Pathogenic bacteria was cultured in 38% of patients in whom at least one lower respiratory tract (LRT) culture was obtained (62.5% vs. 38.1% P = 0.24). Pathogenic bacteria resistant to at least one antibiotic class to which is normally susceptible was found in 10% (13% vs. 6%, P = 0.32). No differences were seen in mortality (16% vs. 15%, P = 0.94) or median length of stay (101 vs. 92, P = 0.41).ConclusionAn NICU protocol recommending prophylactic polymyxin use for ELBW infants was implemented more frequently in younger and more premature neonates. Mortality and length of stay did not differ among babies who received polymyxin. Patients who received polymyxin did not grow a statistically significant higher proportion of pathogenic or resistant bacteria from LRT cultures compared with those receiving saline.Disclosures All authors: No reported disclosures.

Does duration of caffeine therapy in preterm infants born ≤1250 g at birth influence neurodevelopmental (ND) outcomes at 3 years of age?

To evaluate the effect of duration of caffeine use on long-term neurodevelopmental (ND) outcomes at 3 years corrected age (CA) in preterm infants with birthweights (BW) ≤ 1250 g. All surviving infants with BW ≤ 1250 g admitted to the Foothills Medical Center neonatal intensive care unit (NICU) from January 2002 to December 2009 who received the first dose of caffeine in the first week of life and were followed up at three years CA were included in the study. Demographics and follow-up outcomes were compared based on early cessation of caffeine ≤ 14 days (ECC), intermediate cessation of caffeine 15-30 days (ICC), and late cessation of caffeine >30 days (LCC). The primary outcome of ND impairment was present if a child had any one of the following: cerebral palsy, cognitive delay, visual impairment, or hearing impairment or deafness. Univariate and logistic regression analyses were performed. Of the 508 eligible infants, 448 (88%) were seen at 3 years CA at follow-up. ECC (n = 139), ICC (n = 122) and LCC (n = 187) groups had a median (range) BW of 979 (560-1250), 1010 (530-1250), and 980 (520-1250) g (p = 0.524) and median (range) gestational age (GA) of 27 (23-33), 28 (24-33), and 27 (24-32) weeks, respectively (p = 0.034). In logistic regression models adjusting for GA,maternal smoking, and each neonatal risk factorseparately (IVH, NEC, sepsis, blood transfusions, BPD, postnataldexamethasone, SNAP-II, and ventilator days), none of the models showed a statistically significant association between caffeine duration and ND impairment. The duration of caffeine use in premature infants in the NICU does not impact on long-term ND outcomes at 3 years CA.

Initiation and Compliance with a Chest X-Ray (CXR) Reduction Protocol in the Children's National Medical Center Neonatal Intensive Care Unit (NICU)

Background: Daily chest X-rays (CXR)s for the sole purpose of verifying the position of the endotracheal tube (ETT) have been deemed by the American Academy of Pediatrics to be one of the top 5 unnecessary tests that increase cost and utilize resources but do not increase efficacy nor safety. Restricting the frequency of CXRs is not associated with an increase in hospital mortality, increased length of stay, nor an increase in duration of mechanical ventilation. Objective: To evaluate the effectiveness of a restrictive CXR protocol in the Neonatal Intensive Care Unit (NICU) by assessing …

Initiation and Compliance with a Chest X-Ray (CXR) Reduction Protocol in the Children's National Medical Center Neonatal Intensive Care Unit (NICU)

Initiation and Compliance with a Chest X-Ray (CXR) Reduction Protocol in the Children's National Medical Center Neonatal Intensive Care Unit (NICU)

Use of a single C-reactive protein level in decision-making during neonatal sepsis evaluation

Background: Use of a single C-reactive protein (CRP) level has been studied in the pediatric population, but limited information is available for the neonatal, particularly Neonatal Intensive Care Unit (NICU) infants. Objective: The objective of this study is to determine if a single CRP level in the context of other laboratory and clinical parameters, can assist in decision-making for antibiotic management. Materials and Methods: We reviewed the medical records of infants admitted to a large regional perinatal center NICU over a 2-year period. Infants in whom a CRP level had been measured were divided into sepsis-treated group if antibiotic therapy was instituted for ≥7 days or the no sepsis group if antibiotics were discontinued after 48 h. Characteristics of delivery, general characteristics of the infant and data at the time of sepsis evaluation were collected. This was a powered study to detect at least 10% difference in the proportion of those with CRP

A targeted noise reduction observational study for reducing noise in a neonatal intensive unit.

