Supporting Feeding of Late Preterm Infants in the Hospital

Abstract

Background: Feeding difficulty is the most common cause of delayed hospital discharge and readmission of late preterm infants. Frequent and adequate feedings from birth are protective against dehydration, hypoglycemia, and jaundice. The National Perinatal Association's feeding guidelines provide the foundation for late preterm infant standards of care. Feeding at least every 3 hours promotes nutritional status and neurologic development. One feeding assessment every 12 hours during the hospital stay can ensure quality of infant feeding. Problem: At a large urban hospital, medical record reviews were completed to evaluate nursing care practices consistent with the hospital's late preterm infant care standard policy. Feeding frequency and nurse assessment of feeding effectiveness were far below acceptable targets. A quality improvement team was formed to address inconsistency with expected practice. Methods: The project included an investigation using the define, design, implement, and sustain method of quality improvement. Parent education, nurse education, and visual cues were developed to sustain enhanced nursing practice. Results: Late preterm infants who received feedings at least every 3 hours increased from 2.5% (1 of 40) to 27% (11 of 40); (M = 0.275, SD = 0.446), p = 0.001. Documented breastfeeding assessments increased from 2% (5 of 264) to 8% (10 of 126), p = 0.001. Documented bottle-feeding assessments increased from 15% (39 of 264) to 31% (53 of 172), p < 0.001. Intervention time was cut short due to reprioritization of efforts in response to the COVID-19 pandemic. Conclusion: Interventions and implementation of this process improvement is easy to replicate through attainable and sustainable goals directed toward improved outcomes for late preterm infants.

A survey among healthcare professionals from seven countries reported diverse nutritional practices of late preterm infants

“…The National Perinatal Association in the United States just recently published the first feeding guidelines for LPT 14 . In our study, healthcare professionals in very high HDI countries reported that they referred to their hospital or national guidelines, probably being not specific for LPT.…”

Standardizing Care of the Late Preterm Infant

“…The most challenging area of care for nurses was the breastfeeding needs of LPIs (Lober et al, 2021). LPIs should breastfeed every 2 to 3 hours, and often need increased nursing support to do so effectively (AWHONN, 2017; Coleman, 2020; Jonsdottir et al, 2020).…”

“…The literature search revealed the importance of using standardized care practices for LPIs with a special emphasis on breastfeeding. Adequate feeding affects the LPI's ability to manage hypoglycemia, hyperbilirubinemia, and hypothermia (Ahmed & Rojjanasrirat, 2021; Lober et al, 2021). Human milk reduces risk of both short-term and long-term morbidities (Natalia et al, 2022).…”

Impact of an Infant-Driven Feeding Initiative on Feeding Outcomes in the Preterm Neonate

“…In addition, although direct breastfeeding was allowed in our protocol, we found that attempts at direct breastfeeding were not consistently documented, especially if the infant did not latch, and therefore rates of direct breastfeeding itself were unable to be assessed. Breastfeeding rates in late preterm infants at time of discharge are lower than in full-term infants 20. Because the emphasis of IDF is not on volume of intake but developmental skills, it is logical that IDF may lead to higher direct breastfeeding rates.…”

“…Breastfeeding rates in late preterm infants at time of discharge are lower than in full-term infants. 20 Because the emphasis of IDF is not on volume of intake but developmental skills, it is logical that IDF may lead to higher direct breastfeeding rates. However, additional studies are needed to investigate these findings, and to determine the potential impact of IDF on direct breastfeeding and/or provision of human milk after NICU discharge.…”