Implementation of a non-separation pathway for late preterm infants in a tertiary care center: a prospective feasibility study.

Background: Late preterm infants (34 + 0-36 + 6 weeks' gestation) are at increased risk of feeding difficulties, hypoglycemia, hypothermia, and early mother-infant separation. Although skin-to-skin contact and rooming-in are recommended components of family-centered neonatal care, evidence regarding the implementation of integrated non-separation strategies in late preterm infants remains limited. This study evaluated the implementation, feasibility, safety, and early clinical outcomes of a Non-Separation Pathway in a tertiary care setting. Methods: We conducted a prospective observational cohort study after implementation of a Non-Separation Pathway at a Belgian tertiary university hospital. Mother-infant dyads with infants born between 34 + 0 and 36 + 6 weeks' gestation were enrolled between April 2023 and March 2024. The pathway consists of three interconnected components: (1) immediate and sustained delivery-room SSC, (2) continuous rooming-in, and (3) structured feeding support according to a standardized protocol based on Academy of Breastfeeding Medicine. Primary outcomes were pathway implementation, feasibility, and safety, with complete non-separation as the primary implementation outcome. Secondary outcomes included feeding practices, hypoglycemia, weight loss, length of stay, and feeding status at discharge. Results: Sixty-nine mother-infant dyads were included. Mean gestational age was 35.6 weeks and mean birth weight was 2,502 g. Complete non-separation was achieved in 37.3% of dyads, delivery room skin-to-skin contact in 82.6%. Vaginal birth (aOR 5.12, 95% CI 1.51-17.39) and higher gestational age (aOR 2.14, 95% CI 1.06-4.35) were independently associated with complete non-separation. Respiratory support was independently associated with lower odds of delivery-room skin-to-skin contact (aOR 0.04, 95% CI 0.004-0.41). Hypothermia occurred in 18.8% of infants and was associated with surrogate skin-to-skin contact (aOR 6.67, 95% CI 1.71-26.03). At discharge, 75.4% of infants received any mother's milk and 34.8% were exclusively breastfed. Conclusions: Implementation of the Non-Separation Pathway demonstrated that delivery-room SSC was feasible for most late preterm infants in a tertiary neonatal setting and was not associated with major safety concerns. However, complete non-separation throughout hospitalization was achieved in only 37% of dyads and remained constrained by respiratory support requirements, cesarean delivery, maternal and neonatal complexity, limited intermediate-care capacity, and the absence of rooming-in facilities in the NICU.