When we think of preemies, we think of extremely tiny babies born several weeks or months before their due date. But did you know that even babies born just prior to 37 weeks gestation are still considered preemies and face their own set of challenges? We’re going talk about what a late preterm baby and an early term baby is, they might need to stay in the NICU, and the unique challenges they face in the NICU and beyond.
Late preterm babies vs. early term babies
Every single week of gestation counts! A baby is considered full term at 37 weeks gestation; however, the longer a baby is in the womb, the lower the probability of challenges after birth.
Early term refers to babies born at 37 or 38 weeks gestation.
Late preterm refers to babies born from 34 weeks gestation to 36 weeks and six days gestation.
Why would an early term or late preterm baby need to stay in the NICU?
Although early term babies born at 37+ weeks may not look preterm, their organ systems are still not fully matured. These babies may still face complications as they adjust to life outside the womb.
Respiratory problems
In the hours after they are born, late preterm and early term babies may experience respiratory distress. These respiratory issues may be mild or severe, and may require respiratory support. Late preterm and early term babies may experience apnea, a pause in breathing because the brain doesn’t remind them to breathe.
Thermoregulation
This is the baby’s ability to stay warm and maintain a normal body temperature. In the last months of gestation, babies develop a type of fat called “brown fat.” This fat gives them the energy to maintain a normal body temperature. Since late preterm babies don’t have that, it takes them more energy to stay warm. These babies may be under lights to keep warm and greatly benefit from skin-to-skin care (all babies do!)
Hypoglycemia
Hypoglycemia is a condition in which the level of glucose in the blood is lower than normal. Glucose is the main source of fuel for the brain and the body.
Jaundice
Jaundice usually occurs because the baby’s liver isn’t mature enough to get rid of bilirubin in the bloodstream. Phototherapy treatment helps reduce bilirubin levels through photo-oxidation, which adds oxygen to the bilirubin and makes it easier for the liver to break down and remove it from the bloodstream.
Sepsis
Because their immune systems are immature, late preterm babies are susceptible to infections and sepsis, a systemic infection of the bloodstream.
Feeding difficulties with late preterm babies
For late preterm babies in the NICU, feeding can be a challenge. Their immature organ systems affect their coordination to suck, swallow and breathe. It takes a lot of energy for a late preterm baby to not just eat, but to take in enough volume enough times per day without getting too fatigued.
Late preterm babies can be deceptively vigorous, yet ineffective during feedings. They may appear to be eagerly sucking, but they may not be transferring the milk. This causes two problems:
- The baby isn’t getting the nutrition they need or the volume they need to grow and stay hydrated.
- If breastfeeding, the mother’s breast isn’t being emptied, thus stimulating more milk, causing supply to decrease.
It’s important for mothers of late preterm babies to pump after each feeding to make sure the breasts are empty. This will stimulate more milk production and build a good supply.
Taking part as much as possible in your baby’s care from day one will help parents’ awareness of their baby’s feeding challenges. The more often you are in the NICU feeding your baby, the better you will get at reading their cues. How do they behave when they are full versus when they are just tired?
Once home, you will have the skills to notice if they’re not waking for feedings or if the quality of their feedings declines, because you spent time working with them on feeding in the NICU.
Consult with a lactation consultant or a neonatal therapist in the NICU if you have concerns about your late preterm baby. Talk to your pediatrician or a lactation consultant once home if you still have concerns.
Taking home your late preterm baby
A late preterm baby may look robust, but it’s important to remember that they are still considered preemies. On the outside they may look like any other infant, but their organ systems are still significantly immature.
RSV
Late preterm babies are susceptible to hospital readmissions. One of the factors behind readmissions is often respiratory syncytial virus (RSV). RSV may look like the common cold in children and adults, but it can be serious for preterm infants, due to weaker immune and respiratory systems. Help prevent RSV by keeping your baby away from crowds and public areas during RSV season. Insist your family and visitors practice consistent hand washing.
Ongoing development after the NICU
Accessing interventions
Your baby is developing all the time. If you’re concerned about developmental delays, especially related to feeding, it’s beneficial to seek help as early as possible. In the NICU, ask a therapist or the discharge coordinator what services are available depending on your state, region or insurance. If you’re already home, ask your pediatrician.
Trust your gut
Just because a late preterm baby is at risk for the issues discussed above doesn’t mean your baby will actually experience them. But the sooner you are able to advocate for an assessment, the better. Late preterm babies have a 25-50% higher probability for developmental delays and learning difficulties. Some of these may not even arise until school age. If your child seems to be struggling with motor skills, speech or other problems compared to their peers, have them evaluated.
Don’t stress over whether your baby is meeting milestones. But do stay aware so you can bring it to your pediatrician’s attention and get your baby the interventions they need.
Most importantly, take it one day at at time.
