Care of the Late Preterm Consensus 

Evidence based, expert aided Guidelines for Care of the Late Preterm Neonate

Gestational Age: 34+0 to 36+6 weeks

Date of Initial Publication: October 2024

Date of Reviews: 

Authors: 

Amy Cohen, MD, Nadege Brutus, DO, Stephanie Grayson, MD, Michelle Kelly, MD, Kirstie Marcello Donnelly, MD, Joseph Asaro, DO, Maureen Dowling RD, Melissa Weissman APN, Jonathan Knowlton MD, Mark Castera MD, Purvi Kapadia Jethva, MD, Jason Burgess ANC, Anna Sosnovski MD, Adriana Jepsen MD, Thomas Habib MD, Sam Garber MD, Allie Pulsifer APN, Colleen Flounder RD, Amy Lembeck DO, Shehla Siddiqui MD, Courtney Merchant MD, Hannah Chalal MD, Lori Christ MD, Betsy Salazar MD, Joanna Parga Belinkie MD, Lottie Chapman APN, Jennifer Peterman RN, JoAnn Blaser RN, Sharon Hangliter RD, Jill Cummins RD, Jacki Kroons RD, Jennifer Tioseco MD, Sherry Thrash RD, Alina Ivashchuk MD, Stacy Greblick RN, Jherna Balany MD, Michelle Kwok PA, Melissa Micallef MD, Diana Yanni MD, Dave Carola MD, Hayato Unno MD, Erin Price OTD, Sarvin Ghavam MD

Communicating Author(s): Sarvin Ghavam MD, Betsy Salazar MD, Sherry Thrash RD 

Background

The care of the late preterm neonate is diverse as the population it applies to. Late preterm neonates consist of neonates born from 34 + 0/7 weeks gestation to 36 + 6/7 weeks gestation. Late preterm neonates compromise a large proportion of neonatal intensive care admissions and their care tends to have large inter and intragroup variation among medical care providers. Consistency of care has been proven to improve neonatal outcomes and this regional consensus sought to find agreement in late preterm care regarding admission policy, respiratory care, definition of significant cardiopulmonary episodes and discharge criteria.

Consensus goals

• Providing consistent care to the late preterm population across the Mother Baby to Neonatal Care units.
• Defining unified criteria for admission and discharge.
• Consistent feeding and nutritional care parameters. 

Abstract

This consensus involved over 25 local hospitals including the CHOP Newborn Care Network, Hospital of University of Pennsylvania, Pennsylvania Hospital, Thomas Jefferson University, Temple University Hospital, Cooper Hospital, and Christiana Care Hospital. With high consensus levels, local consensus was that late preterm neonates born greater than 36 weeks have automatic admission to the Mother-Baby Unit (MBU)/Well Baby Nursery (WBN); neonates born in the 35-week gestation age range could have a trial of admission directly to the MBUs (based highly on local practice and comfort) and neonates born less than 35 weeks’ gestation should have direct admission to the Neonatal Intensive Care Unit (NICU). 

Guidance on further clarification of admission criteria as well as discharge criteria were agreed upon, including definition for significant cardiopulmonary event in the late preterm gestation as well as minimum length of stay prior to discharge for neonates having cardiopulmonary events in the late preterm population. 

Specific recommendations for nutritional support for these neonates was developed based on current available literature in order to insure proper growth, caloric and vitamin needs. Late preterm infants, born between 34- and 36-weeks’ gestation, account for approximately 75% of all preterm births yet there are minimal published guidelines directing best feeding practices. Studies have shown that compared to their term counterparts, they are at a higher risk for developing complications such as hypoglycemia, oral feeding difficulties, nutrient deficits, and inadequate weight gain. Delayed intervention and inadequate nutrition support can prolong hospital stays and contribute to poorer short- and long-term health outcomes. Nutritional needs within the late preterm population inversely correlate with both gestational age and birth weight. Care plans should be tailored to meet metabolic needs and compensate for developmental delays associated with prematurity. Utilizing a structured framework for nutrition recommendations can improve outcomes by supporting breastfeeding, guiding supplementation and formula selection when needed, and outlining strategies for monitoring growth parameters. 

