What are the care recommendations for late preterm (near-term, 34-36 weeks gestation) infants?

Care Recommendations for Late Preterm Infants (34-36 Weeks Gestation)

Late preterm infants require specialized care protocols that address their unique physiological vulnerabilities, including temperature instability, feeding difficulties, hypoglycemia, and hyperbilirubinemia to reduce morbidity and mortality risks.

Definition and Significance

• Late preterm infants are those born between 34 0/7 weeks and 36 6/7 weeks gestation, representing approximately 73% of all preterm births 1
• Despite appearing similar in size to term infants, late preterm infants are physiologically and metabolically immature, missing critical third-trimester development 2
• These infants have 2-3 times higher risk of morbidities compared to term infants 3

Temperature Management

• Maintain body temperature between 36.5°C and 37.5°C after birth through admission and stabilization 4
• For late preterm infants (≥34 weeks gestation), room temperature should be maintained at 23°C rather than 20°C to maintain normal temperature 4
• Implement skin-to-skin care with a parent immediately after birth for temperature regulation in infants at low risk of needing resuscitation 4
• When skin-to-skin care is not possible, consider using a plastic bag or wrap to maintain normal temperature 4
• Monitor for hypothermia, which is associated with increased neonatal morbidity and mortality 4, 5

Feeding Support

• Late preterm infants have decreased breastfeeding rates compared to term infants due to maternal delayed lactation onset, infant immaturity, decreased effective milk emptying, and mother-infant separation 4
• Inadequate human milk intake in the first days can lead to longer hospital stays and higher readmission rates 4
• When supplementation is necessary, use expressed maternal milk or pasteurized donor human milk when available, as formula supplementation has been associated with increased exclusive formula feeding at discharge 4
• Develop individualized feeding plans that account for immature feeding skills and inadequate breast stimulation 6
• Monitor for feeding difficulties, which are common in this population 2

Glucose Management

• Implement routine screening for hypoglycemia, as late preterm infants are at increased risk 2, 5
• Skin-to-skin care has been shown to reduce hypoglycemia risk (273 fewer infants/1000 were hypoglycemic when skin-to-skin care was used) 4
• Consider intravenous glucose infusion when necessary to avoid hypoglycemia 4

Jaundice Management

• Monitor closely for hyperbilirubinemia, as late preterm infants are at increased risk 4, 2
• Breastfeeding 9-10 times per day is associated with lower bilirubin concentrations 4
• Colostrum feedings increase stooling, which increases bilirubin excretion 4
• Keep infants requiring phototherapy in close proximity to the mother to facilitate cue-based feeding and additional breastfeeding support 4
• Formula supplementation should only be considered if bilirubin concentrations are approaching exchange transfusion levels 4

Cord Clamping

• For late preterm infants (≥34 weeks gestation), delayed cord clamping for at least 60 seconds is recommended 4
• Delayed cord clamping facilitates postnatal cardiovascular transition, increases hemoglobin and hematocrit, and improves iron status 4
• Be aware that delayed cord clamping may increase rates of polycythemia and hyperbilirubinemia requiring phototherapy 4

Vitamin and Mineral Supplementation

• Administer intramuscular vitamin K1 (0.5-1.0 mg) on the first day of life to reduce vitamin K deficiency bleeding risk 4
• Provide vitamin D supplementation (400 IU/day) for infants consuming less than 28 ounces of commercial infant formula per day 4

Antenatal Corticosteroids

• A single course of antenatal corticosteroids (2 doses of 12 mg intramuscular betamethasone 24 hours apart) is recommended for pregnant patients with singleton pregnancies between 34 0/7 and 36 6/7 weeks who are at high risk of preterm birth within 7 days 4
• Antenatal corticosteroid administration in late preterm period decreases respiratory morbidity 4
• Avoid antenatal corticosteroids in pregnant patients with pregestational diabetes mellitus due to risk of worsening neonatal hypoglycemia 4

Monitoring and Follow-up

• Late preterm infants have higher hospital readmission rates in the first month of life 1
• Monitor for respiratory complications, which are common in this population 2
• Consider closer follow-up after discharge to identify and address complications early 1, 3

Common Pitfalls to Avoid

• Treating late preterm infants as if they were term infants - they require specialized care protocols 3, 2
• Failing to monitor for temperature instability, which can exacerbate other complications 5
• Underestimating feeding challenges, which can lead to dehydration, hypoglycemia, and hyperbilirubinemia 6
• Discharging too early without adequate feeding establishment and parent education 1
• Not providing adequate breastfeeding support, leading to early breastfeeding cessation 4, 6