Infants who are born late preterm represent the largest population among infants born <37 weeks gestation. At present, there is no routine data collection on the outcomes of late preterm infants in England. Although there are some international position statements with regards to care and monitoring of the late preterm infant [14], there is limited published data on what gestation and birth weight cut offs are used to decide whether these babies can be cared for in a mother-baby unit setting versus those requiring direct special care baby unit admission. This is the first survey which documents admission practices among all units in England and represents an important piece of data for ongoing surveillance of this group and for future service development and planning.
Until recently, the majority of research in relation to morbidity and outcome of preterm infants has focussed on infants born at extremes of prematurity [15]. This is not surprising given that this group is the most at risk among preterm babies. However, recent reviews have demonstrated that infants born late preterm are also at risk [16]. One of the issues facing clinicians who look after late preterm infants, is deciding which infants require admission to the neonatal or special care unit and which infants can be safely nursed on the post natal ward. There are clear advantages to keeping mothers and babies together. These include improved maternal and infant bonding and easier facilitation of breast feeding [17]. From the baby’s perspective, admission to the neonatal unit is frequently accompanied by intensive monitoring of vital signs, blood sugar and temperature. Late preterm infants are also more likely to undergo evaluations for suspected sepsis [18]. In some cases this level of care may delay discharge for certain babies.
Our study highlights that for the majority of units, care of some late preterm infants on the post natal ward is a consideration. In addition to the maternal and baby benefits, this practice also results in a significant cost saving as the daily cost of caring for infants admitted to neonatal intensive care and special care far exceeds that for infants and mothers nursed on the postnatal ward.
Based on our own local experience, any infant of gestation 35 weeks or more, whose birth weight is >1700 g and who is otherwise well, can be considered eligible for direct post natal ward admission. Regular departmental audits of this guideline have previously shown that approximately 76% of all late preterm infants who fulfil this criteria are admitted to the postnatal ward directly from the delivery suite with approximately 10% going on to require neonatal unit admission and a further 10% requiring readmission to hospital following discharge. We believe this strategy works well for our population of late preterm infants, though careful monitoring and follow-up after discharge is essential.
One of the limitations of this study is that other than asking about the presence or absence of paediatric nursery nurses on post natal wards, we did not establish why individual units adopt different direct post natal admission policies and how individual units came to establish their local guidelines. It is therefore difficult to explain why larger units appear to admit smaller babies born at earlier gestation to the post natal ward. The role of transitional care units on the postnatal ward requires further evaluation. We also acknowledge that there are many other providers of and factors influencing high quality infant care on the PNW that were not assessed in this study. These include midwifery staffing levels and training in addition to breast feeding advisors. Future studies may therefore concentrate on prospectively collected data on all late preterm infants who are directly admitted to the postnatal ward and the factors that influence their admission.
