Late Preterm Infant Feeding Pathway Education

DEFINITION: Infant of 34 0/7 weeks to 36 6/7

Prior to Delivery
Provide literature to parents on challenges expected in feeding the late preterm infant and benefits of
breastfeeding . Discuss skin to skin and benefits for mother and late preterm infant due to low energy
reserves .Instruct on prolonged skin to skin sessions during most of the first 24-48 hours. Instruct on
breast massage and hand expression. If time allows show video. Educate about risks of formula feeding
however also provide information about supplementing with formula if medically necessary.
After delivery:
1. The late preterm infant (LPI) is even more intolerant of separation from the mother than the term
infant sometimes resulting in hypothermia, respiratory instability and hypoglycemia . Place stable infant
skin to skin, adding a warm blanket to infants back. Encourage rooming in(NPA)
2. Assist with breastfeeding in the 1
st
hour. . The LPI has fewer and shorter awake periods and low
energy stores. Observe for feeding cues instructing on subtle cues as an indication to attempt
breastfeeding.
3. Continue prolonged session of skin to skin to promote stabilization of vital signs and blood sugar.
Separation from skin to skin increases the infants cortisol levels decreasing blood sugar and increasing
work of breathing. Ask that visitors wait to hold a late preterm infant. Parents will need to be informed
that bright lights, talking and being handed off to multiple visitors may cause the baby to shut down. A
shut down baby looks like he is sleeping with tightly shut eyes, furrowed eyebrows and pale color. Some
infants may even respond to stressful stimuli with abnormal breathing, skin mottling, tachycardia,
bradycardia or emesis. It is best to limit visitors until the infant is more mature, often the first 2 weeks.
4. The LPI has less muscle tone than the fullterm infant making them more susceptible to positional
apnea. Provide and instruct on supportive positioning for the late preterm.
5.Instruct on breast massage/ hand expression and place on nipple or moms clean finger to infants
mouth to entice sleepy infant. Offer pumping colostrum even if mom chooses formula since colostrums
is even more valuable for the late preterm infant.
First 24 hours Postpartum:
1. Maintain prolonged sessions of skin to skin reclined to 45 degrees again reinforcing good positioning.
Keep lights low and interruptions to a minimum.
2. Continue intermittent hand expression of colostrum with the goal of breast stimulation and removal
of colostrum if available. Feed colostrum to infant by parents clean finger or clean plastic spoon per
policy.
3. The LPI has more risk for feeding difficulties than the fullterm infant. Observe and document latch
and swallowing during breastfeeding session per policy. Continue hand expression and pumping if LPI
does not breastfeed well. Observe bottle feeding infant for coordination of suck,swallow and breathing.
4. If no latch by 3 hours of age and no colostrum, begin pumping for 15 minutes. Continue breast
massage/ hand expression hourly. Feed expressed colostrum. Continue skin to skin.
5. If no colostrum has been obtained by 6 hours of age feed 5cc formula and reattempt latch. If no
latch, place skin to skin for 1 hour. Again attempt to latch after 1 hour. Return to skin to skin.
6. Continue hand expression hourly and pumping every 3 hours until infant breastfeeds well. If infant
does not breastfeed well and no colostrum is obtained, continue to feed 5cc formula every 2-3 hours for
the first 24 hours. May need to attempt latch again after feeding. Continue skin to skin.
7. Stress importance of feeding frequently, at least 10 breastfeedings or 8-10 formula feedings per day.(
NPA)
7. If infant still does not breastfeed well by 12 hours of age consult Lactation by paging or leave a
voicemail message if not available. Continue feeding at least every 3 hours.
8. Provide written and verbal late preterm infant feeding information including subtle infant feeding
cues, developmental care of late preterm infant and signs of stress and overstimulation. Assess parents
ability to recognize and respond appropriately to late preterm infant feeding cues and readiness for
engagement.
24-48 hours of life
1. Ensure continued adequate feedings. A Healthcare professional such as the RN or Lactation
Consultant should assess breastfeeding at least twice per day evaluating: suck swallow, breathing and
babys latch and milk transfer.(NPA)
2. Monitor weight daily. A weight loss of more than 3% per day or 7%by day 3 merits further evaluation
and close monitoring.(NPA)
3. Supplement no more than recommended volumes (If breastfeeding is inadequate (NPA)
See supplementation policy
4. Provide Hospital Grade breast pump
5. Continue prolonged sessions of skin to skin
Prior to discharge
1. Provide a breastfeeding assessment by Lactation Consultant twice prior to discharge.
2. Provide a feeding plan tailored to late preterm infant/ mother dyad.
3. Confirm that a call back phone call will be made by LC to follow up on breastfeeding after discharge.
4. Instruct to schedule follow up appointment with pediatrician at 24-48 hours after discharge.