Download PDF
Am J Perinatol 2015; 32(08): 747-754
DOI: 10.1055/s-0034-1396689
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Postpartum Triage, Services Provided, and Length of Stay for Infants Born At 35 Weeks Gestation

James I. Hagadorn
1   Divison of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut
2   Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
,
Saritha Salikooti
1   Divison of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut
2   Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
,
Mariann Pappagallo
1   Divison of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut
2   Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
,
Jose Arias-Camison
3   Divison of Neonatology, St. Francis Hospital, Hartford, Connecticut
,
Scott Weiner
4   Divison of Neonatology, The Hospital of Central Connecticut, New Britain, Connecticut
,
Jorge Alba
5   Divison of Neonatology, Manchester Memorial Hospital, Manchester, Connecticut
,
Victor Herson
1   Divison of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut
2   Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
› Author Affiliations
Further Information

Publication History

05 June 2014

01 October 2014

Publication Date:
23 December 2014 (online)

Also available at
    Permissions and Reprints

Abstract

Objectives The aim of this article is to (1) compare the care setting to which 35-week infants are initially triaged postpartum to the level of services subsequently provided; and (2) identify factors known at delivery or immediately postpartum associated with services received and length of stay during the birth hospitalization.

Study Design In this multicenter retrospective study of 35-week infants born between 2007 and 2008, service capabilities of the initial postpartum care setting were categorized as level 1 or neonatal intensive care unit (NICU) using American Academy of Pediatrics definitions. Subsequent services actually provided were categorized as routine care, level 1, or >level 1.

Results Over half of 431 studied infants were sent to a level 1 nursery postpartum. Of these, over 90% ultimately received routine care or level 1 services. Of 200 infants triaged to a NICU, the majority received only routine care or level 1 services. The great majority of infants requiring > level 1 services were identified promptly postpartum. Initial triage to the NICU was associated with significantly (p < 0.05) increased length of stay despite provision of similar services.

Conclusions This study suggests a need for improved triage of 35-week infants and provides tools for this purpose. Validation of the models presented here is warranted.

