Outcomes of 35-Week-Old Infants Routinely Admitted to Higher Levels of Care

To understand the prevalence and time course of symptoms and interventions for 35-week-old infants routinely admitted to the level II special care nursery (SCN) for observation.

This single-institution, retrospective, cohort study analyzed electronic medical records of infants born at 3507 to 3567 weeks' gestation from 2023 to 2024.

Of 186 infants, 31% were admitted to the neonatal intensive care unit, 67% to the SCN, and 2% to the well newborn nursery (NBN). Thirty-eight percent were discharged from the NBN; these infants had higher birth weights and lower rates of interventions. The median length of stay (LOS) was 8 days. Tachypnea was documented in 97%; 42% received respiratory support. Hypothermia was documented in 68%; 33% received incubator care. Hypoglycemia was present in 37%; 18% received dextrose gel, and 12% received intravenous fluid. Tube feeding was used in 58%. Apnea, bradycardia, desaturation (ABD) events were recorded in 33%. Most symptoms and interventions started in the first 24 hours of life and concluded by 96 hours. Tube feeding was associated with a 161% longer LOS, and monitoring after ABD events was associated with a 62% longer LOS.

Routine admission of 35-week-old infants to the SCN for observation resulted in most being discharged from the SCN. Tube feeding and monitoring after ABD events were associated with extended LOS. These interventions may indicate overmedicalization for some infants.