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Caring for the late preterm baby

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frances millerd

on 2 April 2013

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Transcript of Caring for the late preterm baby

What is different about
late preterm babies? Dads can do Kangaroo Care too (5). Keep baby the right temperature Jaundice It means a baby that was born at 34 weeks or after, but before 37 weeks. In other words, your baby was born about 4 to 6 weeks before the due date. Late preterm babies have different needs from term babies or earlier preterm babies (1). What does late preterm mean? Late Preterm Baby They need extra help staying warm and keeping their blood sugars balanced

They are more likely to get jaundiced

They are more at risk for getting sick

They might need more help with feeding

Your midwife will visit often to check up on you & baby

With your special care, they can thrive and grow into healthy children (2,4,5) less fat
less sugar stores
thinner skin
more water in their bodies Keeping your baby warm is important because she can use up a lot of energy trying to get warm. Late preterm babies need extra help staying warm because they have (2) : Baby’s temperature should be between 36.5 - 37.5 C A hat helps
baby stay warm Dress him in the same
number of layers you are
wearing, plus one. A great way to keep your baby warm is to hold her skin to skin against you, with a blanket over top (3,4).

This is called Kangaroo Care. Hot tip: Kangaroo Care helps your baby’s heart rate & breathing be regular and calm. It helps your baby sleep more deeply, cry less and gain weight better. (4) Taking care of your Tips for taking care Protect baby from germs All babies get sick easily. Preterm babies are more at risk. Their immune systems are not as ready. If they had been born later they would have received more antibodies from their mothers (2). Your breastmilk will help build
your baby’s immune system (2,3). Visitors Once your baby is home, it’s a good idea to limit the amount of visitors. Make sure that no one who might be sick comes to your home (2). Any visitors should wash their hands well before touching the baby Provide soap
& clean towels If the baby has any brothers or sisters,
you may need to teach them about having
clean hands around the baby . (2,3,6) Call your midwife if: Baby’s nostrils keep flaring when he breathes
Baby's skin or mouth looks blue-ish (a little blue on the hands & feet can be normal)
You have trouble waking up baby to feed
Baby is projectile vomiting
Baby is peeing less Health Canada recommends you vaccinate your preterm baby at the normal time (2 months old) to protect your baby from sickness. (6) Your baby may also be able to get an RSV vaccine. RSV is a virus that sometimes makes babies quite sick. Ask your public health clinic about this (6). Vaccination What is Jaundice? Jaundice happens when babies break down red blood cells faster than they can clean up the by-products of those cells. When babies are jaundiced their skin or eyes usually look yellowish (7). (2,3,7,8,6) Jaundice
& preterm babies Preterm babies tend to have more jaundice. This is because their bodies are less ready to clean up those red blood cells (2). A certain amount of jaundice is normal. Your midwife will watch your baby carefully to make sure the jaundice is at a safe level. Testing for jaundice If your midwife is concerned, she will order a test that measures the level of jaundice. If the level is high, your baby may need to go back to the hospital. Jaundice can be treated by shining special lights on the baby’s skin. Jaundice is the most common reason for a baby to go back to the hospital (2). Your baby should be able to go home again within a few days. Treating Jaundice To minimize jaundice Feed your baby early and often (3) You can help your baby clear her jaundice
by placing her in sunlight (8). For example breastfeed her in a sunny window. Breastfeeding
late preterm babies (2,3,9-11) Breastmilk has even more benefits for babies born early than babies born at term (3). Your body knows that your baby was born early and will make special colostrum (early breastmilk). This special breastmilk has extra antibodies to protect your baby (9). How breastfeeding helps premature babies
Protects against illness
Helps with brain development
Helps you bond with your baby
It’s less stressful for your baby than bottle or cup feeding You baby may breastfeed right away or need some help learning. It's normal for preterm babies to take some time to get good at breastfeeding (2,3). Your midwife will work with you to make sure your baby is getting the food she needs. Together you will make a plan. Will I be able to breastfeed
my late preterm baby? If your baby needs extra milk Your midwife may suggest that you use a breast pump & "top-up" baby with that milk after breastfeeding. You & your midwife may also decide it would be best to top-up with donor breastmilk or formula for a while. There are a few ways to give extra milk to your baby. It’s your choice what method works best for your family (3,9). (5,7,9) Nipple Confusion Nipple confusion has not been proven by research (11). However experts believe that some babies won’t breastfeed as well if they are given a bottle early on (9). It may depend on the baby and the milk supply of the mother. Latching onto a bottle is different from latching onto a breast. Generally babies have to work harder to get milk from a breast than from a bottle. It’s possible that your baby will be less willing to breastfeed if she is given a bottle early on (9). Lactation Aid You can supplement your baby at the breast by using this special tool made from a bottle and feeding tube. Ask your midwife for more information on how to do this. Pros Helps baby & mother learn to breastfeed
Helps build milk supply
Baby gets other health benefits from being at the breast
May be less stressful to baby than cup or bottle feeding Cons Baby must be able to latch
Must clean tubing and bottle
Takes some set up
May be slower than some other methods Finger Feeding Uses the same equipment as the lactation aid: bottle & feeding tube. The finger must be held in the baby’s mouth so that the tongue is flat and forward. The finger should be a far back in the baby’s mouth as possible (9). Ask your midwife for more information. Pros Helpful if baby unable to latch or sleepy
Baby sucks in similar way to breastfeeding
May be less stressful to baby than cup or bottle feeding Cons Proper technique is important
Must clean tubing and bottle
May be slower than other methods Cup feeding Babies can be fed with a small cup such as medicine cup. You do not pour the milk down the baby’s throat. You place the cup rim against the baby’s lip and slowly tip the milk toward the baby. Stop when the milk is in touching the baby’s lip. The baby will lap up the milk with his tongue (9). Pros Won’t interfere with latch at breast
Cups are easy to clean Cons Easy to spill milk
May be more stressful to baby than lactation aid Bottle feeding Easy & fast
Not much milk spills May make breastfeeding harder (nipple confusion)
Must clean bottles & nipples
May be more stressful to baby than finger feeding or lactation aid Pros Cons If you choose to bottle feed, ask your midwife about the best type of bottle & nipples & how you should hold the bottle. References (2,3) (2) (3,9,10) (9,10) (9,10) (3,9,10) (9,10) (2) Pacifiers Pacifiers are not a good idea for preterm babies. Using pacifiers can lead to breastfeeding problems and less breastfeeding, even in term babies (12). All your baby’s sucking time should be at the breast in order to help build your milk supply. Sucking can also be tiring for preterm babies (2). If you’d like to use a pacifier, talk to your midwife about when would be a good time. 1. Engle WA. A Recommendation for the Definition of “Late Preterm” (Near-Term) and the Birth Weight–Gestational Age Classification System. Seminars in perinatology. 2006, February; 30(1):2-7.

