by Anne Eglash MD, IBCLC, FABM
The Early Term Infant is defined as an infant born between 37 0/7 and 38 6/7 weeks’ gestation, whereas late preterm infants are born between 35 0/7 and 36 6/7 weeks’ gestation.
According to the updated Academy of Breastfeeding Medicine protocol #10 entitled ‘Breastfeeding the Late Preterm and Early Term Infants, Second Revision 2016’, early term infants have more health risks as compared to full term infants, born between 39 0/7 and 41 6/7 weeks.
In the last decade many US hospitals have changed their standard orders for the care of late preterm infants due to their higher risks of hypothermia, low blood sugar, high bilirubin, poor feeding resulting in dehydration, and sepsis.
This updated protocol recognizes that early term infants are more prone to high bilirubin levels, hospital readmission, and decreased breastfeeding initiation and duration. In addition, early term infants born via Cesarean birth have a higher risk of neonatal intensive care unit admission, sepsis, respiratory problems, and hypothermia.
This protocol outlines special principles of care for late preterm and early term infants, which differ from care of the full term infant.
Which of the following is NOT a special recommendation for late preterm and early term infants?
- A. Strongly consider supplementing this population at 7% weight loss, as opposed to 10% weight loss in the full term population.
- B. Observe these infants in a step-down nursery for the first 24 hours, in order to watch these infants closely for hypothermia, hypoglycemia, hyperbilirubinemia, and sepsis.
- C. Consider manual or pump expression after nursing in the 24 hours postpartum, with the intention of supplementing expressed colostrum if the infant has a low feeding score.
- D. Use skin-to-skin as much as possible to avoid hypothermia, or wrap the clothed infant in double blankets.
See the Answer
The answer is B
Read the Abstract here
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
This protocol points out that the Baby Friendly Hospital Initiative (BFHI) principles of care for term infants are not necessarily sufficient to prevent all risks associated with late preterm and early term status. However, I believe these babies are safer in a BFHI certified hospital, where staff undergo 18 hours of breastfeeding training and maintain routines that optimize breastfeeding support. Many of the principles of care in this protocol outline Baby-Friendly steps such as observing feedings at the breast, rooming-in, and establishing a feeding at the breast within the first hour. These infants are often weaker at the breast, meaning that they may not be transferring milk as well, increasing the risk of readmission for dehydration, hypoglycemia, and hyperbilirubinemia. Hospital staff who are not trained in breastfeeding evaluation and management have fewer skills to assess breastfeeding adequacy. This could lead to inappropriately high supplementation, infant consequences of insufficient feeding, and risk of insufficient support for the establishment of mother’s milk supply.
This protocol should be a call to action for all hospitals to fulfill as many of the Baby Friendly Hospital Initiative steps as possible, to support breastfeeding success in this vulnerable population.