Wednesday, January 14, 2009

The Late Preterm Infant & Getting to Know Your Baby

Posted by Kim:

I am the Coordinator of a non-profit group called Exceptional Families and we provide parent to parent support to families who have children with special needs. Part of my responsibility as the Coordinator is to attend the Boulder County Health Department's monthly cross-disciplinary meeting for children birth to 3 years old. This month we had a therapist from the Tiny Tim Center present the following information to us. It is shocking and eye opening considering our current birth environment and the prevalence of preterm induction and cesarean birth.

I am making no judgments here because I am all the things that I would now preach against (unfortunately I have learned more about birth since my children were born). My first son was an induced preterm labor due to fetal distress. While there was nothing I could do about this induction the statistics below are still frightening to me and make me cringe that I never once doubted my doctor or sought a second opinion. This being said, I do believe we did right by Connor inducing his birth and providing him with a better chance of survival outside the womb (I will post Connor's birth story soon). Griffin however is a different story. His induction was the typical convenience birth at 40 weeks. It has taken me several years to process his birth and I will always regret the induction (birth story also to follow).

Please read over the following information and consider it carefully. Share it with friends, family and clients. While it is particularly focused on late preterm births (and sometimes this can not be avoided), I think the "Get To Know Your Baby" section can also be applied to full term children in some situations. Every baby is different, but if you can read their signals you can better respond to their needs.

Children need their 40 weeks!

The late preterm infant is:
  • born 34 - 37 weeks
  • 75% of all preterm births are in this category
  • Many are from induced deliveries or C-sections
  • Studies have shown an increase in morbidity rate, as well as long term outcomes showing developmental delays, special education for pre-k and behavior problems that persisted to 8 years of more.
Brain Development
  • At 34 weeks the brain has fewer sulci
  • During the last 4 weeks of gestation there is an increase in the development of axons, dendrites, synapses etc
  • The is the most active phase of synaptogensis (40,000 new synapses per second)
  • At 34 weeks the brain only weighs 65% of term brain weight
  • Frontal lobes are last to develop
  • Late preterm babies are more vulnerable for bilirubin induced brain injury and neurological injuries
Medical Issues for Late Preterm Infants

Respiratory Control
  • 33-38 weeks there are changes in lung compliance, they are still developing how to
  • breathe, they may have apnea and bradycardia
  • Increase incidences of SIDS
  • Less body weight, decreased ability to regulate body temperature


Motor Challenges
  • Mild hypotonia, decreased stamina & endurance
  • Difficult feedings secondary to tone issues
  • May hear respiratory sounds due to decreased muscle activity in intercostals and upper airway
What we might see

State Organizational Challenges
  • Decreased arousal and alertness (can affect attachment between baby and parents)
  • Sensitivity to environment (light, noise, activity) therefore may have problems getting to deep and active sleep (brain development occurs when in active REM sleep)
Feeding Issues
  • Less effective suck and swallow
  • Breastfeeding may be difficult because they are sleepier, have difficulty stabilizing their temperatures and they are unable to coordinate suck/swallow/breathe
  • Education and support for parents
  • Scheduling babies activities for when they are in arousal states
  • Kangaroo mother care (skin to skin)
  • Infant Massage
  • Knowing awake/sleep states and stressor signs that baby is communicating to you
  • Using environmental modifications keep lights, noise and activity down preserve active REM sleep

Organized Physiological Behaviors
  • Skin is pink and stable throughout
  • Breathing is regular and smooth
  • Gastrointestinal is stable and there are regular elimination patterns
Disorganized Physiological Behaviors
  • Cough, breathing intervals are variable (too fast or too slow)
  • Gasp, Startle, Twitch, Sneeze, Tremor

Organized Motor Behaviors
  • Tone is balanced
  • Posture is flexed and relaxed
  • Movements are smooth and close to the body
Disorganized Motor Behaviors
  • Tone is hypertonic or hypotonic
  • Posture: arms salute, sitting on air, toe or finger splay, fisting, high arm position
  • Movements: squirm, jerky, gape face, tongue extension, arching

Organized State Behaviors
  • Awake States are calm alert, alert and focused, and may be fussy and crying
  • Sleep States are deep sleep, active sleep and drowsy sleep
Disorganized State Behaviors
  • Hypoalert, hyperalert, gaze averting, uncontrollable fussing and crying, upward gaze, staring, grimace

Behaviors that help baby become organized/Helpful self regulation behaviors
  • Hands to mouth/face
  • Hand & Foot clasping
  • Leg/foot bracing
  • Sucking and suck search
  • Tucking
  • Grasping and holding
  • Looking and attending
Ways to promote Baby's Development at Home
  • Light reduction
  • Noise reduction
  • Positioning
  • Comforting
  • Look for signs of stressors indicating need for a rest
To see this complete presentation please visit

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