Late Preterm Infants on Mother Baby Unit Thoughts?

[laurencsmile]

Our hospital has an LPI pathway (for babies as low as 34 1/7 weeks) but I am told 'we dont follow the pathway' by the charge rns because it would require a nicu RN to float to the mother baby unit.

So we care for LPIs on mother baby who the NICU clears after 10 minture APGARs. For LPIs we have a 6:1 patient ratio (3 couplets) with blood sugars and vitals every 3 hours. Is this appropriate? I thought LPIs should spend 24h in the nicu or with a nicu RN before going to a well baby care unit but I can't find a clear recommendation from AWHONN. I get nervous taking care of the 34-35 weekers as a 'well-baby' RN with no NICU training and 6 patients to care for even if they are doing well because they can be 'great pretenders' per the literature and what I have seen in my practice (hypothermia & hypoglycemia)

Also, if a baby is doing well (sucking, swallowing, stable VS) after 24 hours what should the staffing be for a well-baby unit. Again, we do 6:1 patients (3 couplets) Thoughts on proper staffing for Late Preterm Infants?

[Kitiger, RN]

What is LPI? Never mind. It's late preterm infant, right?

[NICU Guy, BSN, RN]

34 weeks is about the beginning of infants learning how to coordinate the sequence of taking a bottle (suck, swallow, breathe). If they are able to take a bottle without desaturations, without oxygen, and being able to maintain their temperature (essentially act like a term baby), they are pretty stable.

2 hours ago, laurencsmile said:

with blood sugars and vitals every 3 hours

Our protocol is blood sugars before each feed. Once you have three blood sugars in a row >60, then stop. Q3 vitals and feeds are appropriate.

The biggest issues with stable 34-35 weekers is NEC. Feed volumes should be limited (starting out at 20-40mL/Kg/day) to decrease the likelihood of developing NEC, then progress the volume up each day. Abdominal circumference every 4-6 hrs. Look for distended, taut abdomen, bowel loops, discolored belly, and persistent emesis. All are signs of belly issues.

[Nunya, BSN]

You can't read the whole article without paying but I think there enough here to show it's a dangerous practice. One neo I knew said his sickest baby EVER was a 34 weeker. I've done NICU and I sure as heck wouldn't want a 34 weeker on a MBU. They can go bad so so fast.

https://r.search.Yahoo.com/_ylt=AwrEzewYR.heQi4A4RBx.9w4;_ylu=X3oDMTBydDI5cXVuBGNvbG8DYmYxBHBvcwM2BHZ0aWQDBHNlYwNzcg--/RV=2/RE=1592309656/RO=10/RU=https%3a%2f%2fwww.jognn.org%2farticle%2fS0884-2175(15)31230-2%2ffulltext/RK=2/RS=kN877IIML3psJ7gtcNnVwEPHxco-

[NRSKarenRN, BSN, RN]

Above referenced article link:

Newborn Clinical Outcomes of the AWHONN Late Preterm Infant Research‐Based Practice Project https://www.jognn.org/article/S0884-2175(15)31230-2/fulltext