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The management of late preterm infants: effects of rooming-in assistance versus direct admission to neonatal care units

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Abstract

Late preterm infants (LPIs) represent a significant percentage of all neonates (6–8%), but there are limited published data on their postnatal management. Our aim was to compare the frequency of neonatal intensive care unit (NICU) admission and the breastfeeding rate of LPIs born at 35+0–36+6 weeks of gestation who were cared for by initial rooming in strategy rather than directly admitted to the special care unit (SCU) and, eventually, to the NICU. We carried out a retrospective study in the perinatal centers of Careggi University Hospital (CUH) and San Giovanni di Dio Hospital in Florence, Italy, where the first and second strategies were applied, respectively. Main outcomes were LPIs admission rate at SCU/NICU and breastfeeding rate at discharge. We studied 190 LPIs born at SGDH and 240 born at CUH. The admission rate in SCU (81 vs. 43%; P < 0.001) and NICU (20 vs. 10%; P = 0.008) was higher in SGDH than in CUH, as was the exclusive breastfeeding rate (36 vs. 22%; P < 0.001). However, infants who were assisted in rooming-in at CUH and infants with similar clinical characteristics at SGDH had similar mixed (60 vs. 69%) and exclusive (35 vs. 31%) breastfeeding rates.

  Conclusion: Postnatal assistance of LPIs in rooming-in, eventually followed by admission in SCU/NICU based on their clinical conditions, allowed to safely halve their hospitalization. The assistance of infants in rooming-in did not negatively affect their breastfeeding rate. These results support the possibility of assisting LPIs in rooming-in.

What is Known:

• Late preterm infants represent a significant percentage of all neonates.

• Early rooming-in and breastfeeding is recommended for late preterm infants.

What is New:

• Postnatal assistance of late preterm infants in rooming-in, followed when necessary by admission in neonatal units based on clinical conditions, allowed to safely avoid about half the number of hospitalizations in comparison with direct admission in neonatal units.

• This strategy did not affect breastfeeding rate. Infants who were admitted to SCU/NICU after initial rooming-in had worst breastfeeding rate.

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Not applicable.

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Data are available on reasoned request.

Abbreviations

CUH:

Careggi University Hospital

LPIs:

Late preterm infants

NICU:

Neonatal intensive care unit

SCU:

Special care unit

SGDH:

San Giovanni di Dio Hospital

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Authors and Affiliations

  1. Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy

    Carlo Dani

  2. Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, Florence, 50141, Italy

    Carlo Dani, Martina Ciarcià, Francesca Miselli, Michele Luzzati & Caterina Coviello

  3. School of Midwifery, University of Florence, Florence, Italy

    Federica Azzarelli

  4. Neonatal Intensive Care Unit, San Giovanni Di Dio Hospital, Florence, Italy

    Marianna Ferrara, Ilaria Lori & Marco Pezzati

Authors
  1. Carlo Dani
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  2. Martina Ciarcià
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  3. Francesca Miselli
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  4. Michele Luzzati
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  5. Caterina Coviello
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  6. Federica Azzarelli
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  7. Marianna Ferrara
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  8. Ilaria Lori
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  9. Marco Pezzati
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Contributions

CD and MP conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. MP, FM, ML, CV, FA. MF, IL contributed to the protocol design, to the data collection, to the management of the study, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Carlo Dani.

Ethics declarations

Ethics approval

The study was approved by the local pediatric ethics committee and was conducted in accordance with Good Clinical Practice guideline and ethical standards as laid down in the 1964 Declaration of Helsinki.

Consent to participate

Not applicable due to the retrospective design of the study.

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Not applicable.

Conflict of interest

CD received honoraria from Chiesi Farmaceutici SpA for scientific consultancy.

Additional information

Communicated by Daniele De Luca

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Dani, C., Ciarcià, M., Miselli, F. et al. The management of late preterm infants: effects of rooming-in assistance versus direct admission to neonatal care units. Eur J Pediatr 181, 1643–1649 (2022). https://doi.org/10.1007/s00431-021-04337-z

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  • DOI: https://doi.org/10.1007/s00431-021-04337-z

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