Discharge Criteria for the Late Preterm Infant: A Review of the Literature

Characteristics of late preterm infant readmissions: A systematic review

BACKGROUND

Prematurity represents a critical health disparity. It is important to note that late preterm (LPT) infants comprise the majority of preterm births, yet they are the least studied within the premature population. Evidence-based practice guidelines are now a decade old, indicating the potential need for review and revision.

OBJECTIVES

This systematic review proposed the assessment of sociodemographic characteristics of LPT infants, clinical practice standards, and associated hospital readmission rates, mortality, and morbidity to determine the need for revision of evidence-based practice guidelines for these infants.

DATA SOURCES

The Preferred Reporting System Items for Systematic Reviews and Meta Analysis methodology provided the framework for the completion of this review. Literature searches of PubMed/Medline (Ovid), Web of Science, Cumulative Index of Nursing, and Allied Health Literature Plus databases and citation searches included articles published after 2012 using the search terms "late preterm infants," "readmissions," and "readmission rates."

CONCLUSIONS

The literature search identified 11 studies meeting search criteria. These studies included quasi experimental, retrospective, and prospective cohort studies. These studies highlighted the characteristics of LPT infants that potentially contribute to increased readmission rates, morbidity and mortality rates, health care costs, and long-term health inequities. Overall findings indicate the need for review and revision of evidence-based practice guidelines for these infants.

IMPLICATIONS FOR PRACTICE

This systematic review manifests the vulnerability of LPT infants and the accompanying need for up-to-date clinical practice guidelines to effectively reduce their morbidity and mortality rates, hospital readmissions rates, and burden of health care costs.

Readiness for Hospital Discharge and Its Correlation with the Quality of Discharge Teaching among the Parents of Premature Infants in NICU

Objectives

To assess the extent of the readiness for hospital discharge and the correlation with discharge teaching quality among parents of premature infants' in the NICU.

Background

Low readiness for discharge from the hospital can lead to negative outcomes in healthcare for infants born prematurely and their parents. Discharge guidelines are a basic approach to ensure the readiness of the parents for discharge from the hospital. No investigation has ever been conducted into the sufficiency of hospital discharge guidelines for premature infants and their impact on parental readiness for hospital discharge.

Design

Data was collected from four hospitals in China using a correlational descriptive study.

Methods

Two hundred and eight parents of premature NICU-hospitalized infants of four tertiary hospitals in Henan Province from May to October 2020 were enrolled. The general information questionnaire, the readiness for hospital discharge scale- (RHDS-) parent form, and the quality of discharge teaching scale- (QDTS-) parent form were used for data collection. Spearman correlation analysis and descriptive statistics were used to analyze the data.

Results

The total score for hospital discharge readiness was high (8.05 ± 1.11). The total score of the quality of discharge guidelines was moderate (7.44 ± 1.44). Moreover, the discharge teaching quality was positively correlated with the parents' readiness. Positive correlations were found between PRHDS and QDTS subscales, including content received and delivery, physical-emotional status, knowledge, and expected support.

Conclusion

The quality of the discharge guidelines perceived by parents of premature infants was moderate, which may have reduced their readiness for hospital discharge. Relevance to Clinical Practice. This study furnishes basic information on the importance of readiness of discharge for the parents of premature infants. The teaching guides nurses to enhance the quality of discharge teaching and the readiness of parents for discharge from the hospital.

Incidence, Risk Factors, and Reasons for 30-Day Hospital Readmission Among Healthy Late Preterm Infants

OBJECTIVE

Late preterm infants have an increased risk of morbidity relative to term infants. We sought to determine the rate, temporal trend, risk factors, and reasons for 30-day readmission.

METHODS

This is a retrospective cohort study of infants born at 34 to 42 weeks' gestation in California between January 1, 2011, and December 31, 2017. Birth certificates maintained by California Vital Statistics were linked to discharge records maintained by the California Office of Statewide Health Planning and Development. Multivariable logistic regression was used to identify risk factors and derive a predictive model.

