Breastfeeding: Late Preterm Baby

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KEY POINTS

• Babies born between the 35th and 37th weeks of pregnancy may not feed well. Things that help are to touch and hold your baby, try to breastfeed often, and give your baby extra breast milk, human-donated milk, or infant formula.
• Your baby should be seen by her healthcare provider within 48 hours after leaving the hospital to check your baby’s weight and how well your baby is feeding.
• Ask your healthcare provider what problems you should watch for and when and how to reach the provider.

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Babies born between the 35th and 37th weeks of pregnancy may not feed well. They may also have trouble breathing and keeping their body temperature normal. They are at risk for low blood sugar, jaundice, and infections. These babies are sleepy, and often have problems latching on and sucking properly. Things that help are to touch and hold your baby, try to breastfeed often, and give your baby extra breast milk, human-donated milk, or infant formula.

How do I start?

• When your healthcare provider tells you it’s safe, hold your baby skin to skin on your chest to help slow his breathing and heart rate and keep him warm.
• Make sure your baby is close to your breasts. Any time your baby wants something in her mouth, it should be your breast.
• When your baby makes little sounds, moves her arms and legs, moves her mouth and tongue, brings her hands to her mouth, or turns her head, she is showing you that she is ready to feed.
• For the first day, it’s a good idea to hand express some colostrum (the first milk) after feedings. This lets you give your baby extra milk after each feeding. Feed your baby according to the instructions you’ve received from the lactation consultant or your provider.
• Some babies are very sleepy, so you may need to wake your baby for feedings. He should feed at least 8 to 12 times in 24 hours.

What if my baby does not latch on and breastfeed?

The hospital staff or a lactation consultant can help you learn and practice what you need to do.

Hold your baby skin to skin while you massage and hand express your milk. You can express it into a spoon, cup, or special syringe and feed it to your baby. It is best not to use bottles at this stage. Using bottles for feedings may make it harder for your baby to breastfeed.

Sometimes, the use of a nipple shield (a soft silicone nipple cover) will help your baby suck better. However, this may cause problems with milk supply and your baby’s ability to get enough milk. Work closely with a lactation consultant when you are using a nipple shield.

If your baby is dehydrated (doesn’t have enough fluid in her body) or has lost too much weight, you may need to supplement with donor milk from a human milk donor bank or with infant formula if you cannot express enough milk.

If you are supplementing or if the baby is not nursing well, you should pump or express your milk regularly every 2 to 3 hours during the day and every 4 hours during the night. It’s best to use a hospital-grade electric pump.

What happens when we go home?

• Keep feeding as you have been doing in the hospital. If you are supplementing, keep doing that. Your baby’s healthcare provider or a lactation consultant will check to make sure that your baby is getting enough milk.
• Your baby should be seen by her healthcare provider within 48 hours after leaving the hospital. The provider will check your baby’s weight and how well your baby is feeding and make sure there are no other problems.

How do I know my baby is getting enough?

Your baby is probably getting enough milk if:

• Your baby wakes up to feed every 2 to 3 hours and nurses for up to 30 minutes each time.
• Your baby acts satisfied after feedings and then sleeps until she wakes up for the next feeding.
• Your baby urinates 6 times a day and has at least 4 bowel movements a day by 5 days of age.
• Your baby is gaining weight. Ask about weighing your baby.

If your baby is hard to wake up, or falls asleep at the breast, express your milk and feed it to your baby with a spoon, cup, syringe, or supplemental nursing system when your baby is more awake. This helps you keep your flow of milk and milk supply.

If you are not sure that your baby is getting enough milk, call your healthcare provider or lactation consultant.

Questions to ask your healthcare provider

• How often should I bring my baby in for a checkup?
• How many times should I feed my baby each day?
• How long should my baby go without eating?
• What problems should I watch out for?
• How will I know if I should call you and how do I reach you?