Excessive noise in neonatal intensive care units (NICUs) can interfere with infants' growth, development and healing.Local problem:Sound levels in our NICUs exceeded the recommended levels by the World Health Organization. We implemented a noise reduction strategy in an urban, tertiary academic medical center NICU that included baseline noise measurements. We conducted a survey involving staff and visitors regarding their opinions and perceptions of noise levels in the NICU. Ongoing feedback to staff after each measurement cycle was provided to improve awareness, engagement and adherence with noise reduction strategies. After widespread discussion with active clinician involvement, consensus building and iterative testing, changes were implemented including: lowering of equipment alarm sounds, designated 'quiet times' and implementing a customized education program for staff. A multiphase noise reduction quality improvement (QI) intervention to reduce ambient sound levels in a patient care room in our NICUs by 3 dB (20%) over 18 months. The noise in the NICU was reduced by 3 dB from baseline. Mean (s.d.) baseline, phase 2, 3 and 4 noise levels in the two NICUs were: LAeq: 57.0 (0.84), 56.8 (1.6), 55.3 (1.9) and 54.5 (2.6) dB, respectively (P<0.01). Adherence with the planned process measure of 'quiet times' was >90%. Implementing a multipronged QI initiative resulted in significant noise level reduction in two multipod NICUs. It is feasible to reduce noise levels if QI interventions are coupled with active engagement of the clinical staff and following continuous process of improvement methods, measurements and protocols.

Cerebral Oxygenation Using Near-infrared Spectroscopy (NIRS) before, during and after Therapeutic Hypothermia: A Comparison of Cerebral Saturations between those Infants on Sedatives and Anti-Epileptics and those who are not, all of whom are Undergoing Cooling

Objectives: The aims of this study include the following: to determine the effect of therapeutic hypothermia (Cooling) on cerebral saturations using Near Infrared Spectroscopy (NIRS) before, during and after therapeutic hypothermia; to compare these values between infants receiving sedative and anti-epileptic medications and those who do not. Methods: This study is a retrospective chart review of patients from Children’s National Medical Center (CNMC) Neonatal Intensive Care Unit (NICU) who underwent therapeutic hypothermia with NIRS monitoring from July 2009- December 2014. Cerebral tissue saturations (StO2) using NIRS tissue oximeter (FORE-SIGHT, CAS Medical Systems, Branford, CT, USA) were assessed during the cooling period. StO2 were periodically recorded during 3 phases: before cooling was started, during cooling, and after cooling (30 minutes of rewarming) and averaged to a composite value for each event. Data was then compared based on whether the patient received sedatives and/or anti-epileptic medications. Results: Complete data sets were obtained for 57 subjects, weighting 1.8 kg-4.9 kg, 1-7 days old and gestational age 35.6-42.0 weeks. Cerebral tissue saturations were significantly higher during cooling (paired t-test). Those on Phenobarbital and/or Versed had significantly higher saturations compared to those on no medications. Those on only Phenobarbital also had significantly higher saturations, but to a lesser degree. Subjects where StO2 failed to rise during cooling had a higher chance of dying, perhaps due to critical brain tissue damage from lack of oxygen during birth asphyxia, or failure to recover thereafter. Conclusions: Data from this study suggests that cerebral tissue saturations increase during therapeutic hypothermia, likely due to suppressed cerebral metabolism. Those on anti-seizures medications

Application of Perceived Maternal Parenting Self-Efficacy (PMP S-E) Questionnaire in a Mid-West Community Medical Center NICU in the United States

Preterm birth and infants’ admission to neonatal intensive care units (NICU) are associated with significant emotional and psychological stresses on mothers that interfere with normal mother-infant relationship. Maternal selfefficacy in parenting ability may predict long-term outcome of mother-infant relationship as well as neurodevelopmental and behavioral development of preterm infants. The Perceived Maternal Parenting Self-Efficacy (PMP S-E) tool was developed to measure self-efficacy in mothers of premature infants in the United Kingdom. The present study determined if maternal and neonatal characteristics could predict PMP S-E scores of mothers who were administered to in a mid-west community medical center NICU. Mothers whose infants were born less than 37 weeks gestational age and admitted to a level III neonatal intensive care unit participated. Participants completed the PMP S-E and demographic survey prior to discharge. A logistic regression analysis was conducted from PMP SE scores involving 103 dyads using maternal education, race, breast feeding, maternal age, infant’s gestational age, Apgar 5-minute score, birth weight, mode of delivery and time from birth to completion of PMP S-E questionnaire. Time to completion of survey and gestational age were the significant predictors of PMP S-E scores. The finding of this study concerning the utilization of the PMP S-E in a United States mid-west tertiary neonatal center suggest that interpretation of the score requires careful consideration of these two variables.