RESULTS

Late preterm infants represented 4.3% (n = 122 014) of the study cohort (n = 2 824 963), of which 5.9% (n = 7243) were readmitted within 30 days. Compared to term infants, late preterm infants had greater odds of readmission (odds ratio [OR]: 2.34 [95% confidence interval (CI): 2.28-2.40]). The temporal trend indicated increases in all-cause and jaundice-specific readmission infants (P < .001). The common diagnoses at readmission were jaundice (58.9%), infections (10.8%), and respiratory complications (3.5%). In the adjusted model, factors that were associated with greater odds of readmission included assisted vaginal birth, maternal age ≥34 years, diabetes, chorioamnionitis, and primiparity. The model had predictive ability of 60% (c-statistic 0.603 [95% CI: 0.596-0.610]) in late preterm infants who had <5 days length of stay at birth.

CONCLUSION

The findings contribute important information on what factors increase or decrease the risk of readmission. Longitudinal studies are needed to examine promising hospital predischarge and follow-up care practices.

El empoderamiento de los padres para el cuidado del hijo prematuro

Introducción: El nacimiento, la hospitalización, la transición al hogar y el cuidado de un hijo prematuro son eventos críticos para los padres Materiales y Métodos: Se llevó a cabo un estudio cualitativo descriptivo. Se realizaron entrevistas semiestructuradas entre marzo y octubre de 2020 a 4 padres y 12 madres que tuvieron la experiencia de tener un hijo prematuro. El análisis se realizó con herramientas de la teoría fundamentada. Resultados: Se identificaron cuatro categorías: Afrontando el parto prematuro, experimentando la cotidianidad de la prematurez en la unidad neonatal, empoderándose para el cuidado del hijo prematuro y cuidando en el hogar. La categoría empoderándose para el cuidado del hijo prematuro, emergió como la categoría central dentro de la experiencia. Discusión: La experiencia de tener de un hijo prematuro es compleja, dinámica e implica una alta carga emocional para los padres. El cuidado del hijo prematuro exige el desarrollo de habilidades especificas antes del alta y en este proceso el empoderamiento se constituye como aspecto central. El empoderamiento de los padres facilita la transición y se ve favorecido por el acompañamiento del personal de enfermería, la información, la vinculación con el cuidado de su hijo en la unidad neonatal, el apoyo familiar y las condiciones individuales de cada padre. Conclusiones: En la experiencia de los padres el empoderamiento para el cuidado de sus hijos prematuros se constituye como un elemento central que facilita la transición al hogar y favorece el desarrollo de habilidades para el cuidado en el hogar.

Effects of maternal sound stimulation on preterm infants: A systematic review and meta‐analysis

AIMS

To evaluate the effects of maternal sound stimulation on preterm infants.

BACKGROUND

With an increased focus of studies on maternal sound stimulation for preterm infants, there is a need for an up-to-date systematic review and meta-analysis of randomized controlled trials to measure the effects of maternal sound stimulation on preterm infants.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

We searched PubMed, EMBASE, the Cochrane Library, CINAHL Complete, VIP Journal Integration Platform, China National Knowledge Infrastructure, Wanfang Data and China Biology Medicine disc from database establishment to 28 April 2021.

REVIEW METHODS

We conducted the meta-analysis using Review Manager 5.3. Integrative description was used for data that were not suitable for meta-analysis.

RESULTS

A total of 380 studies between 1979 and 2021 were retrieved and 26 were included in this systematic review. Maternal sound stimulation could significantly reduce the pain level and increase the comfort level of preterm infants during a painful procedure. Compared with routine care, maternal sound stimulation could help preterm infants achieve better physiological stability by reducing their heart rate and increasing their oxygen saturation.

CONCLUSION

Maternal sound stimulation is a feasible and effective intervention for preterm infants, which is highly recommended in the clinical setting.

"What are you carrying?" Experiences of mothers with preterm babies in low-resource setting neonatal intensive care unit: a qualitative study

INTRODUCTION

Babies born preterm often have challenges in feeding, temperature control and breathing difficulty and are prone to infection during the neonatal period. These usually necessitate admission to the neonatal intensive care unit (NICU). Admission to NICU disrupts the mother-baby bonding.

