Problem-Solving with Catherine…

QUESTION:
My niece, on 2/4/16, birthed by c-section a 5#1oz boy with perfect latch and sucking but is labeled a preemie as his due date was 3/7
My grandson was born 5 weeks pre-term, 5#3oz and had a weak suck and labeled preemie.  Required facilitation for increasing sucking strength and became an efficient breast feeder after a month.
Is a preemie determined by the amount of weeks gestation or maturity at birth?
The new boy is doing everything a newborn does…good latching, sucking, eliminating, etc….
I have worked with some infants and young ones with gtubes, but haven’t thought about this question when a “preemie” has developed and appropriate feeding skills since I have never seen a preemie with good sucking!
Anyone?
Thank you…
ANSWER:
I can see how this might seem confusing to you. One of the babies was 36 weeks gestation, which means he is a late preterm infant. The other was 35 weeks gestation, and he is also considered a late preterm infant.

GA (gestational age) is a way of classifying preterms, and can give us insight into potential risk for developmental challenges and potential for associated medical issues. The lower the GA (infant may be as early as 23 weeks), the more likely for both associated medical co-morbidities and the more likely there will be feeding difficulties. The research profiles this correlation, which is most compelling for those infants born at or under 28 weeks GA.

Your little guys are both late preterms so in a group profiled with less risk overall but none the less, some risk d/t been born, in this case, 4-5 weeks early. Every day in the womb is one more day for intrauterine sensory-motor learning to occur, and so even a week longer inside mom can make an amazing difference in how the infant presents and progresses. In addition, other factors come to bear on the infant’s progression to feeding, including components of mom’s own pregnancy and medical issues during that time, the quality of the new infant’s transition to extrauterine life in the delivery room, whether he was delivered at a hospital that is experienced in delivering preterms, whether he was transported to an NICU after birth or was born at a hospital with its own NICU, for example.

Being even “only” 4-5 weeks early of course affects messaging from the brain to the muscles, timeliness of airway opening/closing, and also integrity of musculoskeletal movement, each to a varying degree for each preterm, as each one is unique in his presentation. For late preterms, there is an increased risk for hypoglycemia and hyperbilirubinemia, increased WOB, and intermittent tachypnea.  Each of these can affect drive to feed and coordination of breathing with swallowing, and the drive to suck (i.e., because breathing takes precedence). Sometimes reduced drive to feed (d/t respiratory issues common to late preterms) can be mistakenly perceived as poor sucking, when most topically the suck is fine and the infant is choosing to suck less (or less strongly) so he can focus on breathing.

In addition, there is also the influence of the hospital staff on the infant’s feeding environment, i.e., is the hospital staff volume-driven or infant-guided in their feeding approach? That “approach” is the lens through which the staff then interprets, or misinterprets, infant feeding behavior to families, and then in turn teaches families how to feed their infant,  either in a volume driven way (“he has a poor suck, give him help to suck”) or “he has less drive (due to perhaps hyperbilirubernemia and hypoglycemia and/or just being early) and has increased breathing effort, so we need to re-alert him, rest him intermittently during feeding, offer co-regulated pacing based on his communication and slow the flow rate so he does not fight the flow to breathe.” So the quality of the feeding experience is a part of the picture too.

So many factors go into the feeding experience for each preterm infant. I hope this helps make sense of the multiple reasons for the apparent variability you report. Glad to hear they are both doing well now.

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