2. Darcy AE. Complications of the Late Preterm Infant. Journal of Neonatal Nursing. 2009; 23 (1):78–86.

3. Academy of Breastfeeding Medicine. ABM Clinical Protocol #10: Breastfeeding the Late Preterm Infant (34 0/7 to 36 6/7 Weeks Gestation). 2011, June; 30(3):151-156.

4. Anderson GC. Current knowledge about skin-to-skin (kangaroo) care for preterm infants. Journal of perinatology. 1991;11(3):216-226. 5. Johnston CC, Stevens B, Pinelli J, Gibbins S, Filion F, Jack A, Steele S, Boyer K, Veilleux A. Kangaroo Care Is Effective in Diminishing Pain Response in Preterm Neonates. Pediatric and Adolescent Medicine. 2003;157(11):1084-1088.

6. Canadian Immunization Guide Immunization of Infants Born Prematurely (Internet) 2007 July 18, cited 2013 March 7. Available from: http://www.phac-aspc.gc.ca/publicat/cig-gci/p03-05-eng.php

7. Stables D, Rankin J. Physiology in Childbearing. Edinburgh: Bailliere Tindall Elsevier; 2011.

8 . Salih FM. Can sunlight replace phototherapy units in the treatment of neonatal jaundice? An in vitro study. Photodermatology, Photoimmunology & Photomedicine. 2001, December; 17(6): 272–7. 9. Newman J, Pitman T. Dr. Jack Newman’s Guide to Breastfeeding. Toronto: HarperCollins; 2000.

10. Howard CR Physiologic stability of newborns during cup-and bottle-feeding. Pediatrics 1999;104(6)1204-7.

11. Neifert M, Lawrence R, Seacat J. Nipple confusion: Toward a formal definition. Journal of Pediatrics. 1995, June; 126(6): S125-9.

12. Howard CR, Howard FM, Lanphear B, deBlieck EA, Eberly S, Lawrence RA. Pediatrics. The Effects of Early Pacifier Use on Breastfeeding Duration. 1999, March; 103 (3): 1-6. Your care of your late preterm baby will help him or her thrive & grow
into a strong, healthy child End
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