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The late preterm infant is the infant born at 34 to 36 6/7
weeks gestation. The birthweight of these infants can range from 1500
gms to over 3000 gms. Many of the larger infants appear similar to a
full term infant, but subtle differences are often present. Compared
to full term infants, these near term infants are more likely to have:
- positional apnea,
- less glycogen and fat stores to prevent hypoglycemia,
- mild hypotonia,
- less alert awake periods,
- an uncoordinated suck, swallow, and breathe pattern, and
- a less mature liver.
Problems in any of these areas can effect breastfeeding. A
combination of mild hypotonia, less alert awake periods, and an
uncoordinated suck, swallow and breathing pattern can cause
significant problems with poor infant sucking, which causes decreased
maternal breast stimulation, and decreased breast emptying. This then
proceeds to decreased milk intake by the infant and decreased milk
production by the mother. This leads to poor weight gain and
decreased bilirubin excretion leading to jaundice in the infant
(
Early Jaundice, Evaluation and Management
).
Prevention of the above problems is most important and includes the following:
- Monitoring for jaundice prior to discharge
- Support for maternal breastfeeding
- Early outpatient follow-up within 1-2 days after discharge for
evaluation of weight gain, breastfeeding, and jaundice
- Repeated outpatient follow-up until appropriate weight gain is
demonstrated, and breastfeeding is going well.
- Early intervention to support breastfeeding and breast milk supply.
This may include use of an electric pump to increase maternal milk
supply when these babies have an ineffective suck. Infant
supplementation may also be needed to promote weight gain.
This should be done in a physiologic manner
and can use pumped maternal breast milk if available or formula
(
Supplementing Babies in a Physiologic Manner).
With appropriate support as listed above, most of the near term
premature infants can progress to successful breastfeeding within 1-2
weeks after birth. Lack of the above support can lead to poor
maternal milk supply, jaundice, poor infant weight gain which then can
lead to supplementation or readmission to the hospital
(
Wight, 2003
).
Guidelines for Breastfeeding the Near Term Infant
have been developed by the physicians of the
Academy of Breastfeeding Medicine (
ABM, 2004-1
).
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