Late Pre-Term Infants (Premies)

Babies born three to five weeks early may appear fully grown, but babies born even a bit too soon weigh much less than they would be at full-term. This is because babies gain about half a pound during each of the last five weeks of pregnancy.

The late pre-term baby may show some immature behaviors, including trouble with:

• Body temperature control
• Breastfeeding
• Jaundice
• Resistance to infection

For these reasons, the late pre-term infant needs more careful attention, evaluation and monitoring after birth and during the first few weeks at home.
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Body temperature control

The late pre-term infant may not be able to regulate body temperature as well as the full term infant. You may need to monitor your baby’s temperature more closely to make sure that your baby does not become too hot or too cold. It is not necessary to turn up the heat to keep your baby warm. A normal household temperature is fine for most babies. Don’t put your baby near a sunny window or heater.

Most baby-care experts recommend dressing a baby in the same layers of clothing you would wear to be comfortable. Avoid the urge to overdress your baby. Usually, a baby who is dressed too warmly will fuss, turn red and possibly sweat. A cool baby may also fuss but will not turn red and may have cool, pale or marbled-looking hands or feet. The temperature of your baby’s hands or feet my not be a good measure of your baby’s temperature, but if your baby’s tummy feels cool, add a layer of clothing and recheck your baby’s temperature in an hour or so. Since most of a baby’s heat loss occurs from the surface of the head, wearing a soft cotton hat can help keep your baby warm, as well as removing your baby from any drafts.

The best way to determine temperature is to take your baby’s axillary (armpit) temperature with a digital thermometer. If your baby seems cool all the time (less than 97.6 degrees Fahrenheit or 36.5 degrees Celsius) or too hot (greater than 99 degrees Fahrenheit or 37 degrees Celsius), contact your baby’s health care provider.
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Breastfeeding

Breastfeeding
A baby who is three to five weeks early will soon learn to breastfeed as well as a full term infant, but may need some extra help in the first few days after birth. The late pre-term infant often would rather sleep than eat the first week of life, so it is important to keep an eye on the clock and not let your baby go more than 3 hours between feedings. The following points may help you get started:

• Ask your nurse to give you some extra help with waking and positioning your baby at the breast.
• If your baby is not latching well, have your nurse show you how to use the electric breast pump, and pump your breasts for 10 to 15 minutes every 3 hours.
• If available, ask to be seen by one of the lactation (breastfeeding) consultants. The lactation consultant can visit you while you are in the hospital and give you some extra help with breastfeeding.
• Make sure you know whom to call for help once you get home. The hospital staff and/or lactation consultant can help you find breastfeeding assistance after you leave the hospital.

Most new parents worry about how to tell if their baby is getting enough to eat. This is especially true for parents with an early baby. The 4x4x4 rule is good: at least 4 bowel movements by the fourth day of age for the first 4 weeks of life. Once mother’s milk is in your baby’s system, the stools will be mustard color and runny. Many babies have a stool with almost every feeding. Your baby should also have wet diapers every day.

If your baby continues to be very sleepy, misses feedings, and/or does not have daily wet diapers and bowel movements, call your baby’s health care provider. (See section on breastfeeding.)


If your baby is very sleepy, misses feedings, and/or does not have wet diapers every day, call your baby’s health care provider.
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Jaundice

About 45 to 60 percent of full term infants and about 80 percent of premature infants can experience a small amount of jaundice. This type of jaundice is not the same as jaundice that occurs in older people, and it does not mean that something is wrong with your baby’s liver. It is simply a result of your baby’s not fully formed liver.

Refer to section on jaundice for more detailed information on this important topic.
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Resistance to infection

The possibility of illness is especially frightening for parents of newborns. Limiting visitors soon after your baby’s arrival home and asking friends and family with illnesses not to visit can help protect your baby. Good hand washing is the best way to prevent the spread of infection. This includes washing hands after using the bathroom, after every diaper change, after blowing your nose, after you sneeze or cough into your hands, and before you pick up your baby. If someone in your household is sick, dry your hands with disposable paper towels rather than cloth towels.

It is important to recognize when your baby is not acting like him or herself. (e.g., baby appears unusually irritable, restless, sleepy or lethargic.) Trust your instincts. All babies get sick, but not every illness is life threatening.

Call your baby’s health care provider if your baby has any of the following symptoms or if you are worried about illness:

• Breathing problems (flaring nostrils or noisy breathing)
• Frequent or projectile vomiting
• Blood or mucus present in stools
• Watery stools or sudden change in the number of stools
• Loss of appetite
• Abnormal temperature (either too hot or too cold)
• Bad smelling drainage from the umbilical cord
• Swelling or redness of the eyes
• Any rashes

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