Consensus was reached on unified car seat test failure criteria, which includes desaturations of <90% for greater than 20 seconds and bradycardia less than 80 bpm (*specific outliers defined). Unified thermoregulation guidelines were developed for the subpopulation of late preterm neonates both within the NICU and in the Mother Baby Units, including radiant warmer fails and criteria for NICU transfers. Recommendations for antenatal steroids based on ACOG recommendations and in conjunction with OB-GYN colleagues were developed, along with respiratory care guidelines, use of CPAP as initial mode for respiratory support as well as the indications for surfactant use. 

The late preterm neonate population is a large proportion of NICU admissions and often a source of variation in care by practitioners; this consensus was able to reach strong consensus around several key factors driving the care of this population. 

Initial Care of the Late Preterm Neonate

Automatic Admission to the NICU recommended for 

• All neonates born less than 35 weeks GA
  • Please see GA criteria below
• Birthweight < 2 kg
  • Provider discretion can be used
• Need for respiratory support
• Failed CCHD Test
• Require Dextrose containing IVF secondary to hypoglycemia

Strong consideration for Admission to NICU 

• Feeding difficulties, significant weight loss from birthweight (BW)
  • Weight loss of >10% from BW
• Temperature instability unable to be addressed in MBU/WBN
  • Temperature stability is vital, recommendation for transfer to NICU if neonate requires more than 2 instances of a warmer bed (fails open crib)
• Significant apnea, cyanosis, desaturation episode noted in MBU/WBN
  • Witnessed color change episode (considerations can be made if directly related to a feeding event).
  • Neonates monitored on a pulse oximeter or monitor in an MBU/WBN setting with significant changes in heart rate or pulse ox limits, or witnessed apneic episodes

Consideration for Admission to NICU based on local hospital policies/structure

• Need for IV antibiotics secondary to sepsis evaluation
• Treatment for NOWS/NAS
• Failed car seat test
  • Consider discussion with Neonatology 

Admission by Gestational Age Criteria

34 to 34+6 wk GA

• Automatic admission to NICU

35 and 35+6 wk GA

• Based on local clinical data, consideration can be given to admitting 35 week GA neonates born greater than 2kg to the MBU/WBN
  • If admitted to the MBU/WBN, a minimum hospital stay of 48 hours is recommended
    • In conjunction with local MBU/WBN and Maternal/OBGYN practices
  • Specific MBU/WBN criteria for acceptable feeding must be predetermined
  • Recommendation for breastfeeding (if parental choice) followed by supplementation with pumped breastmilk, donor milk (if available or based on unit policy) or formula
  • Glucose monitoring during the first 24- 48 hours life is recommended
• If admitted to the NICU as per individual NICU discretion, would consider transfer to MBU/WBN following a suggested 12-24 hours observation if neonate shows
  • Stable temperatures without need of radiant warmer or incubator
  • Acceptable blood glucoses
  • Acceptable feeding with breastfeeding and supplementation, as per parental desires
  • Stable respiratory status without noted desaturations, apnea or bradycardia episodes

36 to 36+6 weeks

Automatic Admission to MBU/WBN for all neonates born greater than 36 weeks and >2kg

• Transition to NICU is recommended for those neonates that meet any of the criteria for NICU admission

Admission and observation to the NICU is recommended

Significant Apnea, Bradycardia, Desaturation Episodes in MBU/WBN

• Witnessed color change episode (considerations can be made if directly related to a feeding event).
  • Neonates monitored on a pulse oximeter or monitor in an MBU/WBN setting with significant changes in heart rate or pulse ox limits, or witnessed apneic episodes

