Breastfeeding the Late Preterm Infant

Alicia Fonder

Updated October 21, 2024 22:30

My baby was born at 35 weeks gestation. We are already home from the hospital and the doctor said she is doing well. Is she different from a full-term baby and should she be breastfed differently?

That's great your baby was healthy enough to come home from the hospital! While extremely premature babies will likely spend time in the NICU and not immediately latch at the breast, babies who are considered late preterm (born between 34 and 36 weeks gestation) may be discharged after just a couple of days in the hospital and be able to do some latching. However, your late preterm baby should not be treated the same as a full-term infant and may need extra breastfeeding support. Late preterm infants may need to follow the CBAs of breastfeeding, which is the reverse of the ABCs of breastfeeding, if they are not able to transfer enough milk while breastfeeding.

The CBAs of Breastfeeding

C	Calories	Make Sure Baby is Getting Enough by counting diapers, watching weight gain and contentment. If baby has milk transfer issues, reserve their energy by bottle-feeding (ideally breast milk) before latching.
B	Build	Establish/Maintain Milk Supply by nursing and/or pumping on demand, aiming for 8-12 times in 24 hours.
A	Attach	Practice Latching by offering the breast as “dessert” to keep baby familiar with the breast.

C: Calories

The main focus is ensuring that baby is getting all the calories she needs.

Pay close attention to milk transfer by:

- Watching for signs that baby is getting enough to eat. Your doctor’s office or WIC office can do a weighted feeding to get an idea of how much milk baby received while breastfeeding.
  - If there are milk transfer issues, baby should get expressed breast milk in a bottle first, so she doesn’t tire out at the breast and lack energy to drink milk from a bottle. Use paced bottle-feeding with a slow-flow preemie nipple until baby’s due date.

B: Build

The next focus is building milk supply.

When baby isn’t latching effectively, you will need to:

- Hand express or pump on a schedule of every 2-3 hours (ideally using a hospital-grade double electric breast pump).
  - Hand express to remove colostrum and use a pump once milk “comes in.” Begin removing milk in the first hour after birth.
  - The correct flange size is almost as important as the pump you choose when it comes to pumping success.
  - Hands-on pumping will increase milk output and fat content.

A: Attach

The last (but important) step is attaching baby to the breast.

Remember, if milk transfer is a concern, latch your baby after she has received expressed breast milk to ensure she gets the calories she needs.

- Letting your baby nurse for 5–10 minutes after bottle-feeding keeps her familiar with breastfeeding and acts as a "dessert" to finish the feeding.
- Nipple shields are a short-term solution that may make latching easier for your baby.
- Once your baby is gaining weight well, shows signs of getting enough milk (which are the same as those we look for in full-term babies), and has a strong enough suck to effectively remove milk from the breast, latching can become more primary.

Additional Information & Suggestions:

- Late preterm babies have a harder time maintaining their body temperature, blood sugar and experience higher levels of stress, so skin-to-skin contact is very important for them.
- Late preterm babies are at higher risk for developing jaundice, and it may not be discovered until after hospital discharge. Know what to look for and contact your doctor if baby shows signs of jaundice.
- Late preterm babies are often sleepier and need to be woken to feed every 2 hours during the day and every 3 hours at night.
  - Even when awake, late preterm babies may not show clear hunger cues, such as bringing their hands to their mouths, as this action requires coordination that they may not have developed yet.
- Late preterm babies can have “confusing” behavior and are often:
  - Less alert, make less eye contact and make less “cooing” noises.
  - Easily overstimulated, causing them to tire out quickly.
  - Move through stages of sleep and alertness very quickly without much warning.

Learn more about newborn stages and how to recognize and respond to signs of overstimulation here.

Reach out to your peer counselor for support. When babies are born early, there are often additional challenges with breastfeeding and getting help as early as possible makes those challenges easier to overcome.