Jump to content

Late Preterm Infants on Mother Baby Unit Thoughts?

Posted

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

Specializes in Private Duty Pediatrics. Has 42 years experience.

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

NICU Guy, BSN, RN

Specializes in NICU. Has 6 years experience.

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.

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-