Implementation of a Late Preterm Protocol
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Authors
Lynch, Jonna
Issue Date
2023-05-11
Volume
Issue
Type
Manuscript
Language
Keywords
Nursing , Quality Improvement , Preterm
Alternative Title
Abstract
Background:
Late preterm infants born between 34 to 37 weeks’ gestation often have feeding issues due to decreased stamina and immature development. Hyperbilirubinemia can result from poor feeding and subsequent dehydration.
Problem:
Lack of a standardized, late preterm feeding protocol with routine administration of intravenous fluids.
Purpose/Aims/Goals:
The main aim of this quality improvement project was to implement timely enteral feedings with the 34–36-week gestation late preterm infants.
Methods & Sample:
Setting was a Level III 30-bed NICU in the Midwest. A new protocol was developed with stakeholder feedback before and after implementation. A chart review was completed to compare pre-implementation and post-implementation data on two subgroups of 34-week gestation infants (7 pre-implementation; 3 post-implementation) and 35-week gestation infants (19 pre-implementation; 10 post-implementation).
Results:
A decrease in length of stay was found for both post-protocol implementation groups. The percentage of patients requiring phototherapy decreased in the 34-week group by 17% and increased in the 35-week group by 19%. The time to full volume feedings (140ml/kg/day) decreased in both post-implementation groups. Neither post-implementation group required intravenous fluids during their hospital admission. Both groups had decreased need for NG feedings.
Conclusions:
Initiating enteral feedings within the first 1-4 hours of life decreased the length of stay, decreased the days to full feeding volumes, and decreased the need for nasogastric tube feedings. While the percentage of patients requiring phototherapy in the 35-week cohort increased, the duration of phototherapy in days was minimal.
Implications for Practice/Research:
Implementation of a late preterm protocol to promote early enteral nutrition may improve oral feeding skills in the late preterm population and decreases the need for nasogastric gavage feedings. While a larger population of infants would be beneficial, the data found a decreased length of stay in infants admitted under a late preterm protocol.
Description
Citation
Publisher
Creighton University
License
Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University