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5.1 The 'late preterm' 'early term' baby

Infants born 34 weeks 0 days to 36 weeks 6 days gestational age are categorised as 'late preterm'. Infants born between 37 weeks 0 days to 38 weeks 6 days gestational age are categorised as 'early term'.

Definitions of gestational age periods from LPT to postterm. (Engle WA, Kominiarek M. Late preterm infants, early term infants, and timing of elective deliveries. Clin Perinatol. 2008;35(2):325&endash;341.)

Definitions of gestational age periods from LPT to postterm. (Engle WA, Kominiarek M. Late preterm infants, early term infants, and timing of elective deliveries. Clin Perinatol. 2008;35(2):325&endash;341.)

Infants born physiologically mature and capable of a successful transition to the extrauterine environment must be an important priority for the obstetric practitioner.

Late preterm and early term infants are at higher risk for short-term and long-term morbidities and mortality than term infants.

Yet those late preterm infants with no significant respiratory problems or other problems of prematurity are often cared for on the postnatal ward, with the temptation to treat them as you would a term baby. Called 'the great pretenders', these infants may present with subtle immaturity that requires a trained eye to detect, and proactive management to prevent subsequent problems.

Some problems these infants may encounter:

  • Respiratory instability and interrupted lung development
  • Poor ability to clear normal lung fluid (particularly if delivered by elective, pre-labour caesarean section)
  • Increased incidence of apnoea
  • Little respiratory reserve
  • Temperature instability
  • Less glycogen and brown fat stores available to protect against hypoglycemia
  • Reduced ability to conjugate and excrete bilirubin, increasing need for phototherapy to treat jaundice
  • Neurological immaturity
  • Poor state regulation - may go from hyper-alert to deep sleep without intervening stages
  • Easily overstimulated, then exhausted - may fall asleep before full breastfeeding taken
  • Lower tone
  • Reduced immunological competence.Keeping mother and infant together reduce the risk of infections.
  • Poor breastfeeding establishment and increased breastfeeding-associated re-hospitalisations6
  • Higher mortality throughout infancy
  • Higher incidence of mental and physical developmental delay at 24 months

Don't be complacent

These babies are NOT term babies. They may initially appear to cope well but exhibit decreasing stamina and ability after several days - watch them closely!

Remember: Late preterm = Great Pretenders

Preterm infants, rely on health care professionals to assess their growth and provide appropriate medical care and nutritional guidance. The WHO growth standards start at term and although they are recommended for preterm infants once they reach this age, they do not provide preterm infant growth assessments prior to term.

The Fenton growth chart for preterm infants has been revised to accommodate the World Health Organization Growth Standard and reflect actual age instead of completed weeks, in order to improve preterm infant growth monitoring.

Access to the Fenton growth charts can be found at External https://live-ucalgary.ucalgary.ca/resource/preterm-growth-chart/preterm-growth-chart

Postpartum care

Initial treatment should be no different from any other infant:

  • Skin-to-skin contact immediately after birth - initial resuscitation, drying, and observations occurring on mother's chest.
  • Leave in skin-to-skin contact until after the first breastfeeding, and keep the infant skin-to-skin whenever possible.


© Health e-Learning-IIHL

Remember!

Skin-to-skin care will provide:

  • Optimal physiological stability
  • Temperature stability
  • Improved oxygen saturation and gas exchange
  • Enhanced immune protection (colonization with mother's normal flora; maternal antibody development targeted to baby's needs)
  • Decreased crying
  • Increased opportunities to breastfeed
  • Improved milk production
  • Enhanced maternal-infant bonding
  • Longer exclusive and total breastfeeding
  • Book a follow-up appointment for 24 - 48 hours after discharge for a reassessment ofthe infant and the feeding plan.

Lactation Management

The importance of breastfeeding for a preterm infant is even more significant than for full term infants. Yet it is the very nature of the immaturity of the preterm and late preterm that creates breastfeeding challenges. Poor stamina, low tone, difficulty with latch and suck all contribute.

Additional skills you may need:

how to teach hands-on pumping, and knowledge of its effect
how to teach body and jaw support during breastfeeding for an infant with hypotonia
how to teach breast compression and massage
the use of some lactation aids, eg a nipple shield (with caution) or an at-breast tube feeding device (eg SNS)

Refer early to an IBCLC for discharge planning and follow-up where feasible.

Hands-on pumping

Hands-on pumping

Hands-on pumping.
© Cecilia Finoli

Click on the link below from the Stanford School of Medicine website where you'll be able to access a 9.5 minute video that will teach you about 'hands-on pumping' and how to do it.

Externalhttp://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html

What signs of late prematurity are evident in this 35wk gestation infant?

What signs of late prematurity are evident in this 35wk gestation infant? .
© Michelle Pensa Branco

What should I remember?

  • The infant feeding cues.
  • How to teach parents to recognise milk transfer.
  • Expectations about the frequency of breastfeeding.
  • When and how to begin complementary feeding.

Skills Competency

If you are working with infants with special needs please take the time to download and review the information in the skills competency. You can then ask a colleague or supervisor to confirm your competencies in this area related to knowledge, skills, and attitude.

When you have successfully completed this topic and practiced what you have learned you will be ready to do your Skills Competency. Click on the title of this box to downloadPDF Domain 6 Helping Mothers and Babies with Special Needs competency form for you to complete with your Supervisor.

Continued education of interest

For continued education on this topic consider the lecture CE43 Breastfeeding the Late Preterm and Early Term Infant.