Changing of bloodstream infections in a medical center neonatal intensive care unit.

Bloodstream infections (BSIs) are associated with high mortality and morbidity in neonatal intensive care units (NICUs). The epidemiology of these infections may change after the application of new infection control policies. The aims of this study are to reveal the changing epidemiology of BSIs in our NICU and inspect the effects of infection control efforts. We reviewed and analyzed the clinical characteristics of culture-proven BSIs in our NICU from 2008 to 2013 and compared them with our two previously reported data (1992-2001 and 2002-2007). The mortality rate decreased from 16.3% in 1992-2001 to 5.6% in 2008-2013. In the recent study period, Gram-positive infections became predominant (58.0%). Coagulase-negative staphylococci remained the most commonly isolated organisms (26.0%). Group B Streptococcus (GBS) BSIs had the highest mortality rate (30.0%). Most GBS-infected infants' mother did not perform prenatal GBS screening. There was a decrease in the total fungal infection rate after fluconazole prophylaxis for very-low-birth-weight (VLBW) neonates, but the infections of fluconazole-resistant Malassezia pachydermatis increased. The incidence of central line-associated BSI increased to 10.6% in 2011. After restricting the catheter duration to <21 days, the incidence decreased to 4.2% in 2013. Through the years, the overall mortality rate of BSIs in our NICU decreased. Maternal GBS screening is an important issue for avoiding early onset GBS mortality. Fungal infection rate decreased after antifungal prophylaxis policy for VLBW infants, but we should be aware of resistant strains. Restriction of the catheter duration may decrease the incidence of catheter-related BSI.

Utility of Targeted Neonatal Echocardiography in the Management of Neonatal Illness.

To describe the impact of targeted neonatal echocardiography on management of neonatal illness in a tertiary perinatal center neonatal intensive care unit (NICU). We conducted a retrospective analysis of consecutive targeted neonatal echocardiographic studies that were performed over an 18-month period in a regional perinatal center NICU in Canada. All studies were performed with a cardiovascular ultrasound machine and transducer and read on a workstation with storage and analysis software. Reporting was done on a standardized document, and any management change resulting from targeted neonatal echocardiography was documented. A total of 303 consecutive targeted neonatal echocardiographic studies were performed on 129 neonates. The mean gestational age ± SD was 27.8 ± 4.3 weeks (range, 23-41 weeks), and the mean birth weight ± SD was 1196 ± 197 g (range, 490- 4500 g). The median number of studies per neonate was 2 (range, 1-8), with most repeated studies for a patent ductus arteriosus (PDA). The most common indication for echocardiography was assessment of a PDA (52.1%), followed by early global hemodynamic assessment of very low birth weight (16.2%) and pulmonary hypertension (12.2%). Of the 303 studies, 126 (41.5%) resulted in management changes. The contribution to management was significantly related to the timing of echocardiography. Around half of the echocardiographic examinations during first the week of life resulted in management changes, compared to 22% of studies after 1 week of age (P = .002). Patent ductus arteriosus management accounted for almost half of the interventions. Targeted neonatal echocardiography is a valuable tool in the NICU and can contribute substantially to hemodynamic management in the first week of life, PDA management in the first 2 weeks of life, and cases of hypotension or shock at any time during the hospital stay.

Impact of Respiratory Morbidities on Neurodevelopmental Outcome of Late Preterm Infants.