Late Preterm Sepsis Evaluation Consensus Recommendations

For Neonates born 34-34+6 weeks GA

• Consider the use of the EOS calculator with adjustment clinical exam markers to help decision for antibiotics administration
• Delivery for maternal indications only without rupture of membranes and no other risk factors
  • May consider clinical monitoring in NICU if only mild to moderate respiratory support needs
  • Use of clinical judgement highly warranted
  • Per AAP Statement
    • Infants born preterm by cesarean delivery because of maternal noninfectious illness or placental insufficiency in the absence of labor, attempts to induce labor or ROM before delivery are relatively low risk of EOS. Depending the clinical condition of the neonate, physicians should consider the risk/benefit balance of an EOS evaluation and empirical antibiotic therapy

For Neonates born ≥ 35 weeks GA

• Recommend Use of the Early Onset Sepsis Calculator
  • Consider re-evaluation of symptoms at 2 hours of life if well appearing neonate with elevated SRS >1
  • Consider the adjusted Clinical Risk Score 

Therapeutic Length of Antibiotics Therapy during a Sepsis Evaluation

• Following evaluation for sepsis and treatment with ampicillin and gentamicin
• Literature supports treatment for 36 hours using 3 doses of Q12hr dosing of ampicillin and 1 dose of gentamicin
  • 34 weeks: 1 dose of gentamicin
  • >35 weeks: 2 doses of gentamicin
• Consideration for use of ampicillin q8 hours for 3 doses and 1 dose of gentamicin equaling 24 hours of total treatment (MIC reaches 48 threshold as early as 24 hrs)
  • 34 weeks 50mg/kg q12hrs
  • >35 weeks 50mg/kg q8 hrs
  • Consideration for 100mg/kg meningitic dosing can be made per local guidance
• Neonates must remain in hospital for 48 hours of observation, even if antibiotic therapy is limited to 36 hours, in order give ample time for blood culture 

Late Preterm Neonatal Consensus Recommendations for Hyperbilirubinemia Management

For Neonates born 34 to 34+6 weeks GA

• Recommendations to follow Stanford Hyperbilirubinemia thresholds
• Threshold for phototherapy recommendations
  • Initiate phototherapy at total bilirubin (mg/dL) of 12 to 14
  • Or if available, consider use of nomograms with preterm phototherapy levels
• For Neonate born ≥ 35 weeks GA please refer to the AAP Revised Guidelines Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation (2022)
  • When possible and neonate stable, consider in-room phototherapy 

Nutrition Recommendation for Late Preterm Neonates

Transitional Formula: (Similac NeoSure 22 cal/oz or Enfamil NeuroPro EnfaCare 22 cal/oz)

Vitamin and Iron Supplementations:

Iron Recommendations

BW  2000-2500g, the recommended iron intake is 1-2mg/kg/d up to 6 months of age

BW < 2000g, the recommended iron intake is 2-3mg/kg/d at least up to 6 months of age

*Start by 2-4 weeks of life

Vitamin D Recommendations

Recommend at least 400 IU (total intake including feeds) 

*Start when on full feeds 

If recommending multivitamin

For Breastmilk/Breastfeeding neonates 1ml of Polyvisol with Iron (for maximum of 4mg/kg/d of iron)

For formula fed neonates 0.5ml of Polyvisol with Iron (for maximum of 4 mg/kg/d of iron) 

*Start by discharge preparation 

Late Preterm Respiratory Care Guidelines

Antenatal Steroid Use in Late Preterm Neonates

Consider shared decision making and discussion with OBGYN/MFM colleagues for maternal corticosteroids for women between 34+0 and 36+6 weeks of pregnancy that are likely to deliver prior to 37+0 weeks.  Consider excluding women with pre-gestational diabetes secondary to increased risk for neonatal hypoglycemia.

If maternal corticosteroid administration prior to delivery, recommendation for glucose monitoring in the late preterm neonate until minimum of 24 of hours of age.

**Please see summary of Antenatal Steroid Use in a Late Preterm Neonate below. 

Recommendations for Respiratory Support in a Late Preterm

• For late preterm neonates demonstrating respiratory distress (as defined by the criteria listed below), strong consideration for initiation of support with CPAP.
• Consideration for High Flow Nasal Canula if mild respiratory distress or for weaning off of CPAP with improvement of respiratory symptoms.

