“Just a Few Weeks Early:” Breastfeeding Challenges in Late-Preterm Infants

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 require close monitoring, evaluation, and follow-up 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, excessive weight loss, and possible infections.


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. Ineffective breastfeeding not only increases a baby’s risk of medical complications, a mother’s milk supply can rapidly decrease if her baby is unable to drain her breasts well. The following strategies can help facilitate successful breastfeeding if you give birth to a late-preterm baby:

  1. Providing your baby with skin-to-skin contact immediately after birth and as often as possible while you are rooming-in will help promote infant feeding behaviors and encourage frequent breastfeeding. Ask your hospital lactation consultant for hands-on assistance with your breastfeeding technique throughout your hospital stay.


  1. Sometimes, using an ultra-thin, soft silicone nipple shield can help your late-preterm baby latch on and stay attached to your breast.


  1. If you deliver a late-preterm infant, you can help ensure that you bring in and maintain an abundant milk supply by using an effective electric breast pump to express the extra milk your infant leaves behind after breastfeeding. Removing the milk remaining after your baby nurses is known as “insurance pumping” or “prevention pumping” because it helps keep your milk supply generous until your infant is big enough and mature enough to drain your breasts well on her own. Having an abundant milk supply also helps your immature, smaller, less-vigorous baby obtain more milk when she attempts to breastfeed because she can “drink from a fire hydrant” instead of having to work hard to get enough milk. Furthermore, the extra milk you remove with the pump makes the ideal supplement if your baby temporarily requires supplemental feedings. Your surplus pumped milk can be stored for later use (in the refrigerator for 3-5 days; in a separate door freezer for at least 3 months; in a deep freezer for at least 6 months).


  1. Ask to be referred for extra help with breastfeeding after discharge, since it often takes several weeks for a late-preterm infant to be able to breastfeed effectively. Arrange to have your baby followed closely and weighed often to ensure she is drinking enough milk. Her first pediatric visit should occur 24 – 48 hours after discharge. A lactation consultant or your baby’s doctor periodically can weigh your baby (identically clothed) before and after breastfeeding to measure how much milk she drinks and monitor her progress. As your baby matures and gains weight rapidly and begins breastfeeding more effectively, you gradually can taper the supplemental milk and decrease your pumping.


Your extra investment of time and effort to safeguard breastfeeding in the early weeks after your baby’s birth will pay off in a thriving infant and a plentiful milk supply that will set the stage for a long-term successful breastfeeding experience.

Adapted from Great Expectations:  The Essential Guide to Breastfeeding by Marianne Neifert, M.D. (Sterling Publishing Co., 2009). 

Copyright ©  2011  Marianne Neifert, MD, MTS     May be duplicated if authorship is cited.     www.dr-mom.com