This study aims to evaluate impact of respiratory and other neonatal comorbidities on neurodevelopmental outcome in late preterm infants (LPT). Retrospective study of LPT infants (34 (0/7)-36 (6/7) weeks' gestation) discharged from the New York University Langone Medical Center neonatal intensive care unit, during January 2006 to December 2010 and received follow-up care up to 2 years of age. Neonatal morbidities were correlated with neurodevelopmental outcomes and assessed by performance on the Mullen Scales of Early Learning during three developmental follow-up visits. A total of 99 LPT completed neurodevelopmental assessment up to 2 years of age. Infants with diagnosis of moderate-to-severe respiratory distress syndrome showed a significantly lower performance in the visual reception on the second (p<0.01) and third visit (p=0.02), as well as lower performance in the receptive language (visit 2, p=0.02; visit 3, p<0.01). A diagnosis of persistent pulmonary hypertension was found to be associated with significantly lower performance in the visual reception at all visits (p<0.01; p=0.02; p=0.02) and in the receptive language on the second and third visit (p=0.03; p=0.02). Combined respiratory morbidities were also associated with lower developmental scores in fine motor (visit 2, p<0.01; visit 3, p=0.04) as well as expressive language (visit 3, p=0.02). LPT with significant respiratory morbidities are at higher risk for long-term developmental delays, mainly affecting cognitive developmental domains.

Validation of noninvasive hemoglobin measurement by pulse co-oximeter in newborn infants.

To describe the accuracy of noninvasive hemoglobin (Hb) obtained with pulse co-oximeter (SpHb) compared with total Hb (tHb) from laboratory co-oximeter in neonates. Neonates with birth weight (BW) <3000 g admitted to LAC+USC Medical Center neonatal intensive care unit were included. SpHb was recorded using Masimo Radical-7 and compared with tHb. A total of three data sets were obtained for each patient. Regression analysis and Bland-Altman analysis were performed. Sixty-one patients (mean±s.d., BW 1177±610 g and gestational age 28.7±3.9 weeks) were enrolled. The mean tHb value was 13.9±2.0 g dl(-1) and the mean SpHb was 14.0±2.0 g dl(-1). There was a moderately positive correlation between SpHb and tHb (r=0.66, P<0.001) with a bias and precision of -0.09±1.67 g dl(-1). Data from a subgroup of infants with gestational age ⩽32 weeks (52/61 patients) were analyzed, and the correlation coefficient was moderately positive (r=0.69, P<0.001) with a bias and precision of -0.23±1.60 g dl(-1). Our results suggest that noninvasive SpHb may be considered as an adjunct to invasive tHb measurements in newborn infants <3000 g especially in preterm infants ⩽32 weeks of gestation.

Risk factors associated with germinal matrix-intraventricular hemorrhage in preterm neonates.

ObjectiveThe purpose of this study is to identify the risk factors associated with the development of germinal matrix-intraventricular hemorrhage (GM-IVH) and the relationship of the severity of disease and prematurity.MethodsA total of 168 premature neonates whose birth weight ≤1500 g or gestational age ≤34 weeks were examined by cranial ultrasound (CUS) for detection of GM-IVH among the babies admitted between January 2011 and December 2012 in our medical center neonatal intensive care unit. The babies were divided into two groups : GM-IVH and non-IVH. Clinical presentations, precipitating factors of the patients and maternal factors were analyzed.ResultsIn univariate analysis, gestational age, birth weight, delivery method, presence of premature rupture of membrane (PROM) and level of sodium and glucose were statistically meaningful factors (p<0.05). But only two factors, gestational age and presence of patent ductus arteriosus (PDA) were statistically meaningful in multivariate logistic regression (p<0.05). Delivery method [normal vaginal delivery (NVD) to Caeserean section] was borderline significant (p<0.10).ConclusionPresence of PDA and gestational age were the important risk factors associated with development of GM-IVH.

Auditory Brainstem Response and Distortion‐Product Otoacoustic Emission Studies in Neonates at High‐Risk for Hearing Loss

Objectives: 1) Recognize that preterm infants less than 1300g have a well-described and markedly increased incidence of hearing loss, possibly attributed to reversible early middle ear pathology. 2) Analyze if distortion product oto-acoustic emissions (DPOAE) and/or auditory brainstem response (ABR) could be useful adjuncts when used in addition to tympanometry and otoendoscopy in evaluation of neonatal hearing and middle ear. Methods: Institutional review board approved prospective study at a tertiary care center neonatal intensive care unit with subjects undergoing ABR, DPAOE, tympanometry, and otoendoscopy studies within 72 hours of birth and in scheduled increments until discharge. From January 2010 to date, 77 neonates have been examined. Results: Our results confirmed that DPOAE could be a reliable and repetitive study from 24 weeks of gestational age and onward. When comparing traditional tympanometry to DPOAE, 85.7% of examinations with type B or C tympanometry also had an abnormal DPOAE result. Conversely, 62.5% of patients with type A tympanometry had a normal DPOAE result. Furthermore, in patients with a clinical diagnosis of AOM or OME, 66.7% percent had an abnormal DPAOE result. Regarding ABR threshold studies, there were several limitations with data acquisition due to incubator interference and background noise; thus, the potential of ABR in this population remains to be determined. Conclusions: This study suggests that DPOAE can be used as a reliable hearing evaluation in the neonatal population. Additionally, it may serve as a useful adjunct and insight into evaluating neonatal middle ear pathology, especially when combined with tympanometry and otoendoscopy.