Guidelines for consideration of Surfactant

1. CPAP ≥ 6
2. FIO2 ≥ 40%
3. Arterial PH < 7.2
4. Arterial PCO2 >60
5. CXR consistent with RDS
6. Clinical exam in conjunction with other physiologic abnormalities:
   1. Respiratory rate: Persistent tachypnea (RR>60)
   2. Grunting persistently
   3. Significant work of breathing and retractions
7. Escalation of any of the symptoms listed above

Consider low threshold for administering surfactant when meeting several of the above criteria. 

Recommendations of providing early surfactant for patients meeting guidelines in a timely manner to avoid further respiratory decompensation. 

Surfactant Administration Methodologies:

Use of MIST or LISA is an acceptable method in providing surfactant to late preterm neonates.

INSURE method is common and safe practice to providing surfactant therapy. 

Recommendation to use local practice in providing surfactant. 

Late Preterm Discharge Recommendations

• Late preterm neonates should show signs of physiologic stability prior to discharge home.
• Late preterm neonates should demonstrate appropriate nutritional intake and weight gain per nutritional recommendations prior to discharge.
• Late preterm neonates should pass a car seat test prior to discharge home.
• Late preterm neonates should be free of significant apnea and bradycardia episodes for greater than 2-3 days prior to discharge home. 

Car Seat Test 

AAP Statement (2009)

Improved survival rates and earlier discharge of preterm (<37 weeks' gestation at birth) and low birth weight (<2500 g at birth) infants have increased the number of small infants who are being transported in private vehicles. Car safety seats that are used correctly are 71% effective in preventing fatalities attributable to passenger car crashes in infants. To ensure that preterm and low birth weight infants are transported safely, the proper selection and use of car safety seats.

The increased frequency of oxygen desaturation and episodes of apnea or bradycardia while sitting in car safety seats suggests that preterm infants should have a period of observation in a car safety seat, preferably their own, before hospital discharge. This period of observation should be performed with the infant carefully positioned for optimal restraint and the car safety seat placed at an angle that is approved for use in the vehicle. A period of observation for a minimum of 90 to 120 minutes or the duration of travel, whichever is longer, is suggested

Proposed Unified Car Seat Parameters:

Inclusion Criteria:

• Less than 37 week’s gestational age at birth.
• Less than 2500 grams (per AAP recommendations, may use local considerations)
• Other medical conditions which place the infant at risk for oxygen desaturation in a semi-upright position of a child car seat. (eg, hypotonia, craniofacial abnormalities)

Time

• 90-120 minutes or the length of the car ride home, whichever is longer

Failure Criteria

• Apnea: greater than 20 seconds cessation of respiratory effort
• Bradycardia: less than 80 beats per minute, or 20 beats less than normal baseline sleeping rate for greater than 20 seconds
  • In the event of testing an infant with a known low resting heart rate, this could be changed with an MD order
  • In case of congenital heart disease saturation parameters for car seat test may modified by physician (consideration for 10% less than baseline oxygen saturation as indication for failure)
• Desaturation: Oxygen less than 90% sustained greater than 20 seconds.

Failed Car Seat Test

• In case of failure of the car seat challenge, must wait 24 hours prior to repeat testing.
• In case of 2 failed car seat challenges, must be admitted to NICU/SCN and must wait another 24 hours prior to repeat testing.

Cardiopulmonary Episodes in a Late Preterm Neonate

Apnea and Bradycardia 

• Consideration for low heart limits for late preterm neonates at 80 bpm
• Brief, isolated bradycardic episodes that spontaneously resolve and feeding-related events that resolve with interruption of feeding are common in convalescent preterm infants and generally need not delay discharge
• Monitor late preterm neonates for a of 48 hours to 72 hours following an apnea or bradycardia episode NOT requiring stimulation prior to DC
  • Apnea: cessation of respirations for greater than 20 seconds with resulting desaturation <85% oxygen saturation
  • Bradycardia: Heart rate less than 80 bpm for greater than 20 seconds
  • High consensus was found for observation period of 72 hours following a significant apnea/bradycardia episode for a LPT neonate
• Some additional literature suggests that late preterm infants with RDS are at a subsequent risk of higher apnea, so may merit some additional monitoring.

