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A national survey of admission practices for late preterm infants in England
Paul F Fleming, Puneet Arora, Rebecca Mitting
1Neonatal Intensive Care Unit, Homerton University Hospital NHS Foundation Trust, London, UK. Narendra.Aladangady@homerton.nhs.uk.
Insights
Admission practices for late preterm infants vary across English neonatal units. Guidelines exist in most units, but specific criteria differ, highlighting the need for further research into influencing factors.
Area of Science:
- Neonatal Medicine
- Pediatric Care
- Public Health
Background:
- Late preterm infants (34-36 weeks gestation) require clear management protocols.
- Uncertainty exists regarding their optimal care setting: postnatal ward versus neonatal unit.
Purpose of the Study:
- To survey national admission practices for late preterm and low birth weight infants directly to the postnatal ward in England.
- To identify variations in admission criteria and influencing factors.
Main Methods:
- A national survey of all 180 neonatal units in England was conducted.
- Data on admission practices for late preterm infants were collected via direct contact.
- Unit designations (SCU, LNU, NICU) and presence of PNW nursery nurses were recorded.
Main Results:
- 161 units (89%) had written guidelines for direct PNW admission.
- Gestational age and birth weight limits for PNW admission varied significantly by unit designation.
- The presence of PNW nursery nurses did not significantly impact admission criteria.
Conclusions:
- Neonatal unit designation in England influences admission practices for late preterm infants.
- Further research is necessary to understand the factors driving these variations and optimize care pathways.
Background:
Infants born at 34(+0) to 36(+6) weeks gestation are defined as 'late preterm' infants. It is not clear whether these babies can be managed on the postnatal ward (PNW) or routinely need to be admitted to the neonatal unit after birth.
Aim:
To conduct a national survey of admission practice for late preterm and low birth weight infants directly to the PNW after birth in England.
Methods:
All neonatal units were identified from the Standardised Electronic Neonatal Database (SEND). Individual units were contacted and data collected on their admission practice.
Results:
All 180 neonatal units in England responded. 49, 84 and 47 Units were Special Care Units (SCUs), Local Neonatal Units (LNUs) and Neonatal Intensive Care Units (NICUs) respectively. 161 units (89%) had written guidelines in relation to direct PNW admission for late preterm infants.The mean gestational age of infants admitted directly to the PNW was significantly lower in LNUs compared to SCUs and NICUs compared to LNUs. Mean birth weight limit for direct PNW admission was significantly lower in NICUs compared to SCUs.72 units had PNW nursery nurses. There was no significant difference in gestational age or birth weight limit for direct PNW admission in the presence of PNW nursery nurses.
Conclusions:
Admission practices of late preterm infants directly to the PNW varies according to designation of neonatal unit in England. Further studies are needed to establish the factors influencing these differences.