Keywords

infant - premature - length of stay - health resources - late preterm
 

  • References

  • 1 Laptook AR. Neurologic and metabolic issues in moderately preterm, late preterm, and early term infants. Clin Perinatol 2013; 40 (4) 723-738
    CrossrefPubMedGoogle Scholar
  • 2 Meier P, Patel AL, Wright K, Engstrom JL. Management of breastfeeding during and after the maternity hospitalization for late preterm infants. Clin Perinatol 2013; 40 (4) 689-705
    CrossrefPubMedGoogle Scholar
  • 3 Ramachandrappa A, Jain L. Health issues of the late preterm infant. Pediatr Clin North Am 2009; 56 (3) 565-577
    CrossrefPubMedGoogle Scholar
  • 4 Young PC, Glasgow TS, Li X, Guest-Warnick G, Stoddard G. Mortality of late-preterm (near-term) newborns in Utah. Pediatrics 2007; 119 (3) e659-e665
    CrossrefPubMedGoogle Scholar
  • 5 Engle WA. Morbidity and mortality in late preterm and early term newborns: a continuum. Clin Perinatol 2011; 38 (3) 493-516
    CrossrefPubMedGoogle Scholar
  • 6 Hellmeyer L, Herz K, Liedtke B, Wohlmuth P, Schmidt S, Hackeloeer BJ. The underestimation of immaturity in late preterm infants. Arch Gynecol Obstet 2012; 286 (3) 619-626
    CrossrefPubMedGoogle Scholar
  • 7 Medoff Cooper B, Holditch-Davis D, Verklan MT , et al. Newborn clinical outcomes of the AWHONN late preterm infant research-based practice project. J Obstet Gynecol Neonatal Nurs 2012; 41 (6) 774-785
    CrossrefPubMedGoogle Scholar
  • 8 Phillips RM. Multidisciplinary guidelines for the care of late preterm infants. Introduction. J Perinatol 2013; 33 (Suppl. 02) S3-S4
    CrossrefPubMedGoogle Scholar
  • 9 Ananth CV, Friedman AM, Gyamfi-Bannerman C. Epidemiology of moderate preterm, late preterm and early term delivery. Clin Perinatol 2013; 40 (4) 601-610
    CrossrefPubMedGoogle Scholar
  • 10 Mathews TJ, Miniño AM, Osterman MJ, Strobino DM, Guyer B. Annual summary of vital statistics: 2008. Pediatrics 2011; 127 (1) 146-157
    CrossrefPubMedGoogle Scholar
  • 11 Shapiro-Mendoza CK, Tomashek KM, Kotelchuck M, Barfield W, Weiss J, Evans S. Risk factors for neonatal morbidity and mortality among “healthy,” late preterm newborns. Semin Perinatol 2006; 30 (2) 54-60
    CrossrefPubMedGoogle Scholar
  • 12 Phillips RM, Goldstein M, Hougland K , et al; National Perinatal Association. Multidisciplinary guidelines for the care of late preterm infants. J Perinatol 2013; 33 (Suppl. 02) S5-S22
    CrossrefPubMedGoogle Scholar
  • 13 Academy of Breastfeeding Medicine. ABM clinical protocol #10: breastfeeding the late preterm infant (34(0/7) to 36(6/7) weeks gestation) (first revision June 2011). Breastfeed Med 2011; 6 (3) 151-156
    CrossrefPubMedGoogle Scholar
  • 14 Raju TN, Higgins RD, Stark AR, Leveno KJ. Optimizing care and outcome for late-preterm (near-term) infants: a summary of the workshop sponsored by the National Institute of Child Health and Human Development. Pediatrics 2006; 118 (3) 1207-1214
    CrossrefPubMedGoogle Scholar
  • 15 Raju TN. Moderately preterm, late preterm and early term infants: research needs. Clin Perinatol 2013; 40 (4) 791-797
    CrossrefPubMedGoogle Scholar
  • 16 American Academy of Pediatrics Committee on Fetus And Newborn. Levels of neonatal care. Pediatrics 2012; 130 (3) 587-597
    CrossrefPubMedGoogle Scholar
  • 17 Stark AR ; American Academy of Pediatrics Committee on Fetus and Newborn. Levels of neonatal care. Pediatrics 2004; 114 (5) 1341-1347
    CrossrefPubMedGoogle Scholar
  • 18 Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS. New intrauterine growth curves based on United States data. Pediatrics 2010; 125 (2) e214-e224
    CrossrefPubMedGoogle Scholar
  • 19 Escobar GJ, Greene JD, Hulac P , et al. Rehospitalisation after birth hospitalisation: patterns among infants of all gestations. Arch Dis Child 2005; 90 (2) 125-131
    CrossrefPubMedGoogle Scholar
  • 20 Tomashek KM, Shapiro-Mendoza CK, Davidoff MJ, Petrini JR. Differences in mortality between late-preterm and term singleton infants in the United States, 1995-2002. J Pediatr 2007; 151 (5) 450-456 , 456.e1
    CrossrefPubMedGoogle Scholar
  • 21 Bérard A, Le Tiec M, De Vera MA. Study of the costs and morbidities of late-preterm birth. Arch Dis Child Fetal Neonatal Ed 2012; 97 (5) F329-F334
    CrossrefPubMedGoogle Scholar
  • 22 Adamkin DH. Feeding problems in the late preterm infant. Clin Perinatol 2006; 33 (4) 831-837 , abstract ix
    CrossrefPubMedGoogle Scholar
  • 23 Laptook A, Jackson GL. Cold stress and hypoglycemia in the late preterm (“near-term”) infant: impact on nursery of admission. Semin Perinatol 2006; 30 (1) 24-27
    CrossrefPubMedGoogle Scholar
  • 24 Roblin DW, Richardson DK, Thomas E , et al. Variation in the use of alternative levels of hospital care for newborns in a managed care organization. Health Serv Res 2000; 34 (7) 1535-1553
    PubMedGoogle Scholar