Late Preterm Infants part 2
Teach Me Tuesday: Late Preterm Infants – Part 2
Little Bits to Grow Your Knowledge
In Part 1, we introduced the clinical challenges common to late preterm infants (34–36 6/7 weeks), including thermoregulation, feeding immaturity, and hyperbilirubinemia. This week, we’re diving deeper into what experienced NICU nurses need to know to manage these patients confidently from admission through discharge.
These infants often don’t follow the same care trajectory as micro-preemies or term babies. They may be in and out of the NICU quickly—or never admitted at all. But don’t be fooled by their size. Their transition to extrauterine life can still be rocky, and they deserve intentional care planning and discharge support. Let’s explore what late preterm care really looks like across the continuum.
🩺 Quick Recap: 5 Common Issues in Late Preterm Infants
Thermoregulation – Easily cold-stressed due to poor brown fat and immature skin.
Hypoglycemia – High risk due to lower glycogen stores and poor feeding coordination.
Hyperbilirubinemia – Delayed hepatic clearance and feeding immaturity → higher jaundice rates.
Respiratory Distress – Grunting, TTN, apnea or mild RDS often seen in first 24 hours.
Feeding Immaturity – Suck-swallow-breathe coordination may not be fully developed, especially <36 weeks.
💉 IV Access: PIVs and NGs in the Late Preterm
Most late preterm infants won’t need central lines or umbilical catheters unless they have complications like sepsis or worsening RDS. That said, peripheral IVs (PIVs) are common—often started for glucose support or empiric antibiotics during the first 24–48 hours.
📌 PIV Pro Tips:
These sticks aren’t always easy—limbs may be fuller, but skin is tougher than a micro-preemie.
Warm the limb, use sucrose, and consider holding the skin taut to improve your success rate.
Secure IVs carefully—these babies move a lot and are frequently in and out of bed for feedings or skin-to-skin.
IVs are often short-term; anticipate frequent weaning as feeds advance quickly.
💡 Spoiler alert: Next week’s Teach Me Tuesday is all about PIV placement tips!
NG or OG tubes are often placed to support babies who are not yet ready for full oral feeds, especially those showing fatigue, tachypnea, or disorganized suck.
🍼 Feeding Cues & Support Strategies
Feeding readiness should be evaluated just like with earlier preemies—by watching behavior, not just gestational age.
Look for feeding readiness cues:
Alertness and rooting
Rhythmic, organized sucking
Coordinated suck-swallow-breathe
Good tone and stamina
Avoid assumptions based on size. These babies may look term, but many still require cue-based, developmentally appropriate feeding to avoid fatigue, aspiration, or oral aversion.
🤱 Breast and Bottle Practice
Late preterms often need exposure to both breast and bottle feeding before discharge. Prioritize non-nutritive sucking at the breast, paced bottle feeding, and skin-to-skin to support feeding endurance.
Consider:
Slow flow nipples or ultra-preemie nipples
Lactation support early, especially if separation delayed milk coming in
Avoid measuring success by volume—focus on feeding quality and coordination
🧤 Discharge Teaching: Thermoregulation
Even at 36 weeks, late preterm infants are at risk for cold stress, especially after discharge.
Teach parents to:
Dress baby in one extra layer
Use hats only if baby is trending cold
Monitor for signs of hypothermia (cool skin, poor feeding, lethargy)
Maintain a home temp of 68–72°F
Also emphasize not to overheat—especially in car seats or swaddles.
🍽️ Discharge Teaching: Feeding
Many late preterm infants are discharged before they’ve fully mastered feeding.
Teach families:
What fatigue looks like during feeds
How to track volume and feeding time
Why scheduled waking may be needed
To schedule early pediatrician or lactation follow-up
⚠️ If baby is going home before regaining birth weight or still on the decline:
May need q3h feeding schedule, even overnight
Pediatrician may order home weight checks (via clinic, home health nurse, or home scale)
Formula-fed infants may be discharged on 24 kcal formula or other fortified options
Parents need clear expectations about what growth looks like and when to call
📋 Discharge Checklist: What Should Be Done?
Late preterms often have a shorter, less intensive stay, so discharge planning can’t be skipped.
Minimum discharge readiness checklist includes:
✅ Stable blood sugar for 24 hours (no IV or gel)
✅ Stable temperature in open crib
✅ No oxygen requirement or active respiratory distress
✅ Bilirubin stable or decreasing, with a clear follow-up plan
✅ CCHD screening completed
✅ State newborn screen collected
✅ Car seat trial completed (if indicated—see below!)
💡 If baby is not yet gaining weight, make sure the discharge plan reflects increased support: feeding schedule, weight checks, possible formula fortification, and close outpatient monitoring.
🚗 Car Seat Education: Not Just for NICU Babies
Late preterms are at higher risk of desaturations and bradycardia in car seats due to immature upper airway tone and head control. That’s why a car seat trial is often required prior to discharge.
But—not all hospitals require them. Always check your local policy.
Car seat trial is typically indicated for:
Infants <37 weeks gestation
Infants <48 hours of age
Any baby with history of apnea, bradycardia, or desaturation
Teach families:
Proper car seat positioning and why it matters
To avoid prolonged sleep in car seats after discharge
Signs of distress in the seat (color change, limpness, unusual breathing)
Not to use inserts or padding that didn’t come with the seat
📅 Follow-Up and Readmission Prevention
These babies are at high risk of readmission for jaundice, feeding failure, and poor weight gain. Make sure families have a clear, documented follow-up plan that includes:
Pediatrician visit within 24–48 hours
Bilirubin and weight check timing
Lactation or feeding clinic referrals
Home health or RSV prophylaxis if indicated
📝 Final Thoughts
Late preterm infants walk a fine line between stability and fragility. They may fly under the radar because they don’t “look like NICU babies”—but their risks are real. Whether they spend a few hours or a few days in our care, these infants need skilled feeding support, careful discharge planning, and families who are well-prepared to care for them at home.
Our role? Recognize the developmental gaps, advocate for their unique needs, and provide education that bridges the space between NICU and home.
