{{rewrite|date=January 2026}} '''Late preterm infants''' are [[infants]] born at a [[Gestational age (obstetrics)|gestational age]] between {{frac|34|0|7}} weeks and {{frac|36|6|7}} weeks.<ref name=Engle>{{cite journal|last1=Engle|first1=William|last2=Tomashek|first2=Kay|last3=Wallman|first3=Carol|title="Late-Preterm" Infants: A Population at Risk|journal=Pediatrics|date=December 2007|volume=120|issue=6|pages=1390–1401|doi=10.1542/peds.2007-2952|pmid=18055691|doi-access=free}}<!--|accessdate=16 July 2014--></ref> They have higher morbidity and mortality rates than term infants (gestational age ≥37 weeks) due to their relative physiologic and metabolic immaturity, even though they are often the size and weight of some term infants.<ref name="Late preterm infants">{{cite web |last1=Barfield |first1=Wanda |author-link=Wanda Barfield |last2=Lee |first2=Kimberly G. |title=Late preterm infants |url=http://www.uptodate.com/contents/late-preterm-infants |accessdate=16 July 2014 |website=UpToDate}}</ref><ref>Wang ML, Dorer DJ, Fleming MP, Catlin EA. Clinical outcomes of near-term infants. Pediatrics. 2004 Aug;114(2):372-6. doi: 10.1542/peds.114.2.372. PMID 15286219.</ref> "Late preterm" has replaced "near term" to describe this group of infants, since near term incorrectly implies that these infants are "almost term" and only require routine neonatal care.<ref name=Engle/><ref name="Late preterm infants"/>
== Risk factors == Several important factors that may predispose late-preterm infants to medical conditions associated with immaturity:<ref name="Engle"/> * [[respiratory distress]] * [[apnea]] * temperature instability * hypoglycemia * [[hyperbilirubinemia]] * poor feeding
At 34–35 weeks, the brain weight is only about two-thirds that of a full-term baby. This may lead to an increased risk of:<ref>{{cite journal|last1=Moster|first1=Dag|last2=Lie|first2=Rolv|last3=Markestad|first3=Trond|title=Long Term Medical and Social Consequences of Preterm Birth|journal=The New England Journal of Medicine|date=July 17, 2008|volume=359|issue=3|pages=262–273|doi=10.1056/nejmoa0706475|pmid=18635431|doi-access=free}}<!--|accessdate=16 July 2014--></ref><ref>{{cite journal|title=Early School-Age Outcomes of Late Preterm Infants|journal=Pediatrics|date=December 15, 2008|volume=123|issue=4|pages=e622-9|doi=10.1542/peds.2008-1405|pmid=19336353|last1=Morse|first1=S. B.|last2=Zheng|first2=H.|last3=Tang|first3=Y.|last4=Roth|first4=J.|s2cid=46233619}}<!--|accessdate=16 July 2014--></ref> * Intellectual disability * Developmental delay/disability * Special needs – education * Retention in kindergarten * [[Cerebral palsy]]
==Neonatal nutrition== Late preterm infants have an increased risk of being underweight and stunted at 12 and 24 months of age versus term infants.<ref>{{cite journal|last1=Santos|first1=Ina|title=Late preterm birth is a risk factor for growth faltering in early childhood: a cohort study|journal=BMC Pediatrics|date=November 16, 2009|volume=9|issue=71|page=71|doi=10.1186/1471-2431-9-71|pmid=19917121|pmc=2780991 |doi-access=free }}</ref>
Proper nutrition is essential for normal growth, optimal neurologic and cognitive development, immune protection, and long-term health.
