IN FOCUS EDITORIAL
Improving Outcomes for Late Preterm Infants and Their Mothers Brenda Baker, Guest Editor
Correspondence Brenda Baker, PhD, RNC, CNS, Virginia Commonwealth University, P.O. Box 980567, Richmond, VA 23298. [email protected]
Brenda Baker, PhD, RNC, CNS, is a perinatal clinical nurse specialist at Virginia Commonwealth University, Richmond, VA.
n 2005 the National Institutes of Health (NIH) convened a workshop of experts to address issues surrounding outcomes of near-term infants, and participants addressed definition and terminology, epidemiology, etiology, biology of maturation, clinical care, and public health issues (Raju, Higgins, Stark, & Leveno, 2006). The expert panel recommended discontinuation of the use of the term near-term infant and the adoption of the term late preterm infant (LPI) for infants born between 34 0/7 and 36 6/7 weeks gestation. The committee’s consensus indicated that near-term was misleading and conveyed an impression that these infants were “almost term,” which resulted in underestimation of risk to this rapidly growing population (Raju et al., 2006).
during the transition to extrauterine life, tailored feeding plans that consider their neurologic development, and close follow-up after discharge. The articles in this In Focus series highlight care specific to LPIs and their families and present evidence-based practices for the clinical setting.
In the same year, the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) launched the multiyear Late Preterm Initiative to address the unique physiologic needs of this population (Medoff-Cooper, BakewellSachs, Buus-Frank, Santa-Donato, & Near-Term Infant Advisory Panel, 2005). The goal of the AWHONN initiative is to optimize the health of late preterm infants by raising awareness, educating nurses and other clinicians, and disseminating and implementing evidence-based practice to change the way these infants are assessed and cared for (Medoff-Cooper et al., 2005). The work of the National Institute of Child Health and Human Development (NICHD) expert panel and AWHONN’s leadership helped change the course for LPI care and began a trajectory of research and dissemination specific to LPIs. Through its Late Preterm Infant Research-Based Practice Project, AWHONN significantly expanded the body of knowledge about and awareness of the most prevalent late preterm infant physiologic risk factors and clinical complications including respiratory distress, thermal instability, hypoglycemia, hyperbilirubinemia, feeding challenges and sepsis (Medoff-Cooper et al., 2012).
Samra et al. propose an engagement model and an instrument to identify parents of LPIs at risk for poor engagement. Patient and family engagement are crucial for improved outcomes in health care and are key components of value-based purchasing programs under the Affordable Care Act. Patient engagement is considered a proxy for high value care coordination. The Parent Risk Evaluation and Engagement Model Instrument (PREEMI) model and instrument conceptualizes key parent inputs of the engagement model. It is a promising tool for evaluating parent engagement that allows opportunities to intervene prior to discharge to improve transition of the LPI to the home setting.
Briere et al. present an evidence-based review of the literature published in the past 5 years on practices supporting breastfeeding the LPI. Based on the results of this review, they provide practice recommendations for practitioners supporting the efforts of mothers of LPIs to breastfeed. Current literature clearly demonstrates that LPIs and their mothers have unique needs related to successful breastfeeding.
Baker describes interprofessional efforts at an urban academic medical center to provide evidence-based care to LPIs and reduce elective deliveries prior to 39 weeks gestation. After implementation of evidence-based practice guidelines, the incidence of hypothermia, hypoglycemia, respiratory instability, and septic workup decreased in the LPI population. A second improvement effort was undertaken to address elective delivery prior to 39 weeks based on the March of Dimes, Perinatal Quality Improvement Program. The March of Dimes program includes staff education, a 12month quality improvement project to identify patterns and trends related to elective delivery, and
The author reports no conflict of interest or relevant financial relationships.
Late preterm infants are now recognized as a unique group of infants who need close monitoring
C 2015 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses
IN FOCUS EDITORIAL
adoption of a policy addressing elective deliveries prior to 39 weeks gestation. Lastly, Goyal et al. studied the effect of maternal mental health on outcomes for LPIs. In a retrospective cohort study of mothers of LPIs enrolled in a home visiting program, multiple factors were evaluated to determine relationships and outcomes of LPIs. A significant positive relationship was demonstrated between maternal mental health and emergency department (ED) visits. The most common reasons for ED visits included feeding difficulty and asthma/wheezing. These researchers also demonstrated that mothers enrolled in a home visiting program had a reduced incidence of ED visits.
elective deliveries prior to 39 weeks gestation, length of stay following birth, invasive procedures, and separation of mother and newborn due to neonatal intensive care unit admission. Much of this work is being led by nurses.
REFERENCES Medoff-Cooper, B., Bakewell-Sachs, S., Buus-Frank, M. E., SantaDonato, A., & the Near-Term Infant Advisory Panel. (2005). The AWHONN Near-Term Infant Initiative: A conceptual framework for optimizing health for near-term infants. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 34(6), 666–671. Medoff Cooper, B., Holditch-Davis, D., Verklan, M. T., Fraser-Askin, D., Lamp, J., Santa-Donato, A., . . . Bingham, D. (2012). Newborn clinical outcomes of the AWHONN late preterm infant research-based practice project. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41(6), 774–785. doi:10.1111/j.1552-
Research and evidence-based practices surrounding care of LPIs has moved beyond immediate care and into areas focused on longterm outcomes for infants and their families. These areas of focus include reduction of the following:
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6909.2012.01401.x Raju, T., Higgins, R., Stark, A., & Leveno K. (2006) Optimizing care and outcomes for late-preterm (near term) infants: A summary of the workshop sponsored by the National Institute of Child Health and Human Development. Pediatrics, 118, 1207– 1220.