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New literature published on Standardizing Care of the Late Preterm Infant
Smith et al. (2023) conducted a quality improvement project at a level III maternal and newborn hospital to improve compliance with the late preterm infant policy. Through the work of the quality improvement project, compliance with the care practices outlined in the policy improved from 64% to over 90%.
The project focused on compliance with care in the following areas: breastfeeding, hypoglycemia, hyperbilirubinemia and hypothermia. Smith et al. (2023) described the following evidence based practices for each of the four areas of care:
Breastfeeding
• begin skin-to-skin and breastfeeding within one hour of birth
• keep mother and infant together - practice rooming in
• use lactation specialist support
• utilize triple feeding (infant breastfeeds, mother pumps, mother feeds infant pumped milk) to protect maternal milk supply and ensure LPI receives sufficient milk
Hypoglycemia
• blood glucose checks before each feeding x 24 hours
• early, frequent feedings every 2-3 hours
• manage mild to moderate hypoglycemia with breastfeeding, bottle feeding and glucose gel
Hyperbilirubinemia
• assess jaundice in the first 24 hours of life with transcutaneous or serum bilirubin measurement
• repeat transcutaneous or serum bilirubin level measurements every 12-24 hours until discharge
Hypothermia
• encourage frequent skin-to-skin contact
• temperature checks performed every 30 minutes for the first 2 hours of life then every 4 hours for the first 24 hours of life then once per shift if temperature is stable
• delay bathing as long as possible, ideally 12-24 hours of age
The quality improvement project included three major interventions:
1. an online course for all nursing and technical staff caring for late preterm infants. This course provides an evidence based review of care for the late preterm infant including explanations for differences between late preterm and term infants. You can access the learning module HERE
2. A breastfeeding log that includes information about LPI feeding needs and prompts for triple feedings. Smith et al. (2023) found that the use of the breastfeeding log prompted nurses to discuss normal feeding challenges for late preterm infants and allows nursing staff to assess if the infant is being fed frequently enough. You can access the breastfeeding log HERE
3. An EMR shortcut was devised to allow discharge education specific to the LPI to populate to the discharge paperwork.
As you are working to develop and enhance care for the late preterm infant, these tools can assist in helping reach that goal. The online course can provide staff education and reinforce the rationale behind appropriate care for the LPI. The breastfeeding log is a great way to engage parents in care and track the frequency of feedings for the LPI, working to avoid hypoglycemia, excessive weight loss and potentially hyperbilirubinemia.
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