Identify the late preterm infant as atrisk for rehospitalization within the first 2 weeks of life. These infants are referred to as late preterm infants lpi. Vaucher, and the academy of breastfeeding medicine a central goal of the academy of breastfeeding medicine is the development of clinical protocols for managing. Nutrient requirements for preterm infant formulas editor. Since 2005, the imprecise definition of nearterm infants has been replaced with latepreterm, which includes infants born between 3407. Late preterm infants, early term infants, and timing of. Interestingly, infant mortality is greater in late preterm infants for each of the leading 10 causes of death table 1. For all late preterm infants have mother manually expresspump. The best judge of when to start nipple feedings is an experienced nurse.
Transitioning the breastfeeding preterm infant from the neonatal intensive care unit to home, revised 2018 lawrence m. May 01, 2011 the infant formula act of 1980 and its amendments in 1986 defined minimum concentrations of 29 nutrients and established quality control standards for commercial production of infant formulas. Identify three nutritional interventions for the late preterm infant. Treatment for jaundice in a late preterm infant is sometimes started during the first few days of life while the infant is still in the hospital.
Most late preterm infants who require a nipple shield for initial feeding are able to outgrow their need for it at approximately 2 to 4 weeks after their due date. This booklet will help you learn to breastfeed andor feed breast milk to your late preterm baby. Nov, 2017 a 19 day old, former 35 17 week late preterm male infant came to clinic for his first appointment after he was discharged from the neonatal intensive care unit. Multidisciplinary guidelines for the care of late preterm infants. Caring for the late preterm infant a clinical practice guideline late preterm infants, those born between 34 07 weeks and 36 67 weeks, often appear outwardly similar to and are treated like full term infants. Uses the 20 fenton growth charts to report percentiles and zscores.
This is because children born preterm have been managed as if they had been born at term for many years. Identify the late preterm infant as atrisk for rehospitalization within the first 2 weeks of life for feeding difficulties, dehydration and jaundice. Nutrition practice care guidelines for preterm infants in the. However, in order to meet the unique nutritional requirements of preterm infants and preserve the singular benefit of breastfeeding, human milk should be fortified to allow adequate growth and bone mineralization 9. Degree of prematurity, bilirubin level, and other medical conditions. Nutrition practice care guidelines for preterm infants in the community goal these guidelines have been designed to assist wic and communitybased health professionals in caring for the highrisk preterm infant to ensure optimal postdischarge growth and development. Consensusclinicalguidelinesfor late preterm infant lpi. Feeding your preterm infant stepbystep constipation in the preterm infant probiotic use in preterm infants table 6. Because the recognition of the problems of the late preterm infant has been a relatively recent development in neonatology, few evidencebased approaches to the management of these patients have been published for the various care providers who interact with them. Outcomes of implementation of a nicubased late preterm. Mar, 2020 late preterm babies get tired easily and may not be strong enough feeders to drink enough breast milk or formula to gain weight. However, research has shown that they often have some of the same medical issues as early preterm infants, including. Followup recommendations for the late preterm infant. When infant formula is added to the diet, the dominance of bifidobacteria during exclusive breastfeeding decreases.
Most cases were later attributed to consumption of a chloridedeficient soy infant formula. Council of international neonatal nursing coinn position. Breastfeeding the late preterm academy of breastfeeding. Recent studies show that these latepreterm infants are at greater risk for potentially serious health problems than fullterm newborns. But this evidence was not strong enough to recommend fortification of hm after discharge 105, 106. They have higher morbidity and mortality rates than term infants gestational age. Late preterm babies born at 34, 35 or 36 weeks of pregnancy are. With the production of multidisciplinary guidelines for the care of late preterm. Multidisciplinary guidelines for the care of late preterm infants of the 500,000 premature babies born each year in the united states, nearly 75% or 375,000 of them are born at 34 07 through 36 67 weeks of gestational age ga.
