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<html lang="en" class="hexml-course s2e"><!--[if lt IE 8]> <html class="oldie"> <![endif]--><!--Generated at Wed, 12 Oct 2022 23:23:13 +0000--><head><meta name="author" content='["Carole Dobrich"]'><meta name="course" content="MA03"><meta name="topic" content="5.1"><meta http-equiv="content-type" content="text/html; charset=utf-8"><meta name="copyright" content="2022 Health e-Learning"><meta name="robots" content="NONE,NOARCHIVE"><meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1, user-scalable=0"><link rel="stylesheet" href="//static.health-e-learning.com/jigsaw/design/hexml.pack.css?v=1665616993" type="text/css"><script type="text/javascript" charset="utf-8" src="//static.health-e-learning.com/jigsaw/design/hexml.pack.js?v=1665616993"></script><title>MA03: The 'late preterm' 'early term' baby</title></head><body class="loading"><div class="ajax-modal Fixed"></div><div class="watermark"><span>Health e-Learning</span></div><div id="access"><a href="#access" accesskey="a">Access Keys</a><a href="#menu" accesskey="m">Skip to Menu</a><a href="#content" accesskey="c">Skip to Content</a><a href="#footer" accesskey="f">Skip to Footer</a></div><div id="nav"><span class="nav-menu">Maintaining BFHI Education for Nurses and Midwives - Series 2</span><a id="hamburger" href="#"><span class="hamburger hamburger--collapse"><span class="hamburger-box"><span class="hamburger-inner"></span></span></span></a><div class="progress-container"><div id="myBar" class="progress-bar"></div></div></div><nav id="menu"><ol><li><a href="topic_1-0.html"><span class="menu-item-icon">1.0 </span><span class="menu-item-title">Introduction</span></a></li><li><a href="topic_2-0.html"><span class="menu-item-icon">2.0 </span><span class="menu-item-title">Protection of Breastfeeding [Domain 1]</span></a><ol><li><a href="topic_2-1.html"><span class="menu-item-icon">2.1 </span><span class="menu-item-title">A Code History Timeline</span></a></li><li><a href="topic_2-2.html"><span class="menu-item-icon">2.2 </span><span class="menu-item-title">Marketing - the role of the International Code</span></a></li></ol></li><li><a href="topic_3-0.html"><span class="menu-item-icon">3.0 </span><span class="menu-item-title">Understanding the importance of skin-to-skin</span></a><ol><li><a href="topic_3-1.html"><span class="menu-item-icon">3.1 </span><span class="menu-item-title">Infant innate behaviours</span></a></li><li><a href="topic_3-2.html"><span class="menu-item-icon">3.2 </span><span class="menu-item-title">Skin-to-skin and the role of the Health Worker</span></a></li><li><a href="topic_3-3.html"><span class="menu-item-icon">3.3 </span><span class="menu-item-title">Addressing barriers to skin-to-skin</span></a></li><li><a href="topic_3-4.html"><span class="menu-item-icon">3.4 </span><span class="menu-item-title">The loving relationship</span></a></li></ol></li><li><a href="topic_4-0.html"><span class="menu-item-icon">4.0 </span><span class="menu-item-title">Postnatal Interventions</span></a><ol><li><a href="topic_4-1.html"><span class="menu-item-icon">4.1 </span><span class="menu-item-title">The chemistry of feeding</span></a></li></ol></li><li><a href="topic_5-0.html"><span class="menu-item-icon">5.0 </span><span class="menu-item-title">Special needs and infant challenges [Domain 6]</span></a><ol><li class="current mm-selected"><a href="topic_5-1.html"><span class="menu-item-icon">5.1 <i class="fa fa-caret-right" aria-hidden="true"></i></span><span class="menu-item-title">The 'late preterm' 'early term' baby</span></a></li><li><a href="topic_5-2.html"><span class="menu-item-icon">5.2 </span><span class="menu-item-title">Ankyloglossia</span></a></li></ol></li><li><a href="topic_6-0.html"><span class="menu-item-icon">6.0 </span><span class="menu-item-title">Managing common difficulties</span></a><ol><li><a href="topic_6-1.html"><span class="menu-item-icon">6.1 </span><span class="menu-item-title">Engorgement</span></a></li><li><a href="topic_6-2.html"><span class="menu-item-icon">6.2 </span><span class="menu-item-title">Hyperlactation</span></a></li></ol></li><li><a href="topic_7-0.html"><span class="menu-item-icon">7.0 </span><span class="menu-item-title">Supplementation</span></a><ol><li><a href="topic_7-1.html"><span class="menu-item-icon">7.1 </span><span class="menu-item-title">Feeding-line device at the breast or chest</span></a></li><li><a href="topic_7-2.html"><span class="menu-item-icon">7.2 </span><span class="menu-item-title">Cup feeding</span></a></li><li><a href="topic_7-3.html"><span class="menu-item-icon">7.3 </span><span class="menu-item-title">Finger Feeding</span></a></li></ol></li><li><a href="topic_8-0.html"><span class="menu-item-icon">8.0 </span><span class="menu-item-title">Closing session</span></a><hr></li><li class="appendix"><a href="references.html"><span class="menu-item-icon no-topic"><i aria-hidden="true" class="fa fa-book i-topic"></i></span><span class="menu-item-title">List of references</span></a></li><li class="appendix"><a href="contents.html"><span class="menu-item-icon no-topic"><i aria-hidden="true" class="fa fa-file-text-o i-topic"></i></span><span class="menu-item-title">Course contents</span></a></li><li class="appendix"><a href="full.html"><span class="menu-item-icon no-topic"><i aria-hidden="true" class="fa fa-print i-topic"></i></span><span class="menu-item-title">Print version</span></a></li></ol></nav><div id="content"><h1 id="top">5.1 The 'late preterm' 'early term' baby</h1><section class="section" id=""> <div class="content-node"> <p>Infants born 34 weeks 0 days to 36 weeks 6 days gestational age are categorised as 'late preterm'. Infants born between 37 weeks 0 days to 38 weeks 6 days gestational age are categorised as 'early term'.</p> </div> <div class="captionBox"><img width="1280" height="482" data-src="images/Def_LPT_and_ET_in_weeks_Pediatrics_2019.jpg" src="//static.health-e-learning.com/jigsaw/design/lazy_image.gif" alt="Definitions of gestational age periods from LPT to postterm. (Engle WA, Kominiarek M. Late preterm infants, early term infants, and timing of elective deliveries. Clin Perinatol. 2008;35(2):325&amp;endash;341.)"><p>Definitions of gestational age periods from LPT to postterm. (Engle WA, Kominiarek M. Late preterm infants, early term infants, and timing of elective deliveries. Clin Perinatol. 2008;35(2):325&amp;endash;341.)</p></div> <section class="section" id=""> <div class="content-node"> <p>Infants born physiologically mature and capable of a successful transition to the extrauterine environment must be an important priority for the obstetric practitioner.</p> <p> <em>Late preterm and early term infants are at higher risk for short-term and long-term morbidities and mortality than term infants.</em> </p> <p>Yet those late preterm infants with no significant respiratory problems or other problems of prematurity are often cared for on the postnatal ward, with the temptation to treat them as you would a term baby. Called 'the great pretenders', these infants may present with subtle immaturity that requires a trained eye to detect, and proactive management to prevent subsequent problems.</p> <p>Some problems these infants may encounter:</p> <ul> <li>Respiratory instability and interrupted lung development</li> <li>Poor ability to clear normal lung fluid (particularly if delivered by elective, pre-labour caesarean section)</li> <li>Increased incidence of apnoea</li> <li>Little respiratory reserve</li> <li>Temperature instability</li> <li>Less glycogen and brown fat stores available to protect against hypoglycemia</li> <li>Reduced ability to conjugate and excrete bilirubin, increasing need for phototherapy to treat jaundice</li> <li>Neurological immaturity</li> <li>Poor state regulation - may go from hyper-alert to deep sleep without intervening stages</li> <li>Easily overstimulated, then exhausted - may fall asleep before full breastfeeding taken</li> <li>Lower tone</li> <li>Reduced immunological competence.Keeping mother and infant together reduce the risk of infections.