CARE OF YOUR LATE PRETERM BABY AT HOME
- Once your baby is discharged to home, you will be advised to keep a recorded log of feedings at home, with specific attention to frequency & approximate duration of feeding at the breast, & method & type (expressed breast milk, infant formula) of supplementation.
- It is helpful to record daily stool & urine output, color of stools, & the infant’s behavior (e.g., crying, not satisfied after a feed, sleepy & difficult to keep awake at the breast during a feed, etc.).
- If the parents have a written feeding record, it is extremely helpful to your healthcare provider. Your infant will be examined carefully, noting state of alertness & hydration. An accurate infant weight without clothing will be used to calculate percentage change in weight from birth & change in weight from hospital discharge.
- Poor weight gain (<20 g/day) is almost always the result of inadequate milk intake. The median daily weight gain of a healthy full-term newborn is 28–34 g/day. Your baby’s healthcare provider will determine whether the problem is insufficient milk production, inability of the infant to transfer sufficient milk, or a combination of both.
- The infant who is getting enough breast milk should have at least 6 voids & 3 to 4 sizable yellow, seedy stools daily by day 4. He or she should be satisfied after 20 to 40 minutes of breastfeeding. Your baby will be expected to have an age-appropriate weight loss & weight gain (once effective feeding is achieved).
- A 10% weight loss may be acceptable in larger, healthy late preterm or early term infants who are effectively breastfeeding & whose mother is achieving adequate breastmilk supply.
- In some situations, a maximum of 7% weight loss is more appropriate for the smaller &/or IUGR (intrauterine growth restricted) infant.
- Your healthcare provider or LC will assess mother’s breasts for nipple shape, pain, trauma, engorgement, & mastitis. The mother’s emotional state & degree of fatigue will be considered, especially when determining supplemental feeding routines.
- Whenever possible at follow up visits, your baby will be observed feeding at the breast, for complete evaluation of latch, suck, & swallow.
- The process of transitioning from expressing breastmilk & supplemental feeds to exclusive breastfeeding can be extremely challenging & often exhausting for some parents.
- Mothers should not taper breastmilk expressing sessions too rapidly to ensure the maintenance of a generous milk supply that will allow for more effective milk transfer.
- Poor weight gain (<20 g/day) is almost always due to inadequate breastmilk transfer. The response to this is usually to begin or to increase frequency of expressing breastmilk (by hand or pumping), especially after a breastfeed.
- Parents will need to explore ways for the mother to relax while expressing her milk. It is helpful to arrange for help with other chores & for mother to get more sleep.
- The triple feeding regimen (breastfeeding, followed by supplementation & then expressing) for every feed is effective, but some mothers cannot sustain this physically & emotionally, especially if she has limited support at home.
- Electronic scales for performing test weights can be rented for home use.
- Your physician may consider the use of a galactogogue (a medicine or herb to increase your milk supply) if there is documented low breast milk supply despite all other efforts to increase milk production.
- Infants who are not gaining weight well & for whom adjustments are being made to the feeding plan must be evaluated by healthcare professional frequently (e.g., daily or every 2–3 days depending on the situation) after each feeding adjustment either in the clinic or office, or by a home healthcare provider with feedback to the primary care provider.
- The late preterm infant should have weekly weight checks until 40 weeks of corrected age or until he or she is thriving. Weight gain should average 20–30 g/day, & length & head circumference should each increase by an average of 0.5 cm/week.
- Breastfed late preterm infants are at increased risk for iron deficiency & iron deficiency anemia compared with term infants, & routine iron supplementation is recommended.
- Multiple gestations (twins, triplets etc.) more often result in preterm or late preterm birth. The issues of having enough breast milk for two or more infants & feeding two babies at the breast are more challenging than managing a singleton baby. Supplemental feeds are more frequently required.
- The mother of late preterm twins will usually not be able to feed them in tandem until they are older & each baby is effectively feeding at the breast alone. This is due to their immaturity & need for more help with positioning, latch, & continued attention during a feed.
- Some mothers will never produce enough milk to exclusively breastfeed more than one infant, & those infants will need supplementation with donor human milk or infant formula. Your healthcare provider will assist you throughout this process.
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