Journal of Obstetric, Gynecologic & Neonatal Nursing
Principles & PracticeBreastfeeding the Late Preterm Infant
Section snippets
Breastfeeding Management Within Infant Vulnerabilities
The organization and selection of breastfeeding interventions for late preterm infants is predicated by their vulnerabilities. Breastfeeding management options for this population are often extrapolated from those used with either full term infants or with infants less than 34 weeks of gestation. Evidence-based protocols for breastfeeding the late preterm infant are included in Table 1 for help with working with this population. Breastfeeding interventions are designed to prevent adverse
Hypothermia and Hypoglycemia
Immediately following birth if the infant and mother are stable, place infants skin-to-skin on the mother's chest while being dried, covered with warm blankets, and having a cap placed on their head. Extended skin-to-skin contact keeps the infant warm, prevents crying, and allows for frequent feedings, all of which help prevent hypoglycemia (Bergman, Linley, & Fawcus, 2004). Infants interact more with their mothers, are more likely to be breastfed and to breastfeed longer, and show better
Respiratory Instability
Careful feeding positioning is necessary to avoid apnea, bradycardia, or desaturation, especially for the younger infants with decreased muscle tone. They are more prone to positional apnea due to airway obstruction so that feeding positions that cause excessive flexion of the neck or trunk are best avoided. The traditional cradle hold is one of these, as infants may experience extreme flexion of the trunk and neck, impeding full rib cage expansion and contributing to collapse of the airway.
Hypotonia and Immature Feeding Skills
Some infants may be able to effectively latch, suck, and swallow colostrum, especially with jaw support. Others will tire quickly, be unable to sustain nutritive sucking, or lack the strength to draw the nipple/areola into the mouth and generate the −60 mm Hg (Geddes, Kent, Mitoulas, & Hartmann, 2008) of pressure necessary to secure the nipple in place between sucking bursts. Late preterm infants demonstrate a wide range of variations in sucking patterns, sucking intensity, and the frequency and
Supplementation
If the infant cannot obtain adequate colostrum or milk directly from the breast with the use of frequent cue-based feeds, alternate massage, or with the shield in place, supplementation may be required. The best supplement is expressed colostrum/milk or banked human milk if available. Feeding volumes of 5 to 10 ml every 2 to 3 hours on the first day, with 10 to 20 ml on day 2, and 20 to 30 ml on day 3 are suggested (Stellwagen, Hubbard, & Wolf, 2007). Mothers can hand express colostrum into a
Hyperbilirubinemia
Late preterm infants experience a combination of factors that put them at a 7 to 13-fold increased risk for rehospitalization for jaundice (Maisels & Kring, 1998) including slower meconium passage, decreased activity of the bilirubin-conjugating enzyme uridine diphosphate glucuronyl transferase, and low milk intake. Kernicterus is also seen more frequently in late preterm infants (Bhutani & Johnson, 2006). Bilirubin peak levels generally occur around 2 to 3 days in term infants; however, peak
Immature Self Regulation
More than one third of the brain volume at term is acquired during the last 6 to 8 weeks of gestation, leaving late preterm infants at a disadvantage in responding to stimuli and regulating internal processes. Major influences on the initial pattern and ultimate duration of breastfeeding include the ability of the infant to suck efficiently, demonstrate alertness and stamina and ability to self-regulate and respond to maternal soothing behaviors (Lothian, 1995). The immature brainstem adversely
Initiating and Maintaining the Maternal Milk Supply
Initiation and protection of the maternal milk supply starts in the hospital. If the infant is unable to transfer colostrum then hand expression or pumping is best started within 6 hours of delivery (Hill, Aldag, & Chatterton, 2001). Anecdotal reports describe some mothers as having a considerable colostrum bolus available by pump immediately following delivery. Should the infant be unable to latch or transfer colostrum at that time, it may be beneficial to have the mother pump her breasts
Conclusion
The birth of a late preterm infant can be emotionally grueling on new parents, especially when a deceptively healthy-looking infant is subjected to high-risk interventions. Breastfeeding success will improve if clinicians utilize an evidence-based protocol (Table 1). To assure consistent and effective care, the nurse, the lactation consultant, and the mother can mutually construct written feeding plans for use in the hospital and following discharge (Wight, 2003). With twins or higher order
REFERENCES (63)
Feeding problems in the late preterm infant
Clinics in Perinatology
(2006)- et al.
The relationship between cesarean delivery and gestational age among US singleton births
Clinical Perinatology
(2008) - et al.
Kernicterus in late preterm infants cared for as term healthy infants
Seminars in Perinatology
(2006) - et al.
Immature sucking patterns in infants of mothers with diabetes
Journal of Pediatrics
(2006) - et al.
Identification of risk factors for delayed onset of lactation
Journal of the American Dietetic Association
(1999) - et al.
A pilot study of maternal and term infant outcomes associated with ultrathin nipple shield use
Journal of Obstetric, Gynecologic & Neonatal Nursing
(2006) - et al.
The late preterm infant and the control of breathing, sleep, and brainstem development
Clinics in Perinatology
(2006) - et al.
Changes in the gestational age distribution among U.S. singleton births
Seminars in Perinatology
(2006) - et al.
Tongue movement and intra-oral vacuum in breastfeeding infants
Early Human Development
(2008) - et al.
Reduction of masseter muscle activity in bottle-fed babies
Early Human Development
(1995)