In Focus
Evidence‐Based Practice to Improve Outcomes for Late Preterm Infants

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ABSTRACT

Infants born between 34 weeks 0 days to 36 weeks 6 days gestation have been identified as late preterm infants (LPIs) and account for 70% of preterm births and 9% of all births. The rise in elective deliveries in the past decade is believed to have contributed to the number of late preterm births. An interprofessional team including labor and delivery, neonatal intensive care, and postpartum care providers collaborated to address this issue at an urban academic medical center.

Section snippets

How LPIs are Different

Although LPIs may only appear to be smaller than their term infant counterparts, during the last 4 to 6 weeks of gestation, significant growth and development of critical body systems occur. In the LPI hypothermia and hypoglycemia are frequent complications due to limited brown fat stores, greater body water content, immature metabolic responses, and immature peripheral vasoconstriction mechanisms (Darcy, 2009; Gyamfi‐Bannerman, 2012). Hypothermia increases the demands on energy stores and can

National Organizational Initiatives

Numerous national initiatives have focused attention on the need to avoid elective birth prior to 39 weeks gestation to promote the optimum outcomes for newborns by reducing the associated risks of infants born during the late preterm period. Organizations addressing the reduction in late preterm birth and related adverse infant outcomes include the March of Dimes (2012), (AWHONN 2014c, 2014d; Medoff‐Cooper et al., 2014), American College of Obstetricians and Gynecologists ( ACOG; 2014), and

Implementing Evidence‐Based Care for LPIs

In 2008, 161 LPIs were born in our facility; therefore, approximately 8% of all births were LPIs, which closely matched the national rate of 9% (Engle, Tomashek, & Wallman, 2007). Following the retrospective review of LPI admissions, our interprofessional team began addressing strategies for the care of LPIs. The team identified opportunities for improvement in care and found that transfer to the neonatal intensive care unit (NICU) frequently occurred as compensatory resources were exhausted

Eliminating Elective Deliveries Prior to 39 Weeks Gestation

In 2009, awareness of LPI birth data and the multiple national efforts to address elective deliveries lead to the development and adoption of a hospital policy, Elective Deliveries Prior to 39 Weeks Gestation. Adherence to the policy varied by care provider leading to weekly reviews of scheduled deliveries for medical indications by medical staff leadership (see Figures 2 and 3). In 2012 the hospital was approached to participate in the March of Dimes 39+ Weeks Quality Improvement program.

Implications for Practice

Implementation of the LPI Clinical Practice Guideline and weekly interprofessional review of births prior to 39 weeks for medical indication improved clinical care for LPIs changed the culture related to elective births and raised the standard of care for mothers and newborns. Next steps include implementation of an electronic scheduling tool that would incorporate medical indications for induction or cesarean. Currently, LPI outcomes and elective birth prior to 39 weeks continue as data points

Conclusions

Implementation of the LPI clinical practice guideline has established a standard of evidence‐based care that provides preventive care strategies to conserve physiologic reserves and promote transition of the LPI. This approach to care has decreased the number of LPIs experiencing hypothermia, hypoglycemia, respiratory instability, and the number of septic evaluations. For LPIs admitted to the NICU, the length of stay has decreased. Multiple initiatives focused on elective delivery and care of

Brenda Baker, PhD, RNC, CNS, is an assistant professor in the Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.

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    Brenda Baker, PhD, RNC, CNS, is an assistant professor in the Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.

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