</li> <li>Poor breastfeeding establishment and increased breastfeeding-associated re-hospitalisations6</li> <li>Higher mortality throughout infancy</li> <li>Higher incidence of mental and physical developmental delay at 24 months</li> </ul> </div> <div class="box"><div class="box-title"><h3>Don't be complacent</h3></div> <div class="content-node"> <p>These babies are NOT term babies. They may initially appear to cope well but exhibit decreasing stamina and ability after several days - watch them closely!</p> <p>Remember: Late preterm = Great Pretenders</p> </div> </div> </section> </section><section class="section" id=""> <div class="content-node"> <p>Preterm infants, rely on health care professionals to assess their growth and provide appropriate medical care and nutritional guidance. The WHO growth standards start at term and although they are recommended for preterm infants once they reach this age, they do not provide preterm infant growth assessments prior to term.</p> </div> <blockquote> <div class="content-node"> <p> <span>The Fenton growth chart for preterm infants has been revised to accommodate the World Health Organization Growth Standard and reflect actual age instead of completed weeks, in order to improve preterm infant growth monitoring.</span> </p> <p> <span>Access to the Fenton growth charts can be found at</span> <img alt="External" src="//static.health-e-learning.com/jigsaw/design/external.gif"><a href="https://live-ucalgary.ucalgary.ca/resource/preterm-growth-chart/preterm-growth-chart" target="_blank" title="External link"> https://live-ucalgary.ucalgary.ca/resource/preterm-growth-chart/preterm-growth-chart</a> </p> </div> </blockquote> </section><section class="section" id="Postpartum_care"><h2>Postpartum care</h2> <div class="content-node"> <p>Initial treatment should be no different from any other infant:</p> <ul> <li>Skin-to-skin contact immediately after birth - initial resuscitation, drying, and observations occurring on mother's chest.</li> <li>Leave in skin-to-skin contact until after the first breastfeeding, and keep the infant skin-to-skin whenever possible.</li> </ul> </div> <div class="captionBox"><img width="480" height="640" data-src="images/Preterm_35.2_wks_1st_s2s_latch_O2_LeonieM.jpg" src="//static.health-e-learning.com/jigsaw/design/lazy_image.gif" alt=""><p> <br>&copy; Health e-Learning-IIHL</p></div> </section><div class="box"><div class="box-title"><h3>Remember!</h3></div> <div class="content-node"> <p>Skin-to-skin care will provide:</p> <ul> <li>Optimal physiological stability</li> <li>Temperature stability</li> <li>Improved oxygen saturation and gas exchange</li> <li>Enhanced immune protection (colonization with mother's normal flora; maternal antibody development targeted to baby's needs)</li> <li>Decreased crying</li> <li>Increased opportunities to breastfeed</li> <li>Improved milk production</li> <li>Enhanced maternal-infant bonding</li> <li>Longer exclusive and total breastfeeding</li> </ul> </div> </div><section class="section" id=""> <div class="content-node"> <ul> <li>Book a follow-up appointment for 24 - 48 hours after discharge for a reassessment ofthe infant and the feeding plan.</li> </ul> </div> </section><section class="section" id="Lactation_Management"><h2>Lactation Management</h2> <div class="content-node"> <p>The importance of breastfeeding for a preterm infant is even more significant than for full term infants. Yet it is the very nature of the immaturity of the preterm and late preterm that creates breastfeeding challenges. Poor stamina, low tone, difficulty with latch and suck all contribute.</p> <p>Additional skills you may need:</p> <p>how to teach hands-on pumping, and knowledge of its effect<br>
how to teach body and jaw support during breastfeeding for an infant with hypotonia<br>
how to teach breast compression and massage<br>