Late Preterm Thermoregulation Recommendations

Subtopics: Bathing, Isolette Weaning, Radiant Warmer Use, Temperature Regulation in DR and MBU, Parental recommendations and AAP Sleep/Hat/Blanket policy

DR and MBU Recommendations

• Infants should be delivered in ORs or DRs with goal room temperature of >70 degrees (21 Celsius)
  • This should be maintained, if possible during skin to skin, and in the immediate post-natal period
• Drying should occur immediately following delivery prior to skin to skin and during delayed cord clamping. Infants should be thoroughly dried with hat applied prior to skin to skin.
• When transporting, infants should have appropriate thermoregulation measures including an appropriately warmed transport device or adequately swaddled with pre-warmed blankets and hats.
• Use local hospital policy in order to best maintain euthermia in the late preterm population, which is more at risk for temperature instability.
• Closer monitoring of temperature is warranted especially in the first 24 hours of life.
• “Golden Hour” of maintaining warmth following delivery (skin to skin, without interference assuming stability) 

Mother Baby Unit Radiant Warmer Recommendations

• Maintain infant temperature between 36.5 to 37.5 Celsius
• When temp noted to be <36.5 place infant skin to skin with hat and covered with a warmed blanket.
  • Monitor temp q30 min until normothermic.
  • If unable to perform skin to skin add blanket and head covering
  • Consider removing head covering once euthermia is established and monitoring prior to discharge
  • If temperature remains low (< 36.5 C) after 1 hour, move to preheated radiant warmer
• If required, place on Radiant Warmer and set temp 36.5 on skin servo control
  • Skin probe over upper quadrants of abdomen to avoid brown fat stores
  • Monitor temp and vital signs q 30 min.
  • May increase set temp to 37 Celsius if temperature is not improving
  • When normothermic x 1 hour, place infant skin to skin or swaddle with hat
    • Monitor temp q 30 min for 2 hrs to establish thermal stability
  • If unable to maintain or achieve euthermia over 1-2 hours please consult NICU for further recommendations
• For temp 32-34.9 place infant in preheated isolette on skin servo control with set temperature of 36-36.5
  • Recommendation for NICU consultation and consider transfer to NICU
  • Check glucose

Late Preterm Bathing Policy

• Postpone bathing until infant has achieved thermal and cardiorespiratory stability and is a minimum of 6 hours old.
  • Ideally, postponing bathing until up to 24 hours of age has been shown to positively impact rates of hypothermia, hypoglycemia, and exclusive breastfeeding.
  • If infant is born to an HIV positive mother, bathing as soon as possible after birth. Utilize aseptic technique before skin breaking procedures and consider early bathing for exposure to active HSV lesions, Hepatitis B or C.
• Immersion and swaddle bathing are recommended over sponge bathing.
• Water temperature and environment-
  • Ensure that bath-water temperature ranges from 38 °C to less than 40 °C (100 °F to less than 104 °F).
  • Consider using a thermometer to assess water temperature before bathing.
  • Recommended room temperature 26–28 °C (79–81 °F).
  • Minimize air currents and convective heat loss.
• Place infant skin to skin after bath and cover with blanket or utilize appropriate rewarming measures.
• Bath infant every few days.

Late Preterm Incubator Weaning 

Late preterm neonates requiring isolette for thermoregulation will require a wean to open crib prior to discharge. Follow local guidance on isolette use when placed in isolette.