10 Years after Baby-Friendly Designation

Mothers of preterm and sick infants admitted to the neonatal intensive care unit (NICU) often encounter more difficulties with breastfeeding than mothers of healthy term newborns. The extent to which Baby-Friendly designation is associated with breastfeeding rates for NICU infants over time is unknown. This study aimed to determine the rate of breastfeeding initiation and continuation in a US, inner-city, level 3 NICU 10 years after Baby-Friendly designation. We compared the rate of breastfeeding initiation and continuation among breastfeeding-eligible mothers with infants admitted to the Boston Medical Center NICU in 1999 and 2009, using chi-square tests. Breastfeeding initiation increased from 74% in 1999 to 85% in 2009 (P = .04). Any breast milk at 2 weeks of age increased from 66% to 80% (P = .05), and exclusive breastfeeding at 2 weeks remained stable between 1999 and 2009. Breastfeeding initiation increased from 68% to 86% among black mothers from 1999 to 2009 (P = .01). Improvement in breastfeeding initiation and any breastfeeding at 2 weeks of age continued 10 years after Baby-Friendly designation among mothers with NICU infants in a US, inner-city, level 3 NICU.

Incidence and risk factors for catheter‐associated bloodstream infections in neonatal intensive care

To determine the incidence and potential novel risk factors for catheter-associated bloodstream infections (CABSI) in neonates. A retrospective study was conducted for infants admitted to the VU University Medical Center neonatal intensive care unit in 2007. One hundred and ninety six infants with a total of 369 central catheters were included. The CABSI rate was 18.1 infections/1000 catheter-days (95% CI 13.7-23.8) according to adjusted criteria used by the Centers for Disease Control and Prevention prior to 2008. Umbilical catheters had a higher infection rate than nonumbilical central catheters: rate ratio (rate ratio 2.4, 95% CI 1.2-4.9). Longer umbilical catheter dwell-time also increased infection rate (p < 0.05). Gestational age, birth weight, duration of parenteral nutrition and the administration of all-in-one feeding mixture versus parenteral nutrition administered in separate components were not related to infection rate in multivariate analysis. Of all catheter types, umbilical catheters carried the highest infection rate. Longer umbilical catheter dwell-time also increased infection rate. The present data suggest that the impact of gestational age and birth weight on infection rate is mainly due to a prolonged hospital stay. The composition, way of preparation and duration of parenteral nutrition did not seem to influence infection rate.

Incidence and Etiology of Late Preterm Admissions to the Neonatal Intensive Care Unit and Its Associated Respiratory Morbidities When Compared to Term Infants

To determine etiology of neonatal intensive care unit (NICU) admission and acute morbidities in late preterm (LPT) neonates. Neonates admitted at New York University Langone Medical Center's NICU were grouped as follows: period 1: all LPT neonates with gestational age between 34(0)/(7) and 36(6)/(7) weeks and born between January 2006 and June 2007; period 2: all term neonates born between January 2007 and June 2008. Neonatal and maternal data were collected from both the groups and compared. Thirty-three percent of LPT births were admitted to the NICU, compared with 7% of term births (p < 0.05). LPT neonates had an increased incidence of low birth weight, hypoglycemia, hypothermia, and hyperbilirubinemia as an admission diagnosis (p < 0.001). The overall incidence of respiratory distress syndrome (RDS) was 9%, 4%, 3%, 0.7%, 0.2% and 0% in 34-week, 35-week, 36-week, 37-week, 38- to 39-week, and 40-week gestational age neonates (p < 0. 001).There was an increased incidence of RDS and persistent pulmonary hypertension, along with an increased need for surfactant replacement therapy, continuous positive airway pressure, and ventilator support in the LPT group when compared with the term neonates (p < 0.001). LPT neonates are at increased risk for hypothermia, hypoglycemia, hyperbilirubinemia, and respiratory morbidity requiring increased respiratory support when compared with term neonates.