the use of some lactation aids, eg a nipple shield (with caution) or an at-breast tube feeding device (eg SNS)</p> <p>Refer early to an IBCLC for discharge planning and follow-up where feasible.</p> </div> </section><div class="box"><div class="box-title"><h3>Hands-on pumping</h3></div> <div class="captionBox"><img width="372" height="423" data-src="images/Hands-on_pumping_CF.jpg" src="//static.health-e-learning.com/jigsaw/design/lazy_image.gif" alt="Hands-on pumping"><p>Hands-on pumping. <br>&copy; Cecilia Finoli</p></div> <div class="content-node"> <p>Click on the link below from the Stanford School of Medicine website where you'll be able to access a 9.5 minute video that will teach you about 'hands-on pumping' and how to do it.</p> <p> <img alt="External" src="//static.health-e-learning.com/jigsaw/design/external.gif"><a href="http://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html" target="_blank" title="External link">http://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html</a> </p> </div> </div><div class="captionBox"><img width="750" height="562" data-src="images/late_pre_term_35_weeks_MPB.jpg" src="//static.health-e-learning.com/jigsaw/design/lazy_image.gif" alt="What signs of late prematurity are evident in this 35wk gestation infant? "><p>What signs of late prematurity are evident in this 35wk gestation infant? . <br>&copy; Michelle Pensa Branco</p></div><div class="box"><div class="box-title"><h3>What should I remember?</h3></div> <div class="content-node"> <ul> <li>The infant feeding cues.</li> <li>How to teach parents to recognise milk transfer.</li> <li>Expectations about the frequency of breastfeeding.</li> <li>When and how to begin complementary feeding.</li> </ul> </div> </div><section class="section" id="Skills_Competency"><h2>Skills Competency</h2> <div class="content-node"> <p>If you are working with infants with special needs please take the time to download and review the information in the skills competency. You can then ask a colleague or supervisor to confirm your competencies in this area related to knowledge, skills, and attitude.</p> </div> <div class="box"><div class="box-title"><a href="images/Skills_Competency_%E2%80%93_Domain_6_Helping_Mothers_and_Babies_with_Special_Needs_v1.2_USA.pdf" target="_blank"><img src="//static.health-e-learning.com/jigsaw/design/article.png" class="icon" alt=""></a><h3><a href="images/Skills_Competency_%E2%80%93_Domain_6_Helping_Mothers_and_Babies_with_Special_Needs_v1.2_USA.pdf" target="_blank">Domain 6 Helping Mothers and Babies with Special Needs</a></h3></div> <div class="content-node"> <p>When you have successfully completed this topic and practiced what you have learned you will be ready to do your Skills Competency. Click on the title of this box to download<img alt="PDF" src="//static.health-e-learning.com/jigsaw/design/page_white_acrobat.png"><a href="https://static.step2education.com/docs/Skills_Competency_Domain_6_Helping_Mothers_and_Babies_with_Special_Needs_USA.pdf" target="_blank"> Domain 6 Helping Mothers and Babies with Special Needs </a>competency form for you to complete with your Supervisor.</p> </div> </div> </section><section class="section" id="Continued_education_of_interest"><h2>Continued education of interest</h2> <div class="content-node"> <p> <span>For continued education on this topic consider the lecture CE43 Breastfeeding the Late Preterm and Early Term Infant.</span> </p> </div> </section><div id="footer"><a href="topic_5-0.html" rel="prev" class="prev">&laquo; Prev</a><a href="topic_5-2.html" rel="next" class="next">Next &raquo;</a><br style="clear: both"><div class="floating-menu"><button class="theme-toggle" title="Toggle colors (dark or light)"><i class="fa fa-moon-o"></i></button><button class="gotoTop" title="Back to top"><i class="fa fa-chevron-up"></i></button></div><a href="javascript:%20window.print()" id="printLink">Print this page</a><span class="noPrint"> | </span>&copy; 2022 Health e-Learning<p class="printOnly">COPYRIGHT: You are permitted to print ONE (1) copy for your personal use only. No graphics, tables, quizzes, videos, etc, may be used in any form without express written consent. Author: ["Carole Dobrich"]</p><p class="dateUpdated">Updated on Wed, 12 Oct 2022 23:23:13 +0000</p></div></div></body></html>