OBJECTIVE

This study explored the lived experiences of mothers with preterm babies admitted to NICU in a low-resource setting.

STUDY DESIGN

This was a qualitative study where 16 participants took part in indepth interviews and 35 in focus group discussions. We included mothers who delivered and were caring for preterm babies at the NICU of Mulago National Referral Hospital.

STUDY SETTING

Data were collected from a public hospital, which works as a district and national referral hospital located in the capital of Uganda.

PARTICIPANTS

Fifty-one mothers with preterm babies in the NICU were sampled and recruited after informed consent. Data were analysed using manual thematic analysis.

RESULTS

There were six themes on the experiences of mothers of preterm babies in NICU: constant worry and uncertainty about the survival of their babies, baby feeding challenges, worries of discharge, communication gaps between mothers and nurses, community acceptability and disdain for preterm babies, and financial challenges.

CONCLUSIONS AND RECOMMENDATIONS

Mothers of preterm babies admitted to NICU in a low-resource setting still need a lot of support other than the medical care given to their babies. Support groups in the hospital and community are recommended to help in dealing with these challenges.

What are the new guidelines and position papers in pediatric nutrition: A 2015-2020 overview

BACKGROUND

Nutrition related publications in pediatric population cover wide range of topics and therefore it is usually difficult for clinicians to get an overview of recent nutrition related guidelines or recommendations.

METHODS

The Special Interest Group (SIG) of Pediatrics of European Society for Clinical Nutrition and Metabolism (ESPEN) performed a literature search to capture publications in the last five years aiming to provide the latest information concerning nutritional issues in children in general and in specific diseases and to discuss progression in the field of pediatric nutrition evidence-based practice.

RESULTS

Eight major topics were identified as the most frequently reported including allergy, critical illness, neonatal nutrition, parenteral and enteral nutrition, micronutrients, probiotics and malnutrition. Furthermore, it was noted that many reports were disease focused or included micronutrients and were, therefore, represented as tables.

CONCLUSION

Overall, it has been shown that most reports on nutrition topics in pediatrics were systematic reviews or guidelines/position papers of relevant societies, but many of them basing the conclusion on a limited number of high-quality randomized controlled trials or large observational cohort studies.

Translation, Adaptation and Psychometric Validation of the Indonesian Version of the Readiness for Hospital Discharge Scale for Parents of Low Birth Weight Infants

PURPOSE

Parental readiness is a requirement for discharge of the high-risk infant from the hospital. Currently, in Indonesia, there are no standard tools to measure parental readiness according to parents' perceptions. This study aimed to undertake cross-cultural adaptation and psychometric validation of the original version (English) of the Readiness for Hospital Discharge Scale (RHDS)-Parent into Bahasa Indonesia.

DESIGN AND METHODS

The cross-cultural adaptation was comprised of seven steps: forward translation, forward translation review, blind-back translation, back translation review, pilot testing of the pre-final version with mothers of low birth weight (LBW) infants, expert panel for conceptual and content equivalence, and initial psychometric testing. In the fifth and sixth steps, content validity index was estimated. In the seventh step, exploratory factor analysis (EFA) and internal consistency reliability were conducted. In total, 146 mothers of LBW infants were included in the psychometric testing using convenience sampling.

RESULTS

The 22 item Bahasa-RHDS-Parent emerged in a four-factor structure evident from EFA. This version has good reliability with Cronbach alpha values for knowledge and coping ability (0.92), physical-emotional readiness (0.89), pain and power (0.83), expected support (0.80) and 0.90 across the total Bahasa-RHDS-Parent.

CONCLUSION

The Bahasa-RHDS-Parent presents good cross-cultural adaptation and initial psychometric properties for assessing parental readiness in parents with LBW infants before hospital discharge.

PRACTICE IMPLICATIONS

This questionnaire can be used by nurses to measure readiness for discharge of parents of low birthweight babies. Further testing is needed with a larger sample and parents of children of other ages and conditions for instrument improvement.

