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Escalation of Care for Late Preterm Infants During the Birth Hospitalization
Neha S Joshi1, Jochen Profit1, Adam Frymoyer1
1Department of Pediatrics, Stanford University, Stanford, California.
Insights
Most late preterm infants needing escalated care require it within 24 hours of birth. Respiratory support, cardiorespiratory monitoring, and thermoregulation were the primary reasons for this increased care need.
Area of Science:
- Neonatal Medicine
- Pediatrics
- Perinatology
Background:
- Late preterm infants (34 + 0 to 36 + 6 weeks) constitute a significant portion of annual births in the US.
- Variations in admission locations for these infants are documented.
- Understanding care escalation patterns is crucial for optimizing resource allocation and patient outcomes.
Purpose of the Study:
- To determine the timing of care escalation for late preterm infants during their birth hospitalization.
- To identify the specific reasons necessitating a higher level of care for these infants.
- To analyze transfer patterns within the birth hospitalization for late preterm infants.
Main Methods:
- A single-center retrospective cohort study was conducted.
- Infants born between 2019 and 2021 at 34 + 0 to 36 + 6 weeks gestation were included.
- Infants with congenital anomalies requiring NICU admission were excluded, focusing on those needing escalation of care post-birth.
Main Results:
- Of 872 infants not admitted to the NICU at birth, 14% (n=124) required escalation of care.
- The most common reasons for escalation included respiratory support (26%), cardiorespiratory monitoring (25%), thermoregulation (23%), and intravenous fluids (22%).
- Care escalation occurred at a median of 12.5 hours post-birth, with 50% within 12 hours and 67% within 24 hours.
Conclusions:
- Escalation of care for late preterm infants predominantly occurs within the initial 24 hours post-birth.
- Respiratory support is the leading indication for increased care needs.
- Cardiorespiratory monitoring and thermoregulation are also significant factors driving care escalation in this population.
Objective:
Late preterm infants represent nearly a quarter of a million infants born in the United States annually. There is a known variation in admission location for these infants. The objective of this study was to identify the timing and reasons for transfer for late preterm infants requiring an escalation in care during the birth hospitalization.
Patients And Methods:
This single-center retrospective cohort study examined the birth hospitalization for late preterm infants (34 + 0 to 36 + 6 weeks) born between 2019 and 2021, specifically focusing on infants requiring an escalation to a higher level of care. Infants with congenital anomalies expecting neonatal intensive care unit (NICU) admission were excluded. The analysis included descriptive and inferential statistics.
Results:
Of 1022 infants, 150 symptomatic infants were admitted to the level III/IV NICU at birth. Of the remaining 872 infants, 14% (n = 124) received escalation of care (n = 77 from level I to II, 25 from level I to III/IV, 22 from level II to III/IV). The most common reasons for escalation were need for respiratory support (n = 32, 26%), cardiorespiratory monitoring (n = 31, 25%), thermoregulation (n = 29, 23%), and dextrose-containing intravenous fluids (n = 27, 22%). Infants required escalation of care at a median of 12.5 hours after birth (IQR 4-40 hours, range 0-133), with 50% (n = 62) occurring within the first 12 hours and 67% (n = 83) within 24 hours.
Conclusions:
Escalation of care for late preterm infants most frequently occurs in the first 24 hours after birth. The most frequent reasons for escalation were the need for respiratory support, followed by cardiorespiratory monitoring and thermoregulation.
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