Late Preterm Infants (Part 1)

Late preterm infants present a special set of challenges for the field of maternal-newborn nursing. The Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) defines a near-term infant as one born between 34 and 36 completed weeks' gestation. While still considered premature, these infants are often under the care of a well-baby nursery after birth. However, it is a mistake to treat these babies as we would a full-term baby. Below are some special things to take into consideration when caring for a late preterm infant.

Thermoregulation
Late pretermers cannot always maintain their body temperature at normal for multiple reasons. To begin with, their neurological development is incomplete and the neurological centers that control thermoregulation are not fully developed. As well, they have less brown fat than full-term newborns and cannot generate body heat via non-shivering thermogenesis.

You may see orders to check these babies' temperatures, with or without a full set of vitals, every 3-4 hours. Also, it is doubly important to make sure that these infants stay wrapped, away from drafts, and have their hats on.

Feeding
Late preterm infants tend to have more feeding difficulty than full-term infants, also for several reasons. For starters, they tend to be smaller and their stomach capacity is not always equal to that of a full-termer. They tend to tire more easily during feeds and do not always eat as much as they need to maintain their weight and body temperature. Their rooting and suck reflexes are not always fully developed, and there is a tendency in late preterm infants to put their tongue to the roof of their mouth. This impeds latch, whether to breast or bottle, and may require oral motor training.

Daily weights and assessment of appropriate output (urine and stool) is vital, whether baby is breast- or bottle-feeding. If weight loss is more than expected (generally around 7% of birth weight), there may be an order to supplement breastmilk with formula. Whether this formula is the standard 20kcal/oz or increased-calorie generally depends on the facility, the ordering provider, and the individual baby.

Some late-preterm babies need to feed every two to three hours in order to take in sufficient nutrition. Others may tire out with such a schedule and need to go three to four hours between feeds in order to rest sufficiently. This totally depends on the baby.

At my facility, we consider sufficient output to be: at least one void for every day old the baby is until four days of age. At that point, we start expecting there to be at least six to eight voids in a 24 hour period. We want babies to stool at least 3 times in 24 hours from day one. If output is sufficient and weight loss is within expected range, we are generally satisfied that the infant is taking in enough.

In the next installment, we'll talk about more issues as they relate to the late preterm infant - hyperbilirubinemia, breathing, and sleeping.