Near Term Infants, Infants born at 34-37 week Gestation.

And the trick to Breastfeeding

> by LTJG Kendra A. Carter RN BSN USPHS

Hey Mom,

I know you are scared, so Am I.

I know you think it is your fault,

It is not.

I am little but mighty,

And you can do something for me that

No one else can, you can give me

The greatest start in the world.

I know it will not be easy, you are tired and

You will ache to want to hold me,

And in time that will be,

But for now, you can supply me with gold,

Breast milk.

Hey Mom,

Thank you for your time and consideration,

Your endless devotion to allow me to grow and

Giving me the best part of you during this time of growth

Your endless supply of gold,

Breast milk.

We as medical professional know the importance of breast milk for
infants. Many would not be aware of this, infants and high performance
cars have something in common.

Infants are high performance car requires consistent care and unique
fuel to keep them running. The infant requires a high caloric intake to
support not only what is happening now but to encourage growth as well.
Similar to the high performance car that requires the unique custom care
as well.

Many people understand the car scenario. And when the nurse and the
family can find that understand; it opens the line of communication and
from there you gain the trust of that growing family.

There is age group of infants that has a unique issues, the
near**-**term infants (gestation age of 34-37 weeks) or late premature
infant with breastfeeding. These infant look full term and may act full
time however there is the immaturity of the internal and particularly
the neurological systems. This makes the near-term infant at higher risk
to become

-   Hypoglycemia & Dehydration the near term infant may not wake up for
    feeding and already at risk to hypoglycemia related to less body
    fat.

-   Hypothermia- the near term infant has less body fat and may be 1-
    1.5 pounds less than full term infants.

-   Infection & hyperbilirubinemia, related to the immature immune
    systems as well as less body fat and the near term infant
    uncoordinated ability to feed.

The near term infant can become over stimulated, resulting in an
unorganized state making feeding very difficult. The over stimulation
cause the infant to become exhausted easily and move between the
hyper-alert state ( needed to breastfeed) to a deep- sleep state and may
sleep several hours include not waking for feedings. Lasting, the near
term infant has a less coordinated suck, swallow, breathe pattern when
breastfeeding, again adding to the exhaustion issues.

Since these babies can room in with mother, it is vital that the nurse
and mother work with baby and each other to understand subtle signs for
the infant. Feeding plan for infants between 34-37 weeks of gestations
include:

-   Feed baby every three hours- be aware that these infant can rapidly
    move from a hyper-alert to a deep sleep state and may require waking
    up techniques to feed.

-   Supplement five to ten ml of pumped breast milk using a special
    nurser or syringe feeding techniques.

-   Limit total feeding time to thirty minute to allow infant to rest-
    these infant have an unorganized suck, swallow breathe pattern as a
    result over stimulation can occur and the infant is at a high risk
    of tiring.

-   Allow the mother time to pump afterward as baby sleeps with her.

-   Consult with the physician and lactation consultant to follow up
    with these families after discharge (Shannon, 2008).

Teach mothers and family members to look for sign of an effective latch
and feeding of the infants. Families can help, awaken infant, change
infant's diapers, and provide mothers with a snacks, water and
uninterrupted time for breastfeeding.

Sign of effective latch include:

-   Vigorous, rhythmic sucking burst with brief pauses between sucking
    bursts.

-   Audible swallows and list for soft "k" sound

-   No clicking or smacking sounds during sucking

-   No dimpling in baby's cheeks during sucking

-   Mother reporting a pulling sensation; no pinching through out
    feeding

-   Mother is relaxed and comfortable

-   Baby is having adequate numbers of wet and soiled diapers

-   Baby regains birth weight between days ten and fourteen of life.

Do not let the mothers forget about themselves. Like the car scenario,
the pit crew is your life line as well. Taking care of your self and
baby is first and learn to accept help.

-   Drink to thirst- keep healthy drinks, water, and natural juice,
    watch out for caffeinated drinks.

-   Eat to hunger- keep healthy snacks of veggies and protein snacks.
    This is not the time to diet to lose weight.

-   Let some else take care of the household chores for the first day or
    two at home.

-   Nap when baby nap, do not forget sleep is important to you as well.

Remind Mothers and families to make an area for breastfeeding the baby.
Pit row is important for racing car so is the nursing station for you
and baby. Make sure it is supplied and let others help you design and
keep it supplied. Item such as,

  ----------------------------------- -----------------------------------
  Comfortable chair                   Water, juice, milk

  Pillows                             Health snacks

  Footstool                           Relaxation music

  Aromatherapy                        Telephone

  Sling                               Burp cloths

  Remote control                      Books.

  Make time for yourself and          Make time for you and your other
  significant other                   children.
  ----------------------------------- -----------------------------------

Here is an idea for the phone, leave a message stated that you are busy
taking care of the baby, who arrived on at, he or she weighed in at and
is some many inches long, The price of admission is a casserole in a
freezable, microwaveable, disposable container. Please leave a message,
we will return the call in about 6 months or sooner.

With all infants, preemies, near-term or full term infant encourage the
family to maintain breastfeeding. Remind mothers and family of the
importance of breastfeeding. Provide a list of resources for the family
from lactation consults, location of pumping supplies to home follow-ups
and feeding records to show the family how the infant is progressing as
a result of breastfeeding after discharge from the hospital. It is the
bond between mother and child, the relationship between nurse and family
to help empowered women/ families to breastfeed. The bond between
infant, breastfeeding family and the nurse forms the unique
relationship. Include breastfeeding as part of the everyday conversation
and care plan. Invite mom to participate in this care plan, encourage
her to pump, proper storage of the breast milk and help her with the ups
and down of breastfeeding as well as caring for a new family member.

Another source of information can be found on www.awhonn.org. The AWHONN
Late Preterm Infant Initiative, launched in 2005 as a multi-year
endeavor, addresses the special needs of infants born between 34 and 36
completed weeks of gestation. Goals include increasing health care
provider and consumer awareness of the risks associated with late
preterm birth. Also, ensuring evidence-based educational resources are
available for nurses and health care providers to provide appropriate
assessment and care for these vulnerable newborns. New professional
resources, released July 2007, include Late Preterm (Near-Term) Infant
Assessment Guide and Optimizing Health for the Late Preterm Infant
Presentation Package.

Submitted by LTJG Kendra A. Carter RN BSN USPHS

References:

Meek, Joan, MD, MS, RD, FAAP, IBCLC& Tippins, Sherill. (2002). *American
Academy of Pediatrics-New* *Mother's Guide to Breastfeeding.* New York:
Bantam Books.

Shannon, Teresa, BSN, RN, IBCLC & O'Donnell, Mary Jane, BSN, RN, IBCLC
and Skinner, Kristen, BSN, RN, IBCLC. (January 2008). Breastfeeding in
the 21^st^ Century, Overcoming Barriers to Help Women and Infants.
*Nursing for Women' s Health, volume 11, issue 6, pp570-575.*
Washington, DC: AWHONN.