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Updated: May 19, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Newborn clinical outcomes of the AWHONN late preterm infant research-based practice project
Barbara Medoff Cooper1, Diane Holditch-Davis, M Terese Verklan
1University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, USA. medoff@nursing.upenn.edu
Insights
Late preterm infants (LPIs) face significant neonatal health risks, including hypothermia and feeding difficulties. Younger gestational ages increase these risks, highlighting the need for targeted nursing interventions.
Area of Science:
- Neonatal Health
- Perinatal Medicine
- Pediatric Nursing
Background:
- Late preterm infants (LPIs), born between 34 and 36 weeks gestation, are at increased risk for adverse neonatal outcomes compared to full-term infants.
- Existing research suggests LPIs experience higher rates of morbidity, necessitating further investigation into specific health risks and contributing factors.
Purpose of the Study:
- To identify and describe common neonatal health risks in LPIs.
- To determine the association between gestational age at birth and the incidence of these neonatal health risks.
- To inform evidence-based nursing practices for LPIs.
Main Methods:
- A descriptive analysis of prospective data from a large, multisite study involving 802 LPIs.
- Data were collected from infant medical records across 14 hospitals in the United States and Canada.
- Infants were born between 34 0/7 and 36 6/7 weeks of gestational age.
Main Results:
- Over half of LPIs experienced hypothermia, hypoglycemia, feeding difficulties, hyperbilirubinemia, respiratory distress, or required a septic workup.
- The incidence of these neonatal health problems was significantly higher in infants born at younger gestational ages within the late preterm range.
- While 36% of LPIs initially required special care, 52% received kangaroo care within 48 hours of birth.
Conclusions:
- LPIs are demonstrably at high risk for neonatal health complications during hospitalization.
- Early identification of risks and simple nursing interventions, such as promoting kangaroo care and judicious bathing practices, can mitigate adverse outcomes.
- Findings underscore the importance of specialized care protocols for late preterm infants.
Objective:
To describe the neonatal health risks (hypothermia, hypoglycemia, hyperbilirubinemia, respiratory distress, the need for a septic workup, and feeding difficulties) experienced by late preterm infants (LPIs) from a large multisite study and determine how these risks were affected by gestational age at birth.
Design:
Descriptive analysis of prospective data obtained as part of the AWHONN Late Preterm Infant Research-Based Practice Project.
Setting:
Fourteen hospitals located through the United States and Canada.
Participants:
Late preterm infants (802) born at gestational ages between 34 0/7 and 36 6/7 weeks.
Methods:
Nurses at each site obtained consent from the mother of the infant. The data about the infant were gathered from the infant's medical record.
Results:
Thirty-six percent of LPIs were initially cared for in a special care nursery; approximately one half of these infants were eventually transferred to a well-baby nursery. Of the 64% of LPIs initially cared for in a routine nursery, 10% were transferred to a special care unit or neonatal intensive care unit (NICU). More than one half of LPIs experienced hypothermia, hypoglycemia, feeding difficulties, hyperbilirubinemia, and respiratory distress and/or needed a septic workup. The risk for these problems was higher in infants of younger gestational ages. Thirty-two percent of the infants were bathed during the first 2 hours of life, and by 4 hours, more than two thirds had had their first bath. Fifty-two percent received kangaroo care during the first 48 hours of life.
Conclusion:
These findings support those of smaller studies indicating that LPIs are at high risk for developing health problems during their neonatal hospitalization. Nurses may be able to ameliorate some of these health problems through early identification of problems and simple, inexpensive interventions such as avoiding early bathing and promoting kangaroo care.
