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Human milk is especially important for infants who are born before the final maturation of body organs and systems, including moderately preterm, late preterm, and early term infants.
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Late preterm infants (LPIs) are at risk for underconsumption of milk during feedings at the breast because of immature suction pressures and sleepy behavior, and their mothers are at risk for delayed onset of lactation.
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In-hospital management strategies should focus on protecting the maternal milk volume and
Management of Breastfeeding During and After the Maternity Hospitalization for Late Preterm Infants
Section snippets
Key points
Late preterm infants and mothers: a population at risk for poor lactation outcomes
LPIs and their mothers each bring risk factors to effective breastfeeding that contribute to the high rates of lactation-associated morbidities and shortened duration of breastfeeding in this population.27 In combination, these risk factors predispose infants to inadequate intake during feedings at the breast and predispose mothers to an inadequate milk supply. LPIs have weak suction pressures and immature sleep-wake regulation that place them at risk for underconsumption of milk during
Late preterm infants cared for in the maternity setting should not be considered healthy term infants
Most LPIs are cared for in the maternity area with their mothers, where lactation care is guided by polices consistent with the Joint Commission Core Perinatal Measure on exclusive breastfeeding and/or the Baby Friendly Hospital Initiative (BFHI).70, 71, 72 Both of these sets of guidelines are intended to establish effective breastfeeding practices in the hospital setting for healthy term infants and their mothers.73, 74 However, it is often assumed that these guidelines should be generalized
Management of breastfeeding for late preterm infants and mothers
There are 2 key objectives in managing breastfeeding for this population: protecting the maternal milk supply and ensuring that the infant is adequately nourished. In healthy term populations, unrestricted and effective feedings at the breast accomplish both objectives. For LPIs, separate strategies for each objective are needed until the infant is able to consume all feedings directly from the breast without the additional stimulation provided by the breast pump.27 Although there is
Summary
Human milk is especially important for infants who are born before the final maturation of body organs and systems, including MPIs, LPIs, and ETIs. However, management of lactation and breastfeeding for these populations has not been evidence based, as reflected in the high rates of breastfeeding failure and lactation-associated morbidities, especially for LPIs who are cared for in the maternity setting with their mothers. LPIs are at risk for underconsumption of milk during feedings at the
References (90)
- et al.
Improving the use of human milk during and after the NICU stay
Clin Perinatol
(2010) Bioactive proteins in human milk: mechanisms of action
J Pediatr
(2010)- et al.
Is the late preterm infant more vulnerable to gray matter injury than the term infant?
Clin Perinatol
(2006) - et al.
The late preterm infant and the control of breathing, sleep, and brainstem development: a review
Clin Perinatol
(2006) Developmental physiology of late and moderate prematurity
Semin Fetal Neonatal Med
(2012)Hyperbilirubinemia and bilirubin toxicity in the late preterm infant
Clin Perinatol
(2006)- et al.
Late preterm birth and risk of developing asthma
J Pediatr
(2010) - et al.
Diet- and colonization-dependent intestinal dysfunction predisposes to necrotizing enterocolitis in preterm pigs
Gastroenterology
(2006) - et al.
Development of intestinal immunoglobulin absorption and enzyme activities in neonatal pigs is diet dependent
J Nutr
(2001) - et al.
Increased lactation risk for late preterm infants and mothers: evidence and management strategies to protect breastfeeding
J Midwifery Womens Health
(2007)
Early discharge among late preterm and term newborns and risk of neonatal morbidity
Semin Perinatol
Risk factors for neonatal morbidity and mortality among “healthy,” late preterm newborns
Semin Perinatol
Breastfeeding the late preterm infant
J Obstet Gynecol Neonatal Nurs
Recognizing and treating delayed or failed lactogenesis II
J Midwifery Womens Health
Delayed onset of lactogenesis among first-time mothers is related to maternal obesity and factors associated with ineffective breastfeeding
Am J Clin Nutr
Anatomy and physiology of lactation
Pediatr Clin North Am
Physiology and endocrine changes underlying human lactogenesis II
J Nutr
Lactogenesis. The transition from pregnancy to lactation
Pediatr Clin North Am
Science of bottle feeding
J Pediatr
Tongue movement and intra-oral vacuum in breastfeeding infants
Early Hum Dev
Tongue movement and intra-oral vacuum of term infants during breastfeeding and feeding from an experimental teat that released milk under vacuum only
Early Hum Dev
The maturation and coordination of sucking, swallowing, and respiration in preterm infants
J Pediatr
Mammary physiology and milk secretion
Adv Drug Deliv Rev
Colostrum ingested during the first day of life by exclusively breastfed healthy newborn infants
J Pediatr
Mammary response to exogenous prolactin or frequent milking during early lactation in dairy cows
J Dairy Sci
Milk yield and mammary growth effects due to increased milking frequency during early lactation
J Dairy Sci
Stress during labor and delivery and early lactation performance
Am J Clin Nutr
The baby-friendly way: the best breastfeeding start
Pediatr Clin North Am
Studies in human lactation: milk volumes in lactating women during the onset of lactation and full lactation
Am J Clin Nutr
Breast vs bottle: endocrine responses are different with formula feeding
Lancet
A pilot study of maternal and term infant outcomes associated with ultrathin nipple shield use
J Obstet Gynecol Neonatal Nurs
Human milk: a source of more life than we imagine
Benef Microbes
Changes in immunomodulatory constituents of human milk in response to active infection in the nursing infant
Pediatr Res
Protection of the neonate by the innate immune system of developing gut and of human milk
Pediatr Res
Long-term programming effects of early nutrition—implications for the preterm infant
J Perinatol
Breastfeeding and the risk of postneonatal death in the United States
Pediatrics
Breastfeeding and maternal and infant health outcomes in developed countries
Evid Rep Technol Assess (Full Rep)
The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis
Pediatrics
Late-preterm births: challenges and opportunities
Pediatrics
Maturation of oral feeding skills in preterm infants
Acta Paediatr
Intestinal permeability in preterm infants by feeding type: mother’s milk versus formula
Breastfeed Med
Hypothesis: inappropriate colonization of the premature intestine can cause neonatal necrotizing enterocolitis
FASEB J
Development of the intestinal mucosal barrier
J Pediatr Gastroenterol Nutr
Digested formula but not digested fresh human milk causes death of intestinal cells in vitro: implications for necrotizing enterocolitis
Pediatr Res
Gut responses to enteral nutrition in preterm infants and animals
Exp Biol Med
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2023, American Journal of Clinical NutritionBreastfeeding self-efficacy, social support, and breastfeeding among Chinese mothers with late preterm infants
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2021, Journal of Pediatric NursingCitation Excerpt :Feeding preterm neonates is extremely challenging because they are born between the 24th and 36th weeks of gestation when the fetal growth rate is highest, and therefore, have undeveloped gastrointestinal systems and insufficient nutritional reserves. Preterm neonates who “have a compromised immunomodulatory response, have immature organs including the brain, and are susceptible to inflammatory injury and oxidative stress” making it difficult for mothers to breastfeed their preterm neonates (Meier et al., 2013). Ideal feeding is of paramount importance for the care of preterm neonates.
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Funding: This work was partially supported by NIH Grant Number NR0100009.