INTRODUCTION: Late preterm infants (LPIs) have unique care and discharge needs that have not been well addressed in the routine newborn care setting. A review of birth data for 2007 in our setting indicated that 193 infants were classified as being born between 34 and 36Symbol weeks' gestation, or as LPIs. For 2008, 159 infants were born between 34 and 36Symbol weeks' gestation. Current literature outlines the issues related to this growing population of infants and their unique needs, but little literature was found describing implementation of appropriate care for LPIs in the current healthcare system. Recognizing that LPIs required a different level of care, nurses from the labor and delivery unit, the mother/baby unit, and the NICU, with support from performance improvement staff, undertook a project to determine whether the best care was being provided to this growing population. Using the Association of Women's Health, Obstetric and Neonatal Nurses' (AWHONN') "Near-Term Infant Initiative: A Conceptual Framework for Optimizing Health for Near-Term Infants, 2005," current care practices were outlined and compared to the AWHONN recommendations. Initial review indicated significant areas for improvement, which were related to thermoregulation, glucose management, and discharge teaching.
METHODS: Based on chart audits that included identification of conditions commonly experienced by LPIs, including hypothermia, hypoglycemia, sepsis evaluation, and extended length of stay, the team began to identify areas for improvement and to redesign care for the LPIs.
RESULTS: Of the 159 LPIs born in 2008, 53% experienced thermal instability, temperatures less than 97.5[degrees]C or greater than 99.0[degrees]C; 18% experienced hypoglycemia, 22% experienced respiratory instability, and 34% underwent an evaluation for sepsis. Practice changes focused on better identification of LPIs, improved thermoregulation beginning in labor and delivery unit, and improved communication between caregivers. Documentation and communication of feeding abilities centered on standard terms to describe infant abilities. Current hypoglycemia management followed a protocol designed for term infants with mature suck/ swallow/breath abilities. Discharge teaching for LPIs was redesigned to include specifics including hypothermia, feeding, sleep/wake states, hyperbilirubinemia, and follow-up care.
CONCLUSIONS: Early identification of LPIs has significantly improved the hospital course. Providing evidence-based care that is appropriate for gestational age decreases the demands on the physiologic abilities of LPIs and supports their continued growth and development.