Elsevier

Clinics in Perinatology

Volume 40, Issue 4, December 2013, Pages 689-705
Clinics in Perinatology

Management of Breastfeeding During and After the Maternity Hospitalization for Late Preterm Infants

https://doi.org/10.1016/j.clp.2013.07.014Get rights and content

Section snippets

Key points

  • 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.

  • 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.

  • In-hospital management strategies should focus on protecting the maternal milk volume and

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

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      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.

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