Consideration for weaning process:

• If on Servo control, and thermoneutral temperatures with incubator temperature reaching 29-30 degrees transition to Air control
• Wean temperature by 0.5°C every 3 hours (as a maximum) until the air control temperature is at 28°C, with desired temperature between 36.5-37.5 for 6-12 hours.
• Wean to open crib with appropriate clothing and hat (suggested t-shirt, single or double blanket or sleep sack)
• Failure to wean into the open crib consists of axillary temperatures below 36.5 after corrective measures (adding a blanket and/or hat), increase apnea and/or bradycardia episodes, or change in clinical status. 

*Please refer to local guidelines for babies who LGA, SGA, IUGR, or other concerns when starting the isolette weaning process. 

AAP Hat Recommendations

• For Late Preterm Neonates in Mother Baby Units
  • Secondary to concerns of overheating per AAP guidelines it is advised not to place hats on infants when indoor (exceptions are first few hours of life and while in the NICU)

Summary of Late Preterm Survey Process

In October 2023, we administered a 31-item online survey of late preterm care practices to NICU providers among 18 NICUs. Providers practiced at level II, III, and IV units. We obtained data from the following domains: admission criteria, discharge criteria, respiratory management, nutrition, infectious management, and thermoregulation. We used chi square and fisher exact tests with a threshold of p <0.05 to identify differences in responses between hospitals and provider types. We received 139 responses from 17 NICUs (estimated response rate 55%), including 70 attending neonatologists (50%), 24 fellows, nurse practioners, physician assistants, or hospitalists (17%), and 34 additional providers (24%). There was substantial provider-level variability in across all survey domains (Table 2). There was only over 70% agreement on 2 of the 11 proposed admission criteria, and 6 of the 10 proposed discharged criteria. There were significant differences between hospitals among the following variables: admission gestational age and birthweight, need for NICU admission for IV antibiotics and monitoring for neonatal opioid withdrawal syndrome, the observation period for apnea, preferred respiratory support, preferred surfactant administration method, indication for surfactant and supplementation, use of donor milk and dextrose gel, discharge criteria and weight, and use of the early onset sepsis calculator and sepsis management (Table 2). Between provider types, there were significant differences in automatic GA for admission, preferred form of respiratory support, preferred surfactant administration method, and discharge weight criteria (Table 2, Figure 1 D-E). 

Based on these initial survey results, we conducted 3 follow-up surveys in 2024 to resolve issues around which there was a substantial amount of variation in opinion and practice. Individuals were asked to indicate on a Likert scale of 1 to 9 how much they agreed with the following statements. Values over 6.5 indicated nearing consensus, and those over 7 indicated consensus was achieved. The results can be seen in the Table 1 below:

Late Preterm Sample Parent Brochure

Late Preterm Baby

Late preterm babies are babies born between 34 to 37 weeks of pregnancy. These babies aren't fully grown yet. The last 6 weeks of pregnancy are very important for the baby's brain, lungs, and other parts to grow. Sometimes, late preterm babies aren't quite ready to be born and might need extra care in the neonatal intensive care unit (NICU).

Being Ready

Most late preterm babies usually do okay in the hospital, but they might have some trouble with:

• Low blood sugars
• Low temperatures
• Feeding difficulties
• Breathing troubles
• Risk for infection
• Jaundice (yellowing of the skin)

Late preterm babies will be watched closely and might need medicine, fluids through an IV (a tube in their vein), or help with breathing. Remember, your baby's brain is still growing and needs more time to get ready.

Low Blood Sugar

Sugar, called glucose, is very important for your baby's brain. Late preterm babies are more likely to have low blood sugar. Your medical team will check your baby's blood sugar often. Feeding your baby every 2 to 3 hours and giving them extra calories might help. If your baby's blood sugar stays low, they might need sugar through an IV or help feeding in the NICU.

