The late preterm infant in a baby friendly hospital

[mandyjk77]

Hello, Just wanted to see what other "baby friendly" hospital's policies were regarding a baby 35-36.6 wks. In our hospital, any baby under 35 wks goes to NICU for at minimum 24 hr obs. If they are over 35 wks, vigorous at birth and have stable VS we keep them with moms for kangaroo care and breastfeeding. We will transfer them early if they need a blood sugar b/c they're less than 2500 gms/over 4000gms., or if mom's a Gest. DM, or they're not maintaining their temps etc.... but as long as they're stable we don't separate mom & baby. We had an incident where the baby was transferred to the nursery without mom b/c he started grunting and retracting. He was transferred at 1hr 55 mins of life. Mom was a c/s so he KC with dad during the section and then mom and baby did KC and attempted breast feeding. He was then taken to the NICU per the pediatrician b/c he was 36.6 wks, grunting and retracting and sating at 90%. I know the o2 sat was low but, I thought this was a little over kill. What do you guys think, what are your policies for these late pretermers? Our policies don't address these babies and they fall through the cracks. Please help me out and let me know what you do with these babes.Thanks!!

[Jolie, BSN]

As a NICU nurse and the mother of 2 preemies, I appreciate your (and your hospital's) dedication to keeping moms and babies together if at all possible. But I don't believe that NICU observation for a preterm infant who is grunting, retracting and desatting on room air is overkill.

There is no way to know, without the benefit of time and observation, whether your little patient is experiencing mild transcient tachypnea or heading down the path of respiratory distress syndrome. If there is staff and equipment available to observe the baby 1 on 1 (unclothed) in the mother's room, I would be supportive of that. Kangaroo care is great for maintaining temp and encouraging baby to lie supine, which supports the chest wall. But if any covering is necessary, it becomes difficult to observe color and chest wall movement, as well as to hear grunting. A radiant warmer may be necessary temporarily to allow for better observation of a questionable infant. If that can't be arranged in the patient's room, then the NICU is necessary.

I would never take lightly interfering with bonding, but having been called to patients' rooms to resuscitate infants, I also don't take lightly the un-predictability of a late preemie, especially one delivered by C-section.

Edited to add:

You mention that the baby was transferred at approximately 2 hours of age, after attempting breastfeeding. To me, that is significant. Babies who are experiencing mild TTN will often improve with time, as they cry, move secretions from their airways, and recruit more alveoli.

Babies who are experiencing surfactant insufficiency (RDS) typically worsen with time as they "use up" or diminish their limited surfactant supply and begin to tire with the work of breathing.

The ped allowed this baby 2 hours to "declare" himself. If the baby's condition was declining within that 2 hour time frame, then I absolutely agree with the transfer.

Policies can't possibly address every circumstance. Assessment skills, knowledge of normal transition versus disease process, and experience must be utilized to make decisions regarding every individual baby. What was the outcome?

[mandyjk77]

Thank you for explaining that the way you did! Now I understand why she transferred him to the NICU. I don't know the outcome but I know he was put on 100% O2 for a while and then weaned down, but I don't know how long he spent in the NICU. Thanks again!