Development of a Late Preterm Infant Initiative on the Postpartum Unit

Purpose for the program: Our initiative was based upon the 2005, Association of Women's Health, Obstetrics and Neonatal Nurses (AWHONN) late preterm infant initiative. The purpose was to enhance the care of late preterm infants admitted with thier mothers to the Postpartum unit. Late preterm infants (LPI) are defined as infants born between 34 and 36 6/7 weeks gestation. LPI infants are found to be at greater risk for hypothermia, hypoglycemia, respiratory distress, hyperbilirubinemia, sepsis and feeding difficulties.  This initiative has provided close observation with frequent nursing assessments resulting in fewer admissions to the NICU and has promoted family centered care while providing excellent care to our special infant population.

Proposed change: The changes included more frequent monitoring of vital signs, blood glucose monitoring, and earlier assesements of bilirubin testing. Other changes included delaying the bath and circumcision until at least 24 hours of life and earlier and more frequent support from Lactation Consultants. 

Implementation, outcomes and evaluation: In late 2009, a letter was addressed to all pediatricians notifying them that any stable infant born between 34 and 36 6/7 weeks would be admitted to the LPI nursery in the Post Partum Unit. After a 6 - 8 hour period of observation in the LPI nursery and meeting transfer criteria, the infant would then be transferred into the mother's room. This has resulted in closer observation of the infants with decreased admissions to the NICU. Mothers are also receiving earlier and continued lactation support from lactation consultants.

Implications for nursing practice: This initiative has led to the development of the Late Preterm Infant CPG, Standing Physician orders, increased staff awareness of the LPI and more frequent nursing assessments. As a result of feeding difficulties with the LPI, Registered Nurse Lactation consultants provide earlier and more frequent assistance to the infant and mother.  This has also led to fostering the family centered care concept providing greater bonding between the mother and the infant.

Keywords: Late preterm infant,late preterm nursery and family centered care