Late preterm infant


Late preterm infants are infants born at a gestational age between weeks and weeks. They have higher morbidity and mortality rates than term infants due to their relative physiologic and metabolic immaturity, even though they are often the size and weight of some term infants. "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.

Risk factors

Several important factors that may predispose late-preterm infants to medical conditions associated with immaturity:
At 34–35 weeks, the brain weight is only about two-thirds that of a full-term baby. This may lead to an increased risk of:
Late preterm infants have an increased risk of being underweight and stunted at 12 and 24 months of age versus term infants.
Proper nutrition is essential for normal growth, optimal neurologic and cognitive development, immune protection, and long-term health.

Feeding

The last trimester of pregnancy the fetus is expressing active amino acid transport, calcium, lipid transfer, and glucose facilitated diffusion. Delivery of the premature infant requires higher energy expenditure, but with inadequate intake the infant will have negative nitrogen balance. There are higher needs for Calcium, Phosphorus, and Vitamin D.

Early nutrition and cognitive outcome

For every 10 kcal/kg increase in energy intake in the first week of life, there is a 4.6 point increase in MDI at 18 months. For every 1 g/kg increase in protein intake in the first week of life, there is an 8.2 point increase in MDI at 18 months.

Challenges to feeding

Sources:
  • Small mouth and immature oral muscle
  • Weak suck and poor latch
  • Easily tire with feeding
  • Maternal delayed milk production

    When to start feeding

Factors such as hemodynamic stability, severe IUGR, respiratory, abdominal exam, whether feeding cues are present, and stable glucose could all effect the timing of nutrition. Some preterm infants will be NPO. If infants are unable to start oral or enteral intake intravenous fluids may begin with amino acids or total parenteral nutrition.
According to the American Academy of Pediatrics section on breastfeeding recommendations are all infants should receive human milk.

Nutrient needs by gestational age

Variables34-3637-3839-41
Fetal Growth
Weight gain, g131110
Lean body mass gain, g10.57.26.6
Protein gain, g1.61.31.2
Requirements
Energy, kcal127115110
Proteins, g3.12.52
Calcium, mg120-14070-12070-120
Phosphorus, mg60-9035-7535-75

Fortifiers

Use caution when fortifying single nutrients to prevent alteration of protein/energy ratio. Centers for Disease Control recommends that sterile formulas and fortifiers be used when mom is not available. Powdered formula and HMF may be contaminants. Start with the mom's diet during breastfeeding. Mom should be eating adequate calories, protein, B vitamins and DHA.

How much

Due to lower capacity for feed volume and lower sucking ability relative to infants born at full term, late preterm infants may require more frequent feeding. Failure of the infant to adequately feed can contribute to the development of jaundice.

Colostrum production

production can range from 26 to 56 mL the first day to 113–185 mL for day two. Although colostrum production is not voluminous, it can still meet the needs of the newborn.

Feeding methods

Early nutrition

  • Colostrum Diet; Mother's own milk
  • Trophic Feeds
  • Donor Milk
  • Fortify human milk
  • Consistency in feedings important