Breastfeeding the early-term baby

Is a baby born at 38 weeks harder to breastfeed?

Babies born between 37 weeks and 38 weeks 6 days after conception are not defined as premature; they are early-term. However, even babies born as late as 38 weeks should be watched closely for milk intake. They often need more help with feeding than full-term babies (born at 39 to 41 weeks 6 days). Compared with full-term babies, early-term babies are more likely to have trouble breastfeeding, are sleepier, and do not fuss when underfed. They are at higher risk of jaundice, low blood sugar levels, and dehydration. Early-term babies in particular would benefit from close monitoring while in hospital and a home visit by a health-care provider after discharge.

A) Describing early term babies

Full-term babies are born from 39 to 41 weeks and 6 days gestation.

Babies born at between 37 weeks and 38 weeks 6 days of gestation are not premature by definition; they are called early-term.

Unfortunately these babies are often mistakenly labelled “full-term” (sometimes shortened to “term”) and their feeding problems may be missed because parents and health-care providers assume they are full-term babies and capable of breastfeeding. However, feeding challenges related to early birth can happen in babies born as late as 39 weeks. 

B) Differences between early-term and term babies

Early-term babies have less strength and are easily tired. They are more sensitive to the other causes of sleepiness and poor feeding and should be watched closely for adequate milk intake. They are more prone to health problems which can make feeding even more difficult. 

Compared with full-term babies, early-term babies are more likely to:

  • Have more breastfeeding problems:
  • Have more medical problems:
    • Become cold as they have less body fat.
    • Develop jaundice and low blood sugar levels (Norman 2015; Wight 2014; Young 2013).
    • Have breathing problems (Tita 2009; Young 2013).
    • Have blood infections (sepsis) (Tita 2009).
    • Have neurologic problems (Seikku 2016).
  • Spend more time in hospital:
    • Need to be cared for in the neonatal intensive care unit (Tita 2009).
    • Have longer hospital stays (Tita 2009).
    • Return to hospital (Coathup 2020; Young 2013).

While all newborns may benefit from a home visit by a health-care provider after discharge from hospital, these babies in particular would do so (Paul 2004).

References

Coathup V, Boyle E, Carson C, et al. Gestational age and hospital admissions during childhood: population based, record linkage study in England (TIGAR study). BMJ. 2020 Nov 25;371:m4075

Jónsdóttir RB, Jónsdóttir H, Skúladóttir A, et al. Breastfeeding progression in late preterm infants from birth to one month. Matern Child Nutr. 2019 Oct 8:e12893
 
Keenan-Devlin LS, Awosemusi YF, Grobman W, et al. Early Term Delivery and Breastfeeding Outcomes. Matern Child Health J. 2019 Jun 19

Muelbert M, Harding JE, Bloomfield FH. Nutritional policies for late preterm and early term infants - can we do better? Semin Fetal Neonatal Med. 2018 Oct 12

Noble A, Eventov-Friedman S, Hand I, et al. Breastfeeding Intensity and Exclusivity of Early Term Infants at Birth and 1 Month. Breastfeed Med. 2019 Jul/Aug;14(6):398-403
 
Norman M, Åberg K, Holmsten K, et al. Predicting Nonhemolytic Neonatal Hyperbilirubinemia. Pediatrics. 2015 Dec;136(6):1087-94
 
Paul IM, Phillips TA, Widome MD, et al. CS. Cost-effectiveness of postnatal home nursing visits for prevention of hospital care for jaundice and dehydration. Pediatrics. 2004 Oct;114(4):1015-22
 
Seikku L, Gissler M, Andersson S, et al. Asphyxia, Neurologic Morbidity, and Perinatal Mortality in Early-Term and Postterm Birth. Pediatrics. 2016 Jun;137(6). pii: e20153334
 
Tita AT, Landon MB, Spong CY, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med. 2009 Jan 8;360(2):111-20
 
Wight N, Marinelli K; the Academy of Breastfeeding Medicine. ABM clinical protocol #1: guidelines for blood glucose monitoring and treatment of hypoglycemia in term and late-preterm neonates, revised 2014. Breastfeeding Medicine 2014;9(4)
 
Young PC, Korgenski K, Buchi KF. Early readmission of newborns in a large health care system. Pediatrics. 2013 May;131(5):e1538-44