Awhonn is accredited as a provider of continuing nursing. All late preterm infants, especially those born less than 2000 grams, should be closely monitored for growth adequacy, with a low threshold for supplemental feedings of preterm or postdischarge infant formula if suboptimal growth is noted. Feeding difficulties are common and some infants require intravenous nutritional support soon after birth. Formulas for preterm infants were developed with a nutrient profile different from that of human milk and term formulas, in part because of early observations that preterm infants grew better when formula, human milk, or banked human milk was supplemented with protein and minerals atkinson et al. The infant formula act of 1980 and its amendments in 1986 defined minimum concentrations of 29 nutrients and established quality control standards for commercial production of infant formulas. Oct 09, 2014 preterm birth interrupts physiological foetal development, leading to various degrees of immaturity according to the gestational age at which the infant is born.
However, supplementation of breastmilk may be indicated to promote optimal growth. Late preterm lpt infants are at risk for feeding dif. Young,2 and the academy of breastfeeding medicine a central goal of the academy of breastfeeding medicine is the development of clinical protocols, free from. Special considerations for late preterm infants72 medical risks for the late preterm infants feeding the late preterm infant. Breast milk preterm breast milk is 290 mosml or formula for preterm infants e. Late preterm infant mortality is higher than that for. Benefits of human milk in preterm infant feeding feeding choice for every infant 6. Formula feeding for latepreterm infants article pdf available in italian journal of pediatrics 40suppl 2. Upon discharge from hospital preterm infants may require fortification of. Between 1990 and 2006, there was a dramatic 25% increase in the rate of late preterm infants in the united states, although more recently this number has leveled off.
Postdischarge preterm formula alberta health services. Continued on back side what every parent should know a late preterm infant is a baby born 3 to 6 weeks early. A late preterm birth happens between 34 and almost 37 weeks of pregnancy. Late preterm infants tend to feed slower and may need to be fed more often than fullterm babies. Patrica gutweiler, rn, ibclc assisted with the writing of this chapter.
Consensusclinicalguidelinesforlatepreterminfantlpi. Since 2005, the imprecise definition of nearterm infants has been replaced with latepreterm, which includes infants born between 34 07 and 36 67 weeks of gestation. Late preterm infants are infants born at a gestational age between 34 0. Only limited data from controlled trials are available. Latepreterm infants, defined by birth at 34 through 36 weeks gestation, are less physiologically and metabolically mature than term infants. Late preterm infants shown to be at higher risk of hypoglycemia and hypothermia in 1st 12 hrs of life lp infants also shown to have slower lung fluid clearance, less surfactant compared to ft infants there is 2x relative risk of sudden infant death syndrome for lp infants 1. Consider additional glucose checks beyond 24 hours if the protocol values were. Lopera, mph, wenyang mao, mph,b marcy mcmahon, rn, ibclc, barbara l. In 2005, latepreterm births accounted for more than 70% of all preterm births coinn position statement on care of the late preterm infant coinn position. Care plan for late preterm infants gestational age 34 07.
Explain the physiologic reasons that a late preterm infant may breastfeed poorly. Current standards are summarized in the electronic code of federal regulations. Complications are common with late preterm infants, which refers to babies born between 34 weeks 0 days and 36 weeks 6 days of pregnancy. A sample care plan for late preterm infants gestational age 34 07 wks to 36 67 wks challenges desired outcomes shortlong interventions outcomes met. Special considerations for late preterm infants 72 medical risks for the late preterm infants.
If after 10 minutes of manual expression, no milk obtained, feed infant formula by alternate feeding method. Late preterm has replaced near term to describe this group of infants, since near term incorrectly implies that these infants are almost term and only require routine neonatal care. Life sciences research office 9650 rockville pike bethesda, maryland 20814 prepared for the center for food safety and applied nutrition, food and drug administration, department of health and human services, washington, dc 20204 under fda contract no. Guidelines for the use of human milkinfant formula in preterm infants protocol for gut priming in preterm infants. Establishing breastfeeding with the late preterm infant in. Infant will be seen by physicain withing 2448 hours of discharge. Now with integrated gestational age calculator and decision support e. Probiotics and prebiotics use in preterm infants chapter 7. Nutrition and the late preterm infant by jackie wessel, med, rd, csp, cnsd, cle learning objectives upon completion of this article the reader will be able to. Thus, they are at higher risk of morbidity and mortality than term infants. Late preterm infants are defined as infants born between 34 completed weeks and 36 weeks and 6 days of gestation. Educate the mother about breastfeeding her late preterm infant e.