==Feeding== The last trimester of pregnancy the fetus is expressing active amino acid transport, calcium, lipid transfer, and glucose facilitated diffusion. Delivery of the premature infant requires higher energy expenditure, but with inadequate intake the infant will have negative nitrogen balance.{{citation needed|date=January 2026}} There are higher needs for Calcium, Phosphorus, and Vitamin D.{{citation needed|date=January 2026}}
==Early nutrition and cognitive outcome== For every 10 kcal/kg increase in energy intake in the first week of life, there is a 4.6 point increase in MDI (Mental Development Index) at 18 months. For every 1 g/kg increase in protein intake in the first week of life, there is an 8.2 point increase in MDI at 18 months.<ref>{{cite journal|last1=Stephens|first1=Bonnie|title=First-Week Protein and Energy Intakes Are Associated With 18-Month Developmental Outcomes in Extremely Low Birth Weight Infants|journal=Pediatrics|date=August 22, 2008|volume=123|issue=5|pages=1337–1343|doi=10.1542/peds.2008-0211|pmid=19403500|s2cid=6529250}}<!--|accessdate=18 July 2014--></ref>
==Challenges to feeding== Sources:<ref>{{cite journal|last1=Meier|first1=Paula|title=Increased lactation risk for late preterm infants and mothers: evidence and management strategies to protect breastfeeding.|journal=Journal of Midwifery & Women's Health|date=2007|volume=57}}</ref><ref>{{cite journal|last1=Radtke|first1=Jill|title=Journal of Midwifery & Women's Health|journal=Journal of Obstetric, Gynecologic, & Neonatal Nursing|date=January 2011|volume=40|issue=1}}</ref> * Small mouth and immature oral muscle * Weak suck and poor latch * Easily tire with feeding * Maternal delayed milk production
==When to start feeding==
Factors such as hemodynamic stability, severe IUGR, respiratory, abdominal exam, whether feeding cues are present, and stable glucose could all effect the timing of nutrition. Some preterm infants will be NPO (nil per os). If infants are unable to start oral or enteral intake intravenous fluids may begin with amino acids or total [[parenteral nutrition]].{{citation needed|date=January 2026}}
According to the [[American Academy of Pediatrics]] section on breastfeeding recommendations are all infants should receive human milk.{{citation needed|date=January 2026}}
==Nutrient needs by gestational age== {{rewrite section|date=January 2026}} {| class="wikitable" |- ! Variables<ref>{{cite journal|last1=Lapillonne|first1=Alexandre|last2=O'Connor|first2=Deborah L.|last3=Wang|first3=Danhua|last4=Rigo|first4=Jacques|title=Nutritional Recommendations for the Late-Preterm Infant and the Preterm Infant after Hospital Discharge|journal=Journal of Pediatrics|date=March 2013|volume=162|issue=3|pages=S90-100|doi=10.1016/j.jpeds.2012.11.058|pmid=23445854}}</ref> !! 34-36 !! 37-38 !! 39-41 |- | Fetal Growth || || || |- | Weight gain, g || 13 || 11 || 10 |- | Lean body mass gain, g || 10.5 || 7.2 || 6.6 |- | Protein gain, g || 1.6 || 1.3 || 1.2 |- | Requirements || || || |- | Energy, kcal || 127 || 115 || 110 |- | Proteins, g || 3.1 || 2.5 || 2 |- | Calcium, mg || 120-140 || 70-120 || 70-120 |- | Phosphorus, mg || 60-90 || 35-75 || 35-75 |}
==Fortifiers== Use caution when fortifying single nutrients to prevent alteration of protein/energy ratio.{{citation needed|date=January 2026}} [[Centers for Disease Control]] (CDC) recommends that sterile formulas and fortifiers be used when mom is not available. Powdered formula and HMF may be contaminants.{{citation needed|date=January 2026}} Start with the mom's diet during breastfeeding. Mom should be eating adequate calories, protein, B vitamins and DHA.{{citation needed|date=January 2026}}
===How much=== Due to lower capacity for feed volume and lower sucking ability relative to infants born at full term, late preterm infants may require more frequent feeding. Failure of the infant to adequately feed can contribute to the development of jaundice.<ref>{{cite web|archive-url=https://web.archive.org/web/20140728053825/https://www.awhonn.org/awhonn/binary.content.do?name=Resources/Documents/pdf/2H3e1_LPNTWhatParentsNeed.pdf|year=2007|publisher=Association of Women's Health, Obstetric and Neonatal Nurses|website=AWHONN Late Preterm Infant Initiative|url-status=dead|url=https://www.awhonn.org/awhonn/binary.content.do?name=Resources/Documents/pdf/2H3e1_LPNTWhatParentsNeed.pdf|archive-date=28 July 2014|title=What Parents of Late Preterm (Near-Term) Infants Need to Know}}</ref>
===Colostrum production=== [[Colostrum]] production can range from 26 to 56 mL the first day to 113–185 mL for day two.{{citation needed|date=January 2026}} Although colostrum production is not voluminous, it can still meet the needs of the newborn.{{citation needed|date=January 2026}}
===Feeding methods=== * Direct Breast Feeding * Feeding tube at breast * Cup/Finger feeding * Bottle Feeding * Gavage Tube (bolus feeding)
==Strategies to improve outcome==
===Early nutrition===
* Colostrum Diet; Mother's own milk [Contains: [[Lactoferrin]], [[Secretory IgA]], Lysozyme, contains [[oligosaccharides]] (beneficial growth of good gut bacteria), and hormones] * Trophic Feeds (beneficial effect on maturation of the intestinal tract) * Donor Milk * Fortify human milk * Consistency in feedings important
==References== {{reflist}}
==External links== * [https://www.awhonn.org/awhonn/content.do?name=02_PracticeResources%2F2C3_Focus_NearTermInfant.htm AWHONN Association of Women's Health, Obstetric and Neonatal Nurses Resource for Late preterm infant] {{Webarchive|url=https://web.archive.org/web/20140726054302/https://www.awhonn.org/awhonn/content.do?name=02_PracticeResources%2F2C3_Focus_NearTermInfant.htm|date=26 July 2014}} * [http://www2.aap.org/sections/perinatal/Workshop/PDF/B10-Raju.pdf 2012 AAP-Section on Perinatal Pediatrics Workshop on Perinatal Practice Strategies: Late preterm infants] {{Webarchive|url=https://web.archive.org/web/20160304055628/http://www2.aap.org/sections/perinatal/Workshop/PDF/B10-Raju.pdf|date=4 March 2016}}
[[Category:Preterm birth]] [[Category:Midwifery]]