What to expect if you have a late preterm baby

“It’s too soon.” Three words. That’s all I could string together as I stared in shock at the puddle of amniotic fluid on the bathroom floor. It was too soon for my baby to arrive; I was only 35 weeks and four days along—still shy of the 37-week full term milestone. But my little guy didn’t care about the date on the calendar. He was on his way before I finished my newborn checklist.

According to the most recent data from the Canadian Premature Babies Foundation, the rate of preterm birth in Canada is eight percent. Of those preterm births, 85 percent are classified as “late preterm,” occurring between 34 and the end of 36 weeks gestation.

In most cases, it’s unknown why a mom goes into labour early, says Deb Fraser, associate professor in the Faculty of Health Disciplines at Athabasca University in Alberta and an advanced practice nurse in the neonatal intensive care unit (NICU) at St. Boniface Hospital in Winnipeg.

“It’s not the case that parents have done anything that they shouldn’t have that’s resulted in their baby being born early,” she says. “I think, in many cases, babies who are born late preterm come because we’ve been able to help mom keep that baby in utero longer. So families actually need to be congratulated for managing the pregnancy and being able to keep the baby inside for even a few extra days, because that can be really important.” 

Welcoming your baby earlier than expected can be overwhelming, to say the least. Here are some key facts to help you prepare for the road ahead.

Delivering a late preterm baby

While often the size and weight of full-term newborns, these infants can be at a higher risk of health problems. “Many babies are well enough at birth that they can still be skin-to-skin with mom and we don’t have to do anything extra,” explains Fraser.

“But for others, particularly if they have problems with their breathing, they may need some extra care right at the beginning. If the baby is transferred to the observation or step-down unit, or in the neonatal intensive care unit, it’s really for extra monitoring and support to make sure that the baby is doing OK.”

Challenges your preterm baby might face

“One of the most important things for families to understand is that their baby may be almost as big as a full-term baby, but still not necessarily mature,” says Fraser. “I always tell moms that the baby has a few jobs before they are ready to go home. One is having a stable temperature. The other is not having jaundice and needing phototherapy. And the third is being able to eat well. It’s the eating well that often keeps babies in the hospital a little bit longer.”

Late preterm babies may experience challenges in the following areas

Breathing difficulties:

Babies who arrive between 34 and the end of 36 weeks gestation may face respiratory difficulties due to immature lung function. “Late preterm babies are more prone to having distress at birth around their breathing,” says Fraser, who adds that they may require supplemental oxygen or other assistance.

Temperature instability:

The fat stores needed for insulation and heat generation are not fully developed by the time late preterm babies are born, meaning they’re unable to maintain heat as well as babies born at term and are more likely to experience fluctuations in body temperature. Skin-to-skin contact can help regulate your baby’s temperature—another reason why it’s so important.

Jaundice:

The Canadian Pediatric Society estimates that 60 percent of full-term newborns will develop jaundice, a condition caused by the build-up of bilirubin, a yellow substance that forms as red blood cells break down. But for late preterm babies, signs of jaundice may not appear right away.

“In babies who are preterm, jaundice peaks a little bit later than in babies that are born at term,” explains Fraser. This is because late preterm infants have delays in starting feedings and may take in smaller amounts of milk, which increases the risk of jaundice. Their livers, which are meant to filter bilirubin from the bloodstream, may also be less mature.

Most babies won’t need treatment other than increased nursing, but some may require phototherapy (light) treatment to help break down excess bilirubin.

Feeding issues and low blood sugar:

Your baby may be big, healthy and vigorous, yet he’s sleepy and doesn’t eat well, says Fraser, “and that can be challenging and frustrating for families to understand.” When babies don’t feed well, they may experience a drop in glucose levels, causing listlessness, jitteriness, and even further feeding issues. In some cases, babies may need additional calories to help them grow.

Moms may be asked to pump their milk and feed their babies through a tube until they’re strong enough to feed. Some babies may also lack the ability to coordinate the suck and swallow reflexes required for feeding. If your babe is having issues, ask for support from your hospital or community lactation consultant or public health nurse.

Bringing baby home

“It may take until your baby hits the 36-week mark or longer for late preterm infants to be ready for discharge,” says Fraser. As a parent of a late preterm infant, there is some important work to do to prepare for baby’s homecoming, as you’ll need to learn how to meet your babe’s special needs. Questions that you may want to ask include: -What do I do if my baby is jaundiced? - How will I know if my baby is eating enough? - How should I dress the baby to make sure he or she is at a comfortable temperature? - Should I be concerned about taking the baby out or being around large crowds?

While things may continue to feel overwhelming for the first little while after you bring baby home, Fraser stresses that giving it time is the key. “Take the time to get to know your baby, and remember that she's still developing,” she says.

“Once she reaches maturity, she's going to be vigorous and strong, just like every other baby. She just needs that little bit of extra patience and time while she's finishing her growth. Trust yourself, trust your judgment, and know when and where to reach out for help.”

Helpful gear to have at home for near-term babies

An extra strong breast pump

While near-term babies may be able to breastfeed well, they tired more easily than full-term babies and often take at least a few weeks to catch up to full suck/latch strength. Combining both pumping and on-breast latching could help you both out and save you heaps of frustration and energy.

Magnetic snap-ready outfits

If your little one does face time in the NICU, there's a good chance they'll be hooked up to a variety of monitors and cables. While they can look scary, they're usually just for observation. All those wires are hard to get into typical baby sleep sacks and onesies, though. Consider getting NICU-approved magnetic snap outfits.