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We hope you were able to attend one of the Regional meetings for the Care of the Late Preterm Infant initiative. If you didn’t, you missed some great discussions about improving breastfeeding support for the mothers of late preterm infants.
There is a tremendous amount of variation in the approach to feeding support for the late preterm infant, and we discussed points from guidance documents that are listed below:
AAP Policy Statement: Breastfeeding and the Use of Human Milk (2022)
• Multiple factors for late preterm infants lead to breastfeeding difficulties, including maternal delayed onset of lactation, infant immaturity, decreased efficacious milk emptying, and separation of infants from their mothers.
• Frequent feeding on demand, at least 8-10 times in 24 hours, decreases newborn weight loss, the need for supplements, and the risk of clinically significant hyperbilirubinemia.
• Continuous rooming-in with frequent, exclusive breastfeeding is recommended
• Delayed bathing of the newborn until 12 hours after birth allows more uninterrupted skin-to-skin contact and has been shown to improve exclusive in-hospital breastfeeding rates
• At least once every 8-12 hours during hospitalization of the mother and infant, including once within 8 hours before hospital discharge, it is recommended that a health professional trained in formal assessment of breastfeeding perform and document an evaluation of breastfeeding effectiveness.
• Infant supplementation, when necessary, should preferably be with expressed maternal milk or pasteurized donor human milk, when available, because formula supplementation has been associated with increased exclusive formula feeding at discharge.”
• A study has documented that decreased frequency of breastfeeding, significantly less than or equal to 7 times a day, is associated with higher bilirubin concentrations, whereas breastfeeding 9 to 10 times a day is associated with lower bilirubin concentrations
Academy of Breastfeeding Medicine Protocol #10: Breastfeeding the Late Preterm and Early Term Infant, Second Revision 2016
• The Ten Steps to Successful Feeding of the Baby Friendly hospital guidelines alone are insufficient to overcome challenges that late preterm and early term infants and their mothers face in the immediate postpartum period
Are these practices occurring in your facility? If you believe they are, have you observed or audited these practices to know they are occurring as you believe? If you are not utilizing these practices, why not? Can you consider adopting this as part of your improvement work for late preterm infants?
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