Breastfeeding Management for the Late Preterm Infant

Practical Interventions for “Little Imposters”

Marsha Walker
Clinical Lactation 2010 1(1):22-26


Infants who are late preterm (34–36 weeks) may appear mature, but they are physiologically, metabolically and neurologically immature. Late preterm infants are at higher risk for a number of problems including poor feeding, jaundice, hospital re–admittance and potential breastfeeding failure. This article provides specific strategies for working with late preterm infants and avoiding these negative health outcomes.


Sara was born at 35 weeks weighing 6 pounds 6 ounces. Her mother Anna was told that Sara was considered “full term” because of her weight and was even sent home early because she was so “big and healthy.” Sara had a good latch but tired quickly at the breast. Three days later Sara was readmitted for high bilirubin levels and weight loss. Anna’s milk supply was blamed and she was advised to start formula.

This unfortunate scenario is played out all too often but does not have to be the outcome for the breastfed late preterm infant.

The rate of premature births (<37 weeks) in the United States is 12.3% (Martin et al., 2010), with the largest portion of these being the late preterm infant (34–36 weeks). The 8.8% rate of late preterm births places over 450,000 infants at risk for respiratory distress, apnea, bradycardia, excessive sleepiness, weight loss, dehydration, feeding difficulties, weak sucking, jaundice, hypoglycemia, hypothermia, immature self regulation, sepsis, hospital readmission (Adamkin, 2006; Engle et al., 2007), prolonged formula supplementation, and breastfeeding failure.

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