I'm very pleased to share a guest post by Dr. Marianne Neifert, author of Great Expectations: The Essential Guide to Breastfeeding. I had been wanting to write about "late preterm" babies - born between 34 and 36 weeks gestation for a while now. Those of you who have had a baby born at this age know that these babies can pose particular breastfeeding challenges.
I hope that you find this post useful!
Just a Few Weeks Early
Breastfeeding Challenges in Late-Preterm Infants
By Marianne Neifert, M.D.,
Until recently, babies born a few weeks early -- between 34 and 36 weeks gestation -- were referred to as near term infants. However, the designation, near term, implies that an infant is almost term or
almost fully mature, and the misnomer has often caused health
professionals and parents to underestimate the medical risks in this
large, vulnerable population of infants. Recently, the American Academy
of Pediatrics has recommended that infants born at 34, 35, or 36 weeks
gestation be referred to as late-preterm infants to emphasize
that these babies are physiologically immature and have special health
care needs compared to full term infants (born between 37 to 41 weeks).
In addition, the mothers of late-preterm infants are more likely to
have medical complications themselves, such as gestational diabetes,
high blood pressure, or C-section delivery.
The Rising Incidence of Late-Preterm Births
The
proportion of all U.S. births that are late preterm has increased over
the past 15 years. Late-preterm infants now comprise over 9% of all
births, and account for more than 70% of all preterm births (<37
weeks gestation), representing nearly 400,000 babies each year.
Although the reason for the increase in late-preterm deliveries is not
well understood, one explanation is the increased use of fertility
treatments, which has lead to a rise in pregnancies with twins and
higher multiples. Half of all twins and 90% of all triplets are born
preterm. Other possible contributors to the rise in late-preterm births
include the rise in cesarean section births (now 30% of all
deliveries), the need to deliver some infants early due to medical
complications, and more pregnancies occurring among women at an older
age. In addition, performing elective labor inductions or elective
cesarean sections for no clear medical or obstetrical reason sometimes
leads to the unintentional delivery of a late-preterm infant. Both
expectant mothers and obstetricians need to know the importance of
avoiding late-preterm delivery unless it is medically necessary.
Medical Complications among Late-Preterm Infants
Because
many late-preterm babies are the size of infants born at full term,
health care professionals may not always give these at-risk infants the
special treatment and careful screening they deserve. Instead, hospital
personnel and parents tend to treat these apparently healthy infants as
if they were developmentally mature. Late-preterm infants have been
called imposter babies because many of these "slightly early"
newborns masquerade as full-term infants, appearing to need no special
care after birth and being discharged as early as term babies. Yet,
babies born even a few weeks early have an increased risk of medical
complications after birth and may require a longer hospital stay than
full-term infants. Late-preterm infants are more likely to develop low
blood sugar, severe jaundice, breathing difficulties, and infections;
to have difficulty maintaining their body temperature; and to
experience feeding problems and excessive weight loss after birth.
Late-preterm infants also are more likely to be re-admitted to the
hospital in the early weeks of life for medical complications,
including newborn jaundice, breastfeeding difficulties, dehydration,
and possible infections.
The brain and nervous system are among
the last systems to mature during fetal development, and some studies
show that late-preterm infants have a higher risk of developmental and
behavioral problems compared to full-term babies. Late-preterm infants
also have a higher rate of birth defects and an increased risk of
sudden infant death syndrome. For all these reasons, late-preterm
infants require close monitoring, evaluation, and follow-up after birth.
Breastfeeding Challenges among Late-Preterm Infants
The
initiation of successful breastfeeding can be especially challenging
for smaller, developmentally immature, late-preterm infants. These
babies often have trouble latching on to the breast correctly and may
be unable to breastfeed effectively at first because of their lower
muscle tone and tendency to tire easily. Inadequate breastfeeding
increases a newborn's risk for severe jaundice and excessive weight
loss.