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    Nearly Term Infants

    Although your baby is only 3 to 5 weeks early and appears almost full grown, a baby born even a bit too soon comes into the world lacking a large percentage of a full term infant's weight. This is because a fetus will gain approximately a half of a pound during each of the last 5 weeks of pregnancy.

    The nearly term baby may also exhibit some immature behaviors, which can include difficulties with:

    Body Temperature Control

    The nearly term infant may not be able to regulate body temperature as effectively as the full term infant. You may need to monitor your baby's temperature more closely to ensure that your baby does not become too hot or too cold. It is not necessary to turn up your heat to keep your baby warm; a normal household temperature is fine for most babies, avoid placing your baby near a sunny window or heater.

    Most baby-care experts recommend dressing a baby in the same layers of clothing you would wear to be comfortable. Avoid the temptation to overdress your baby. Usually, a baby who is dressed too warmly will fuss, turn red, and possibly sweat. A cool baby may also fuss but will not turn red and may have a cool, pale, or marbled-looking hands/or feet. The temperature of a baby's hands or feet my not be a reliable indicator of your baby's temperature, but if their tummy feels cool, add a layer of clothing and recheck their temperature in an hour or so.

    Since most of your baby's heat loss occurs from the surface of their head, placing a soft cotton hat can help keep your baby warm, as well as removing him/her from any possible drafts. The most reliable way to determine temperature is to take your baby's temperature with a digital thermometer. If your baby seems consistently cool - less than 97.6 degrees Fahrenheit or 36.5 degrees Celsius; or too hot -greater than 99 degrees Fahrenheit or 37 degrees Celsius by an axillary temperature, contact your baby's doctor.

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    Feeding: Breastfeeding

    The baby who is 3 to 5 weeks early will soon learn to breastfeed as well as the full term infant, but may need some extra help in the first few days after birth. The nearly term infant often would rather sleep than eat the first week of life, so it is important to keep an eye on the clock and not let your baby go more than 3 hours between feedings. If by the end of the first day of life your infant is not feeding at least 10 minutes at the breast every 2-3 hours, the following plan should be followed:

    1. Ask your nurse to give you some extra help with waking and positioning your baby at the breast.


    2. If your baby is not latching well, have your nurse show you how to use the electric breast pump and pump your breasts for 10 - 15 minutes every 3 hours.


    3. Ask to be seen by a lactation consultant. She can visit you while you are in the hospital and give you some extra help with breastfeeding.


    4. Make sure you know who to call for help after you go home. The lactation consultant can help you find breastfeeding assistance after discharge.
    Most new parents worry about how to tell if their baby is getting enough to eat. This is especially true for parents with an early baby. The goal is 8-12 feedings per 24 hours. It is good to follow the 4x4x4 rule; at least 4 bowel movements by the 4th day of age, for the first 4 weeks of life. Once mother's milk is in, the stools will be mustard color and runny. Many babies have a stool with almost every feeding. The baby should also have wet diapers every day. If your baby continues to be very sleepy, misses feedings, and/or does not have daily wet diapers and bowel movements, call your baby's healthcare provider.

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    Feeding: Bottlefeeding

    A typical feeding for the nearly term infant on the first day, or day or two after birth, may only be one-half ounce to 1 ounce every 2-3 hours. By the end of the first week, your baby may be taking 2-3 ounces. If your baby is not waking up to feed at least every 3 hours, unwrap the baby and change the diaper. Formula-fed babies may not have a bowel movement every day, but should have several wet diapers each day. If your baby is very sleepy, misses feedings, and/or does not have wet diapers every day, call your baby's healthcare provider.

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    Jaundice

    About 45-60 percent of full term infants and about 80 percent of premature infants can experience a small amount of jaundice. This type of jaundice is not the same type of jaundice that occurs in older individuals, and does not mean that something is wrong with your baby's liver. It is simply a result of your baby's immature liver function.

    Most jaundice is caused by an excessive build up of bilirubin in the blood, a by-product of the breakdown of used red blood cells. Newborns have many more red blood cells than adults, and many of these are broken down after birth. The baby has to get rid of the bilirubin and a specific enzyme is needed for this to happen. Unfortunately in most newborns, and especially earlier babies, this enzyme does not become active for the first few days after birth. If your baby is at risk for, or has hyperbilirubinemia (an increased amount of bilirubin in the blood that can lead to jaundice) a simple blood test can be performed that measures the amount of bilirubin in the blood. Infants with hyperbilirubinemia appear to be sleepier with less "awake time" and so may be reluctant to feed. If you notice that your baby's skin appears yellow and/or they appear unusually sleepy or lethargic, contact your baby's doctor.

    Although most infants with jaundice do not require treatment occasionally these infants require a few days of phototherapy in the hospital.

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    Resistance to Infection

    It is too bad that we can not wave a magic wand and protect our babies from illness and injury once they are home. The possibility of illness is especially frightening for parents of newborns. Limiting visitors soon after your baby's arrival home and asking friends and family with illnesses not to visit can help protect your baby. If someone in your household gets sick, good hand washing is the best way to prevent the spread of infection. This includes washing hands after blowing your nose, after you sneeze or cough into your hands, after using the bathroom, before you pick up your baby and of course after every diaper change.

    It is important to recognize when your baby is not acting like him or herself. For instance, if your baby appears unusually irritable, or restless, or is unusually sleepy and lethargic. Trust your instincts. All babies get sick, but not every illness is life threatening.

    If your baby has any of the following or if you have concerns about illness, call your baby's doctor:

    • Breathing difficulties - flaring nostrils or noisy breathing.


    • Frequent or projectile vomiting.


    • Blood or mucus present in stools.


    • Watery stools or sudden change in the number of stools.


    • Loss of appetite.


    • Abnormal temperature - either too hot or too cold.


    • Foul smelling drainage from the umbilical cord.


    • Swelling or redness of the eyes.


    • Any rashes.

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