The purpose of this report is to define late preterm, recommend a change in terminology from near term to late. A latepreterm infant is a baby born three to six weeks early, or between 34 and 36 completed weeks of gestation. Preterm formula use in the preterm very low birth weight infant. Gestational or preexisting diabetes mellitus, pregnancyinduced hypertension, maternalobesity, tocolytic use for preterm labor, late antepartumintrapartum.
Late preterm infants are physiologically and metabolically immature. In 2005, the american academy of pediatrics and the american college of obstetricians and gynecologists held an expert panel meeting. Late preterm babies dont have as much body fat to keep their temperature normal. For bottle fed infants, offer feeding at least every 3 hours. Supplementation with formula results in a rapid shift in the gut bacterial profile of a breastfed infant. Strengthening nicu healthcare professionals knowledge. Breastfeeding the late preterm 3436 67 weeks of gestation and early term infants 3738 67 weeks of gestation, second revision 2016 eyla g.
Babies born just a few weeks early have special needs that will be closely watched by the nurses and doctors caring for your baby. Supplementation in preterm and late preterm infants after. In a later study, growth and development of preterm vlbw infants were measured in groups that received predominantly human milk, predominantly preterm. Consensusclinicalguidelinesforlatepreterminfantlpifeeding. What parents of late preterm nearterm infants need to know. Treatment for jaundice in a late preterm infant is sometimes started during the first few days of. Five things parents of a late preterm nearterm infant should know and watch for. Head off complications in late preterm infants mdedge. Preterm birth interrupts physiological foetal development, leading to various degrees of immaturity according to the gestational age at which the infant is born. Breastfeeding the late preterm infant marsha walker correspondence marsha walker, rn, ibclc, 254 conant road, weston, ma 02493.
The late preterm infant is described as being born between 340 weeks through 366 weeks gestation. Patient presentation a 19 day old, former 35 17 week late preterm male infant came to clinic for his first appointment after he was discharged from the neonatal intensive care unit. Late preterm infants have unique, often unrecognized, vulnerabilities that predispose them to high rates of nutritionally related morbidity and hospital readmissions. How long do late preterm infants need supplemental feedings. Preterm formulas can be used for supplementation of breastmilk or as a breastmilk substitute but there is little evidence for their use in the late preterm infant. The united nations millennium development goal mdg 4 1 calls for a 23rd reduction in under five years of age mortality. Late preterm infants are born at a gestational age ga between 34 weeks and 0 days, and 36 weeks and 6 days. Cne establishing breastfeeding with the late continuing nursing education cne credit a total of 1.
Nutritional recommendations for the latepreterm infant and the. In addition, a late preterm infant may not be able to take in as much breastmilk or formula as a fullterm infant. Latepreterm infants are physiologically and metabolically immature. Nipple feedings can be considered as the infant matures. Nutrition practice care guidelines for preterm infants in. Assessment and care of the late preterm infant national perinatal association multidisciplinary guidelines for the care of late preterm infants 36 week work group 2018 monthly meetings continued as we worked on practice changes we wanted to implement disposable thermometers trial glucose gel approved on formulary. Overview of late preterm infant health verywell family. Breastmilk is considered the best choice of enteral feeding for late preterm infants. A37a37 october 2014 with 51 reads how we measure reads. Research article outcomes of implementation of a nicubased late preterm infant feeding guideline laura a. Much of the neonatal nutrition literature has focused on the manage ment of very low birth weight infants, a group of infants usually less than.
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