Low Temperatures

Late preterm babies are more likely to get cold. It's important to:

• Keep their room warm (around 70 degrees)
• Keep them away from drafts
• Spend lots of time skin-to-skin with a blanket
• Dress your baby in one layer of clothes plus 1-2 snug blankets.
• Delay bathing if possible until their temperature is normal 

Feeding Difficulties

Late preterm babies might need help with feeding. They need to eat more often, around 8 to 12 times a day, and you may have to wake the baby up if they try to sleep longer than 3 hours. If you’re breastfeeding, hold your baby skin-to-skin to help with milk production. You can talk to a lactation specialist for more help. Start expressing colostrum (early milk) within 6 hours of birth. Your care team can show you how to feed your baby. 

Your baby may need extra calories for help with growth, and sometimes may need to take more volume of feeds. Some babies may need NG tubes (a tube placed from the nose into the belly) to help receive feeds.

Once home, your baby’s doctor will keep a close eye on their growth and health. 

Breathing Difficulties

Most late preterm babies can breathe on their own, but sometimes they need extra help because their lungs are not fully developed. If your baby needs help breathing, your baby’s provider will explain the different ways they can support your baby's breathing.

Apnea of Prematurity

Apnea is when a baby's breathing slows down, which can also cause their heart rate to slow down (called bradycardia) or their oxygen levels to drop (called desaturation). Because your baby was born early, sometimes their brain doesn't send the signal to take a breath on time. This is called apnea of prematurity. Most babies outgrow apnea as they get more mature. Sometimes they might need medicine or help with breathing. Your baby's medical team will explain everything to you if your baby needs this help.

Risk for Infection

Late preterm babies are more at risk for infections in their blood (sepsis) because their immune systems are not fully developed yet. The medical team may want to test the blood for infections. 

To help prevent infections, 

• Always wash your hands before touching your baby
• Limit visitors to healthy people
• Keep your baby’s surroundings clean,
• Consider breastfeeding because breast milk has antibodies that protect against infections.

Jaundice

Late preterm babies might get jaundice, which makes their skin look yellow. Your baby’s jaundice levels will be checked. If your baby needs treatment, they will be placed under special lights called phototherapy. Your medical team will tell you the plan for going home.

Before You Go Home

Before your baby can go home, they need to:

• Eat well.
• Have normal blood sugar levels.
• Keep their body temperature steady.
• Be breathing comfortable without having apnea
• Pass a car seat test.
• Have normal jaundice levels.

Your baby’s doctor will check their growth and learning. Programs like Early Intervention (EI) can help if your baby needs extra support.

Questions When You Are Home

Parents of late preterm babies often have questions or concerns about their babies, especially if the baby had to go to the NICU. There are many groups and organizations that support parents. Check out these websites for more information.

Late Preterm Antenatal Steroid Summary Guide of Recommendations per Committee

Late Preterm Literature Breathing

Late Preterm Thermoregulation Evidence Review

Late Preterm Sepsis Evaluation Evidence Review

Late Preterm Nutrition Literature Review

Late Preterm Nutrition Vitamin Literature Review 

Sources Late Preterm Care Guidelines

Admissions Criteria 

Reiss J et al. Short-Term Outcomes following Standardized Admission of Late Preterm Infants to Family-Centered Care.  Am J Perinatol 2021;38:131–139

Lockyear C et al. Trends in morbidities of late preterm infants in the neonatal intensive care unit. Journal of Perinatology 2023 Nov;43(11):1379-1384

Zupancic J et al. Using the Neonatal Intensive Care Unit Wisely: A National Survey of Clinicians Regarding Practices for Lower-Acuity Care. J Pediatr 2023 Feb:253:165-172.e1

Edwards et al. Variation in Use by NICU Types in the United States. Pediatrics, Volume 142, number 5, November 2018:e2018045

Natile et al. Short-term respiratory outcomes in late preterm infants. Italian Journal of Pediatrics 2014, 40-52

Newman et al. NICU Versus Mother/Baby Unit Admissions for Low-Acuity Infants Born at 35 Weeks’ Gestation. Pediatrics, Volume 151, number 4, April 2023:e2022056861

Congdon et al. Admission and Care Practices in United States Well Newborn Nurseries. Hospital Pediatrics, Volume 13, Issue 3, March 2023

Late Preterm Thermoregulation 

Fulmer et al. Intensive Care Neonates and Evidence to Support the Elimination of Hats for Safe Sleep. Adv Neonatal Care 2020 Jun;20 (3): 229-232. 