Approach to Feeding Difficulties in Neonates and Infants: A Comprehensive Overview

Deglutition disorders (DD) can be transient and considered as physiologic during normal maturation. However, when oral feeding milestones are impaired and bothersome symptoms and aerodigestive consequences are associated, it is interpreted as DD with varying specific entities, such as feeding difficulties, swallowing disorders, aerodigestive illness, and aspiration syndromes. Symptoms related to DD are heterogeneous and managed empirically. This article clarifies current controversies, explains the potential role of safe feeding and physiologic and pathophysiologic perspectives, and highlights current advances in the field. Evidence basis for diagnostic strategies is discussed, and involves evaluation for structure and function tests, and nutrition and feeding assessment.

Late preterm infants - Changing trends and continuing challenges

Late preterm infants, defined as newborns born between 340/7-366/7 weeks of gestational age, constitute a unique group among all premature neonates. Often overlooked because of their size when compared to very premature infants, this population is still vulnerable because of physiological and structural immaturity. Comprising nearly 75% of babies born less than 37 weeks of gestation, late preterm infants are at increased risk for morbidities involving nearly every organ system as well as higher risk of mortality when compared to term neonates. Neurodevelopmental impairment has especially been a concern for these infants. Due to various reasons, the rate of late preterm births continue to rise worldwide. Caring for this high risk population contributes a significant financial burden to health systems. This article reviews recent trends in regarding rate of late preterm births, common morbidities and long term outcomes with special attention to neurodevelopmental outcomes.

Updates on an At-Risk Population: Late-Preterm and Early-Term Infants

The American Academy of Pediatrics published a clinical report on late-preterm (LPT) infants in 2007 that was largely based on a summary of a 2005 workshop convened by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, at which a change in terminology from "near term" to "late preterm" was proposed. This paradigm-shifting recommendation had a remarkable impact: federal agencies (the Centers for Disease Control and Prevention), professional societies (the American Academy of Pediatrics and American College of Obstetricians and Gynecologists), and organizations (March of Dimes) initiated nationwide monitoring and educational plans that had a significant effect on decreasing the rates of iatrogenic LPT deliveries. However, there is now an evolving concern. After nearly a decade of steady decreases in the LPT birth rate that largely contributed to the decline in total US preterm birth rates, the birth rate in LPT infants has been inching upward since 2015. In addition, evidence revealed by strong population health research demonstrates that being born as an early-term infant poses a significant risk to an infant's survival, growth, and development. In this report, we summarize the initial progress and discuss the potential reasons for the current trends in LPT and early-term birth rates and propose research recommendations.

Experiences of Mothers of Extremely Preterm Infants after Hospital Discharge

PURPOSE

The purpose of this study was to describe and understand the experiences of mothers of extremely preterm infants during the first twelve months at home following discharge from a neonatal intensive care unit.

DESIGN AND METHODS

A qualitative, interpretative approach using Gadamer's philosophical hermeneutics was carried out. One focus group and fifteen in-depth, semi-structured interviews were conducted twelve months after hospital discharge. Responses were recorded, transcribed and analyzed using computer-assisted qualitative data analysis.

RESULTS

The study´s participants were twenty women. The following themes emerged from the data analysis: 1) 'The journey home: the discharge process', which included the sub-themes 'escaping the hospital environment: between desire and fear' and 'preparing parents for hospital discharge: practice and formal support'; and 2) 'The difficulty of living with an extremely preterm infant', including the sub-themes 'the challenge of an unexpected form of childcare', 'overprotection of and bond with a child with special needs' and 'disturbance in the social/familiar setting: when a mother becomes a nurse'.

CONCLUSIONS

The process of hospital discharge and the first months at home are difficult. The birth and care of an extremely preterm infant affect the mothers' quality of life as well as their family and social life. Practice and early discharge programmes can make the discharge process easier.

PRACTICE IMPLICATIONS

The knowledge and understanding of the experience of mothers of extremely preterm infants in the first months at home after hospital discharge could help healthcare professionals to develop educational strategies and counselling interventions in accordance with the mothers' needs.