Rhonda and Frank brought in their 5-day-old son, Joey. They were worried. Though Joey weighed 7 pounds at birth, he was born at 35-weeks gestation (five weeks early). The hospital was slam full on his birthday, but since Joey "looked good," he was sent off to the full-term nursery. The lactation consultant had watched him nurse for a few minutes in the hospital, and Mom had come home determined to provide only the best--breastmilk--for Joey.
But something wasn't going right. Though Joey had a number of wet diapers before he left the hospital, it had been eight hours since he'd had another. Rhonda said he seemed sleepier than before and would only nurse about 3 minutes before getting tired and falling off the breast.
In past years Joey would have been considered a "Near Term" infant and treated as a full-term baby. Now, however, he is considered a "Late Preterm Infant" if born between 34 and 37 weeks gestation. These babies are at higher risk for important problems which need to be carefully assessed and treated.
We knew how to keep Joey out of trouble. Anticipating possible difficulties with with blood sugar and yellow jaundice, his levels were checked and followed. Since babies are usually 36 weeks gestation before their sucking and breathing is fully coordinated, we helped Rhonda nurse Joey, then showed her how to pump her milk and give it through a special gadget called the SNS (Supplemental Nursing System). This device helped Joey take the breastmilk without as much effort while not interfering with his learning to nurse effectively. The pump also helped Rhonda's milk supply increase as Joey became more able every day to be a fully breastfed infant. We saw Rhonda and Joey daily and monitored his weight, pees, poops and necessary blood tests. By ten days old, Joey was heading back toward his birth weight--and nursing well.
There has been a 31% increase in pre-term babies in the past two decades and a 40% increase in Late Preterms. This increase can be attributed to women having babies later in life, more infertility treatments, more twins (and other multiple) births, and perhaps an association with obesity in the mother.
What you can do to care for a Late Preterm baby:
1. Follow guidelines for preventing prematurity.
2. Since knowing the exact time of conception can sometimes be tricky, clarify at birth if your baby is Late Preterm. (Your health care provider can do this using The New Ballard [Physical] Exam.)
3. Get careful instructions on how to watch your baby the first few weeks of life.
4. Get help immediately if your baby seems too sleepy, does not nurse well, or is not peeing as expected.
5. Request that your health care provider follow the newest guidelines for care of Late Term Infants.
(http://www.marchofdimes.com/prematurity/21239_5809.asp
http://www.medela.com/NewFiles/specialtyfdg.html#startersSNS
http://www.marchofdimes.com/files/MP_Late_Preterm_Birth-Every_Week_Matters_3-24-06.pdf
(http://pediatrics.aappublications.org/cgi/content/abstract/118/3/1207)