Late Preterm Sepsis Evaluation Evidence

Sanchez et al. Short-course empiric antibiotic therapy for possible early-onset sepsis in the NICU. Journal of Perinatology (2023) 43:741 – 745

Marks et al. Time to positive blood culture in early onset neonatal sepsis: A retrospective clinical study and review of the literature. Journal of Paediatrics and Child Health 56 (2020) 1371–1375.

Puopolo et al. Management of Neonates Born at ≤34 6/7 Weeks’ Gestation With Suspected or Proven Early-Onset Bacterial Sepsis. Pediatrics; volume 142, number 6, December 2018 

Puopolo et al. Estimating the Probability of Neonatal Early-Onset Infection on the Basis of Maternal Risk Factor. Pediatics; Volume 128, Number 5, November 2011.

Late Preterm Hyperbilirubinemia Literature

Slaughter et al. Technical Report: Diagnosis and Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics; Volume 150, number 3, September 2022:e2022058865.

Late Preterm Apnea and Bradycadia, Discharge Planning Literature Review

Lorch et al. Epidemiology of Apnea and Bradycardia Resolution in Premature Infants. Pediatrics; Volume 128, Number 2, August 2011

Eichenwald. Apnea of Prematurity. Pediatrics; Volume 137, number 1, January 2016:e2015375

Canadian Paediatric Society. Paediatr Child Health Vol 5 No 1 January/February 2000

Antenatal Steroids and Late Preterm Neonates Literature

Vidaeff et al. Updating the balance between benefits and harms of antenatal corticosteroids. American Journal of Obstetrics & Gynecology FEBRUARY 2023

Gabriele Saccone,1 Vincenzo Berghella. Antenatal corticosteroids for maturity of term or near term fetuses: systematic review and meta-analysis of randomized controlled trials. BMJ 2016;355:i5044.

C. Gyamfi-Bannerman et al. Antenatal Betamethasone for Women at Risk for Late Preterm Delivery. N Engl J Med 2016 Apr 7; 374(14): 1311–1320.

A. Familiari et al. Antenatal corticosteroids and perinatal outcome in late fetal growth restriction: analysis of prospective cohort. Ultrasound Obstet Gynecol 2023; 61: 191–197.

Deshmukh et al. Neonatal outcomes by delivery indication after administration of antenatal late preterm corticosteroids. AJOG Global Reports November 2022.

Late Preterm Bathing Literature

American Academy of Pediatrics. (2017). Guidelines for Perinatal Care (8^th ed.). Elk Grove Village, IL: American Academy of Pediatrics

Association of Women’s Health, Obstetric, and Neonatal Nurses (2018). Neonatal skin care: Evidence-based clinical practice guideline (4^th ed., pp. 41-49). 

Bedwell, S., & Holtzclaw, B. J. (2022). Early Interventions to Achieve Thermal Balance in Term Neonates. Nursing for women's health, 26(5), 389–396. https://doi.org/10.1016/j.nwh.2022.07.006

Loring, C., Gregory, K., Gargan, B., LeBlanc, V., Lundgren, D., Reilly, J., Stobo, K., Walker, C., & Zaya, C. (2012). Tub bathing improves thermoregulation of the late preterm infant. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 41(2), 171–179. https://doi.org/10.1111/j.1552-6909.2011.01332.x

Nolt,D., O’Leary, S. T., Aucott, S. W. ; COMMITTEE ON INFECTIOUS DISEASES AND COMMITTEE ON FETUS AND NEWBORN (2022). Risks of Infectious Diseases in Newborns Exposed to Alternative Perinatal Practices. Pediatrics,149 (2): e2021055554. 10.1542/peds.2021-055554

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