Babies who are born from 34-36 weeks of gestation are now called late preterm infants. In the past, we did not realize some of the special challenges that many of these babies face. However, research has shown that they are quire different from a full-term baby (39-40 weeks). We even now know that 37-38 week babies also have a higher risk of problems; they are now called early term babies. Babies born 35-36 weeks are likely to be cared for in the normal newborn nursery, not the NICU.
Challenges faced by some late preterm infants include:
- Maintaining body temperature: They lose more heat through their skin because they have a higher body surface area to weight ratio than a full term baby. You may have to be extra careful to be sure your baby stays warm. Your baby may require an extra layer of clothing and monitoring for low body temperature.
- Low blood sugar (hypoglycemia): Their blood sugar metabolism is also immature. If there are other risk factors for hypoglycemia, these babies are at even higher risk. These babies are usually monitored for low blood sugar until levels are stable. They need to feed more frequently, may need supplements if breastfed, and parents should watch for signs of low blood sugar (lethargy, jitteriness, tremors, poor feeding, seizures, irritability).
- Feeding: Late preterm infants have smaller stomachs and may have to feed more often than a full-term baby because they take smaller amounts. They also get tired more easily, and feeding is hard work for a baby! They may need smaller, more frequent feedings. Late preterm infants need to eat at least 8 times a day. They may be sleepy and need to wake up for feeds. Most breastfed late preterm infants should also see a lactation consultant a few days after discharge.
- Weight gain: Because of their feeding challenges, and their need to use more calories to stay warm, these babies have more than the normal weight loss the first week and may struggle to gain weight at a normal rate. Parents may have to work with them and feed them every hour or two to get enough calories in them. Your pediatrician should follow their weight very closely until your baby is gaining weight well, and should be using the latest data we have on newborn weight loss.
- Breathing: The lungs are more immature at this age, and these babies are at higher risk of difficulty breathing, apnea (stop breathing), and not protecting their airway. Newborns will need careful monitoring in the hospital, and parents and caregivers need to watch for signs of apnea or respiratory distress at home.
- Infection: Late preterm infants are at higher risk of infection due to an immature immune system plus the energy spent on staying warm and feeding. Handwashing by caregivers is even more important, as well as flu and whooping cough (Tdap) vaccines for mom, family members, and caregivers. Breastfeeding also provides a tremendous protection against infection. These babies should have limited visitors, avoid crowds, and avoid contact with anyone who is sick. It is also especially important to avoid any exposure to tobacco smoke. Parents and caregivers should monitor carefully for signs of illness.
- Jaundice: Late preterm infants are at a higher risk of elevated bilirubin levels and jaundice. The liver is immature at this age and slower at processing bilirubin. Feeding problems and increased weight loss also increases the concentration of bilirubin in the blood. These babies start treatment for jaundice at lower levels than full term infants due to their higher risk. Ensuring adequate feeding helps to decrease the bilirubin levels and risk of jaundice requiring treatment. See section on jaundice on page 20 for more information.
- Behavior & development: Some late preterm infants have difficulty with overstimulation, bright lights, loud noises, and sudden movements. They may need a quieter, calmer environment.
- Follow-up: Due to these issues these babies need more careful and frequent follow-up. They should be seen 1-2 days after hospital discharge and monitored carefully the first few weeks.