The Late Pre-Term Infant

Why breastfeeding fails to launch in these infants. 

Late pre-term infants refer to babies who are born between 34- 36 6/7 weeks gestation.   These babies are less physiologically and metabolically mature than term infants.  These pre-term infants can often be the same size and weight as full term infants and are often treated by parents, care givers and health care professionals, like they are term babies. The problem with treating these babies like they are term infants is that they are not capable of adequatley performing functions for every day living, like full term babies are.   Thus these late-term, pre-term infants either fall through the cracks because they are perceived to be capable of performing at the term newborn level, or they are treated as pre-term infants who require more interventions than necessary.   In either scenario breastfeeding is compromised. 

There are many factors that prevent breastfeeding from being established  in the late-term, pre-term population.  Sucking, swallowing and breathing is essential for all babies to be able to feed successfully. Late term, pre-term infants often struggle with the abitlity to be able to do this due to their lack of strength and stamina.  Their jaw muscles can be weak causing them to be unable to maintain a latch and suck at the breast at the same time.  Most times these babies appear to be sucking well, but their suck is often not strong enough to cause a let-down at the breast, nor is their suck strong enough to transfer milk from the breast. When they are able to tansfer milk from the breast, they need to be able to swallow the milk down into the passageway that connects to their stomach and not into the passageway that connects to their lungs.  Once they are able to latch, suck and swallow these babies tend to fall asleep quickly at the breast and waking them to finish breastfeeding can be difficult. Bottles are often introduced to assist the baby to feed and can supercede any opportunity to put the baby to breast.  Sometimes theses babies are put on extra calories to help them gain weight and the need for bottle feedings becomes the norm with very little opportunity for breastfeeding.    

So how do we preserve and promote breastfeeding during this uncertain transition period? 

The most important thing you can do to preserve and promote breast feeding in general is to establish a good milk supply. A good milk supply is going to ensure that the baby is not refusing the breast or falling asleep at the breast because it is empty.  Frequent pumping on a regular basis especially during the first few weeks after your late-term pre-term baby is born is essential. 

 The second most important thing you can do is put your baby to breast as often as possible while monitoring the baby’s stamina.  You need to be able to read your baby’s cues to tell you when your baby is hungry, frustrated, or shut-down.    More exposure to the nipple and time feeding on the breast will only help promote breastfeeding.  Since bottle feeding will almost always be introduced and encouraged during this transition from late pre-term to term period, it is essential that you put your baby to breast frequenlty.  

So how do you incorporate breastfeeding into a feeding routine of a late-term pre-term infant? 

An International Board Certified Lacation Consultant (IBCLC) can be very instrumental in helping you navigate safely through this uncertain period to help you not only establish breastfeeding but help you to meet your goals for long-term breastfeeding.   Most home lactation consultation visits are reimburseable by your health insurance provider, under the Affordable Care Act. To check your eligibility, call the phone number on the back of your health insurance card.


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