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Elya Boies, MD
Near-term infants, that is, infants born three to five weeks before their due date, are often those infants with "breastfeeding problems".
I would like to share with you the story of Jane, a seven-day old infant, I saw in the clinic on a Saturday morning for a weight check. In speaking with Jane's mother and reviewing the discharge summary I learned that her mother was 33 years old, this was her first pregnancy and it was complicated by high blood pressure in the last month. A C-section was performed four weeks before her due date because of the high blood pressure and concerns about the baby. Jane weighed 3300 grams (7lbs 4oz) at birth. Jane was transported to the NICU soon after birth due to difficulties breathing. She received IV fluids, antibiotics, oxygen, and bilirubin lights for jaundice.
Feedings were started by bottle with expressed breast milk and formula with one attempt at breastfeeding at 24 hours of age. Jane and her mother began breastfeeding in earnest on the third day when she was transferred out of the NICU to the postpartum floor. The lactation consultant saw Jane's mother in the postpartum unit on the first day to instruct her in pumping and again on the third day to help with positioning and latch. At this time " triple feeds" were begun, that is the baby fed at the breast, then received supplemental formula or breastmilk through a tube taped to the breast (SNS) and mom pumped after every feeding. Jane and her mother were discharged on the fifth day with instructions to feed every two to three hours using the triple feed technique. Jane's discharge weight was 3115 grams (6lb 14oz).
I was seeing Jane two days after discharge. She weighed 3124 grams (up 9 grams from discharge) and on physical exam was alert, healthy, and mildly jaundiced. Her parents reported that she would breastfeed every three hours, latch and suckle for about 10 minutes then would become very sleepy. They worked
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with her for another 30 minutes before giving her 30-40 cc of expressed breast milk via finger feeds. They found the SNS feeding system too cumbersome and were no longer using it. Jane was having yellow-brown stools with each feed.
This case illustrates several important points.
The health of the mother before and after delivery can affect the success of breastfeeding. In this case maternal hypertension resulted in a C-section four weeks before the due date resulting in the delivery of a near-term infant. Fortunately Jane's mother's blood pressure had returned to normal, she was recovering from her C-section well and had no other health problems.
It goes without saying that the infant's health and state of maturity effect breastfeeding. In this case Jane was ill and needed medical treatment and procedures that precluded effective breastfeeding in the early postpartum period. She recovered quickly, as many near-term babies do, and was ready to start breastfeeding by the third day. However, even though Jane weighed as much as many full-term infants, she did not have the coordination or the stamina of a full term infant and therefore could not achieve or maintain an effective latch or suckle. Keep in mind that a baby that was going to weigh 9lbs at term will weigh about 7 lb at 36 weeks gestation. Those of us taking care of these babies should not be deceived by the size of a near-term baby if they are having difficulties. These infants need to be monitored carefully and adjustments made in feeding routines if they are experiencing difficulties with breastfeeding.
continued on page 3
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Published by: SDCBC
Editors:
Kelly Barger, MD
Diana Lee, RD, IBCLC
Angela Tenenini, BS
Jo Ann Shaw, RD, IBCLC
Nancy Wight, MD, FAAP, IBCLC
Designed by:
Creative Impacts
www.creative-impacts.com
Inquiries can be sent to:
San Diego County Breastfeeding Coalition
Children's Hospital
3020 Children's Way, MC 5073
San Diego, CA 92123-4282
sdcbc@breastfeeding.org
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