Caring for Late Preterm Babies

Babies born between 34 and 37 weeks of pregnancy are called late preterm or premature infants. Even if they look full-term, these babies often weigh less and may need extra attention in the first few weeks. Babies gain about half a pound a week during the last month of pregnancy, so even a few weeks early can make a difference.

Because late preterm babies may not yet have fully developed systems, they sometimes need help with:

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

Body Temperature Control

Late preterm babies can have trouble regulating their body temperature. It’s important to keep them warm — but not too warm.

• Dress your baby in about the same number of layers you’d wear for comfort.
• Keep your home at a normal room temperature. Avoid heaters, sunny windows, and drafts.
• A soft cotton hat can help prevent heat loss from your baby’s head.
• If your baby’s tummy feels cool or their hands and feet look pale or marbled, add a layer and recheck in about an hour.
• To check temperature accurately, use a digital thermometer under your baby’s arm.

If your baby’s temperature is below 97.6°F (36.5°C) or above 99°F (37°C), contact your baby’s healthcare provider. 

Breastfeeding

Feeding is one of the most common challenges for late preterm babies. They may tire easily or prefer sleeping to eating, but frequent feeding helps them gain strength.

Try these tips for success:

• Ask your nurse for help with positioning and waking your baby for feedings.
• If your baby isn’t latching well, use an electric breast pump every three hours for 10 to 15 minutes.
• Meet with a lactation consultant before you leave the hospital.
• Know who to call for breastfeeding help once you’re home.

A good sign that your baby is feeding well is the 4x4x4 rule: at least four bowel movements by the fourth day of age during the first four weeks of life. Once your milk comes in, your baby’s stools should be mustard-colored and runny, and you should see several wet diapers each day.

If your baby is very sleepy, misses feedings or doesn’t have wet diapers daily, call your healthcare provider right away.

Jaundice

Jaundice — a yellowing of the skin or eyes — is common in preterm babies. About 80% of premature babies and 45–60% of full-term babies experience some degree of it. This happens because their livers aren’t yet mature enough to remove bilirubin from the blood efficiently.

Your care team will check your baby for jaundice before discharge and may recommend follow-up testing. If your baby’s skin or eyes look yellow after you return home, contact your healthcare provider.

Resistance to Infection

Premature babies have less mature immune systems, so protecting them from infection is especially important.

• Limit visitors at first, and ask anyone who is sick to postpone their visit.
• Wash your hands often — after using the bathroom, changing diapers, blowing your nose, coughing, or sneezing, and before holding your baby.
• Use disposable paper towels for drying hands if someone in the household is ill.
• Trust your instincts if your baby doesn’t seem well.

Call your baby’s healthcare provider if your baby has:

• Abnormal temperature (too hot or too cold)
• Bad-smelling drainage from the umbilical cord
• Blood or mucus in stools
• Breathing problems (flaring nostrils or noisy breathing)
• Frequent or projectile vomiting
• Loss of appetite
• Rash
• Redness or swelling of the eyes
• Watery stools or a sudden change in stool pattern

Taking care of a baby born a few weeks early can feel overwhelming at first, but you’re not alone. Your care team is always available to answer questions and help you feel more confident.