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Nurse’s Notes - Pre-term babies require extra care
By JOANNA LENABURG

Consider this: A term newborn is born between 37 and 40 weeks of gestation. When we think of a baby born at 35 weeks, it should seem close enough, right? The answer is, not necessarily. Babies born between 34 and 36 completed weeks of gestation are actually considered “late pre-term.” Health care providers didn’t used to think too much of these little ones born “a bit early” because of their size and weights. However, late pre-term babies are getting more attention recently, and for good reason.

The late pre-term baby is considered at risk for developing complications after delivery. Some may have feeding problems, difficulty maintaining their temperatures, abnormal blood glucose levels, and may develop jaundice. Special care and attention needs to be given to this unique population of newborns. As parents, knowing what to watch for is important for your late pre-term infant.

Feeding - Due to an immature suck-swallow reflex, these babies can have a difficult time breastfeeding. It will be especially important to start breastfeeding within the first hour after birth if your baby is stable. Placing your baby skin to skin within the first hour after birth will help stimulate your baby to nurse. It is important to feed your baby every two to three hours. If your baby isn’t feeding well, nurses and lactation consultants may have you begin pumping to stimulate your milk production.

Low glucose - Glucose (sugar) is a very important component for bodies to function normally. If glucose levels are low, our bodies do not function like they should. There are many reasons why the late pre-term baby’s glucose levels may run low. If your baby is not nursing well, they aren’t getting the proper amount of calories and nutrients they need. This is why pumping is important because you can give your baby breast milk by a syringe or cup. If you are bottle feeding it is important to offer formula every two to three hours. These newborns may use up a lot of their glucose by breathing harder than normal. This is because their lungs may not be fully mature. Also, if the late pre-term baby is unable to keep their temperature within a normal range, they will use up glucose to help keep them warm. If your baby has a low sugar level, ways to help raise it may range from increasing feedings to IV therapy. Treatment depends on how low the sugar level is.

Temperature - It is not uncommon to have problems keeping the temperatures of late pre-term babies within a normal range. There are numerous ways to help prevent this. A very beneficial way to keep your baby warm is by providing skin-to-skin contact with your newborn. You can also use pre-warmed blankets.

Jaundice - These babies are 2.4 times more likely to develop jaundice than term babies. Jaundice is a yellow discoloration of the skin. This is a result from the newborn’s immature liver not being able to break down extra red blood cells. At first, jaundice can make your baby sleepy and not eat well. If left untreated, the newborn may develop neurologic problems. The late pre-term newborn is more likely to develop jaundice around five to seven days of life. It is important for parents to be able to recognize the symptoms of jaundice. They may include skin discoloration, feeding poorly, sleeping too much, and not having enough wet diapers or bowel movements. These symptoms should be reported to your baby’s physician.

The number of babies born in the late pre-term period is rising. Although these babies may look like term babies, we must be aware of the complications for which they are at increased risk and know how to treat them.

Joanna Lenaburg is an obstetrics clinical nurse educator at Missoula Community Medical Center.
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