Arriving a Few Weeks too Early

By: Jerri Carlisle, BSN, RN, IBCLC

Late preterm infants may have a lower birth weight, but usually look like full-term babies. These babies are called the “great pretenders” because some of their bodily systems are still slightly immature.

These infants can struggle the first few days with temperature instability or difficulty maintaining their warmth. Skin to skin is a great tool to help the baby maintain a good body temperature. A mother will heat up her baby to the perfect temperature with skin to skin . Keeping a hat on the baby’s head will also help with warmth during the first week of life.

Babies born before 38 weeks also have more difficulty with jaundice. Jaundice is a yellow discoloration of a newborn’s skin and eyes due to high bilirubin levels. All newborns have an immature liver, which controls the breakdown of bilirubin. Around day 5-6, the liver should start maturing and handling the higher bilirubin levels. Late preterm babies can have higher bilirubin levels due an even more immature liver and have a higher chance of going “ under the lights “ or having phototherapy.

Feeding is probably the most difficult problem for new parents of a baby born a “few weeks early.” Babies born before 38 weeks are usually lower weight , more sleepy and tired, and have more difficulty breast-feeding or even taking a bottle. Again as the “great pretenders”, they may feed long enough for a few swallows but not actually “ drink “ at the breast enough to gain weight . If the baby is breastfeeding, a bottle or syringe may be used to provide extra milk until the baby’s suck, swallow, and breathe pattern becomes more coordinated.

How can we help these mothers and late preterm infants?

We can change our expectations. We help mothers not feel guilty because breastfeeding is it working out . We expect these babies to not be as efficient at breastfeeding for the first few weeks. Give the babies some time to develop and grow but vigilantly protect and build the mother’s milk supply. These babies may need help with chin support help maintain their suction even on a bottle. Usually once baby’s due date arrives, there will be improvement with the baby’s ability to nurse, stay awake at the breast , and take a bottle if needed.

Having your IBCLC walk with you and track your baby’s progress is so important. An individual plan based on your baby’s development can help give you the confidence you need to be successful. Breast-feeding is not a “one size fits all.” It’s your baby, your journey, and your success. Breastfeeding directly , pumping and feeding a bottle, or doing both provides your baby a huge amount of antibodies to fight infection . ANY is so good!

Ultimately, late preterm infants will thrive with a few extra tips. Maintaining their temperature, watching for elevated bilirubin levels , and establishing a good feeding plan for weight gain are the main concerns. Seek help from an experienced IBCLC and your child’s healthcare provider for reassurance of well- being . Be an advocate for your child and ask questions until you get good answers.