Transitions in the Early-Life of Late Preterm Infants

Abstract

The focus of this article is on the transition of late preterm infants from hospital to home. The current state of literature related to mortality, morbidities, emergency department visits, and rehospitalization underscores the vulnerability of late preterm infants following discharge from hospital. Universal provision of postpartum care to late preterm infants is viewed as an environmental support intended to facilitate transition of these vulnerable infants from hospital to home. Gaps in provision of postpartum care of late preterm infants are situated within the discussion of guidelines and models of postpartum care (home vs clinic) of late preterm infants.

Evidence‐Based Practice to Improve Outcomes for Late Preterm Infants

“…At 35 weeks gestation, significantly fewer sulci are present in the neonatal brain, and only 60% of the total brain weight has developed (Raju, Higgins, Start, & Leveno, ). Neurologic immaturity contributes to limited suck/swallow/breath patterns and results in uncoordinated, exhausting feedings and inadequate intake of calories.…”

“…Neurologic immaturity contributes to limited suck/swallow/breath patterns and results in uncoordinated, exhausting feedings and inadequate intake of calories. Neurologic prematurity also prevents the LPI from giving feeding cues and maintaining awake periods for successful feedings (Darcy, ; Raju et al., ). See Table .…”

“…The incidence of respiratory distress is significant in infants born fewer than or equal to 35 weeks gestation compared to infants born at greater than or equal to 38 weeks gestation (Escobar, Clark, & Greene, ). LPIs experience more respiratory complications due to lack of pulmonary surfactant and an immature respiratory center in the brain, which increase the risk of respiratory distress syndrome and apnea (Darcy, ; Raju et al., 2006). In the last 6 weeks of gestation, critical structural changes in the lungs occur.…”

“…The terminal respiratory units, alveolar saccules, mature into alveoli lined with type I epithelial cells. Also during this period, pulmonary capillaries necessary for gas exchange begin to fill the alveoli and surfactant is present (Darcy, , Raju et al., 2006).…”

“…From the review of literature, a LPI Clinical Practice Guideline was developed and approved by the Perinatal Practice Committee, an interprofessional hospital committee with representatives from labor and delivery, mother/infant, and neonatal intensive units. The clinical practice guideline incorporates current evidence from AWHONN, American Academy of Pediatrics, and the National Institute of Child Health and Human Development (AWHONN, , ; Engle et al., ; Raju et al., 2006). These guidelines recommend anticipatory care to conserve physiologic resources, facilitate throughput to appropriate levels of care, and avoid separation of mother and infant as much as possible (see Figure ).…”