Dani Carlo, Ciarcià Martina, Miselli Francesca, Luzzati Michele, Coviello Caterina, Azzarelli Federica, Ferrara Marianna, Lori Ilaria, Pezzati Marco
Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, Florence, 50141, Italy.
Eur J Pediatr. 2022 Apr;181(4):1643-1649. doi: 10.1007/s00431-021-04337-z. Epub 2022 Jan 6.
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 35-36 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.
晚期早产儿（LPIs）占所有新生儿的比例相当大（6-8%），但关于其出生后管理的已发表数据有限。我们的目的是比较妊娠35-36周出生的晚期早产儿入住新生儿重症监护病房（NICU）的频率以及母乳喂养率，这些晚期早产儿最初采用母婴同室策略进行护理，而非直接入住特别护理病房（SCU），最终也未入住NICU。我们在意大利佛罗伦萨的卡雷吉大学医院（CUH）和圣乔瓦尼迪奥医院的围产期中心进行了一项回顾性研究，这两家医院分别采用了第一种和第二种策略。主要结局是晚期早产儿入住SCU/NICU的比例以及出院时的母乳喂养率。我们研究了在圣乔瓦尼迪奥医院出生的190名晚期早产儿和在卡雷吉大学医院出生的240名晚期早产儿。圣乔瓦尼迪奥医院晚期早产儿入住SCU（81%对43%；P<0.001）和NICU（20%对10%；P=0.008）的比例高于卡雷吉大学医院，纯母乳喂养率也是如此（36%对22%；P<0.001）。然而，在卡雷吉大学医院接受母婴同室护理的婴儿以及在圣乔瓦尼迪奥医院具有相似临床特征的婴儿，其混合喂养率（60%对69%）和纯母乳喂养率（35%对31%）相似。结论：晚期早产儿出生后接受母婴同室护理，最终根据其临床状况入住SCU/NICU，可安全地将其住院时间减半。对婴儿进行母婴同室护理不会对其母乳喂养率产生负面影响。这些结果支持了对晚期早产儿进行母婴同室护理的可能性。已知信息：• 晚期早产儿占所有新生儿的比例相当大。• 建议对晚期早产儿尽早进行母婴同室和母乳喂养。新发现：• 晚期早产儿出生后接受母婴同室护理，必要时根据临床状况入住新生儿病房，与直接入住新生儿病房相比，可安全地避免约一半的住院次数。• 该策略不会影响母乳喂养率。最初接受母婴同室护理后入住SCU/NICU的婴儿母乳喂养率最差。
