Written by Crystal Karges, DTR, CLEC
During my pregnancy with my second child, the last thing I expected was to deliver prematurely; at 35 4/7 weeks’ gestation to be exact. After the experience with the birth of my first child, who practically had to be coaxed from the womb at almost 41 weeks, I was not prepared for the challenges that came with having a late preterm baby.
Rushing to the hospital the night of my daughter’s birth, I remember praying earnestly for her precious life, unknowing of how her beginning moments would unfold. She was born swiftly, weighing a whopping 7lbs of pure sweetness. Unbeknownst by her size, however, the next couple days confirmed her vulnerability and immaturity as a late preterm, and much to my dismay, she struggled with hypoglycemia, hyperbilirubinemia, and poor feedings.
My greatest struggle lay in my inability to properly nourish her in those first critical days. So eager was I to breastfeed, yet her feeding difficulties proved it much more complicated than I had ever imagined. With the help of some fantastic lactation consultants and in my stubborn adamancy and determination, we formulated an effective plan to deliver my baby the vital nutrition she needed to combat the hypoglycemia and hyperbilirubinemia while assisting us in establishing breastfeeding-all so crucial in those first 72 hours.
“Late-preterm infants”, defined by birth at 34 0/7 through 36 6/7 weeks’ gestation, are a population at risk, particularly as they are less physiologically and metabolically mature than term infants. As a result, late-preterm infants are at a higher risk than term infants of developing medical complications, resulting in higher rates of mortality and morbidity during the birth hospitalization. Though many late-preterm infants are frequently the size and weight of some term babies (as was the case with my own baby), there is the potential that they may be managed by caregivers and health professionals as though they are developmentally mature. Herein lies the danger however, as studies have demonstrated the risks this special population faces, including higher rates of hospital readmission during the neonatal period (Engle, et al).
Perhaps one of the most challenging aspects of having a late-preterm, as I discovered with my own baby, are the unique obstacles that may be confronted with breastfeeding. It is particularly crucial to educate mothers on how to evaluate feeding success and what signs to look for to detect dehydration and hyperbilirubinemia. The American Academy of Pediatrics recommends that a formal evaluation of breastfeeding, including observation of position, latch, and milk transfer be undertaken and documented a least twice daily after birth along with a developed feeding plan that is understood by the family. Helping mothers of the late-preterm infants understand the different needs her baby has, along with a targeted feeding plan of care, can help establish breastfeeding success in the short and long term.
I am deeply grateful to the Lactation Consultants who supported my desire to breastfeed while addressing the needs of my baby, who decided to enter the world a bit sooner than expected. Through their gentle guidance, I was able to use a supplementary nursing system to feed her at breast to help promote and establish our breastfeeding relationship while ensuring she was receiving the nutrition she needed. Fast forward five months, and we’re still going strong with exclusive breastfeeding. I know the guidance and support I had in her early days of life were monumental in setting us up for success in the long run.
Lactation Consultants are a vital part of a comprehensive team that can address the unique needs of the late-preterm infant population. What has been your experience in your practice working with late-preterm infants? How have you helped a mother establish breastfeeding?
For more valuable resources on breastfeeding the late preterm baby, please refer to the following:
- Clinics in Human Lactation: Breastfeeding the Late Preterm Infant, by Marsha Walker, RN, IBCLC.
- Academy of Breastfeeding Medicine (ABM) Clinical Protocol #10: Breastfeeding the Late Preterm Infant
- “Feeding Challenges of the Late Preterm Infant” by Karen Cleaveland, MSN, APRN, NNP-BC
- Growth and Development: The Growth of Late Preterm Infants
“Late-Preterm” Infants: A Population at Risk. William A. Engle, Kay M. Tomashek and Carol Wallman. Pediatrics 2007; 120; 1390. DOI: 10.1542/peds.2007-2952
The Relationship of Brain Development and Breastfeeding in the Late-Preterm Infant. Sunny G. Hallowell and Diane L. Spatz. Journal of Pediatric Nursing 2012; 27: 154-162.
Thank you for writing this. My first daughter was born on the first day of 35 weeks, 5lbs 6oz, and she struggled to nurse or keep milk down for the first week or two. She had to be re-admitted to the hospital for dehydration and jaundice for 3 more days, after we went home on day 3. I had to work with lactation consultants and my local La Leche League chapter to teach her how to nurse. Our solution was that I would pump milk, but always let her try to nurse for 10 minutes on each side before switching to the “easy” preemie bottle with my milk in it. And we had to weigh her before and after every feeding to see how much milk she kept down, because the spit up a lot of it. It was an extremely labor-intensive first month, but it did eventually work. We were able to put away the pump and the charts after a month. She was exclusively breastfed for almost 6 months, and she kept nursing up to 19 months of age. We count our blessings that she’s been very healthy since then.
This has helped confirm what I am doing! My baby was born at 36 weeks 6/7 days. And we are doing all that was mentioned here per advice of my lactation consultant. She weighed 6 lbs. 8 oz at birth but dropped to 5lbs 11oz. We are at 18 days and she is up to 6lbs 3 oz….so progress. Even tonight she successfully drained both sides in one feeding for the first time! Thank you for the encouragement.
I find it hard when the infant will not latch and mum has very little expressable colostrum and we have no choice but to give a small amount of infant formula