A baby born at 35 weeks of gestation is considered late preterm, marking a period when the pregnancy is nearing full term but is not yet complete. Parents often wonder if their baby will need specialized care in a Neonatal Intensive Care Unit (NICU). While many babies born at this stage can thrive with standard care, some may require additional medical support due to their developmental immaturity.
Understanding Late Preterm Birth
At 35 weeks gestation, a baby is approximately 18 inches long and weighs around 5 to 6 pounds, continuing to gain weight rapidly. Despite their size, several key physiological systems are still undergoing important maturation. For instance, their lungs, though nearing full development, may not be entirely ready for independent breathing outside the womb. Essential functions like maintaining body temperature and coordinating feeding can also present challenges because these systems are not yet fully robust.
Common Reasons for NICU Admission at 35 Weeks
Late preterm infants often face specific medical issues that necessitate NICU admission. Respiratory distress is a common concern, as their lungs may not produce enough surfactant, a substance that helps keep the air sacs open. This can lead to transient tachypnea of the newborn (TTN), a temporary condition characterized by rapid breathing.
Feeding difficulties are prevalent among 35-week newborns due to immature suck-swallow-breathe coordination. Babies may tire easily during feeds or have trouble effectively transferring milk, which can lead to insufficient weight gain and dehydration. This immaturity can also impact their ability to regulate blood sugar levels, increasing the risk of hypoglycemia.
Maintaining a stable body temperature is another challenge, as late preterm babies have less subcutaneous fat and an immature thermoregulation system. This can result in hypothermia, requiring an incubator to provide a neutral thermal environment. Additionally, immature liver function can lead to higher bilirubin levels, causing jaundice that may require medical intervention.
Factors Influencing NICU Avoidance
Not all 35-week babies require NICU admission; several factors can contribute to a baby remaining with their parents in the postpartum unit. Robust Apgar scores at birth, indicating strong heart rate, breathing, muscle tone, reflexes, and color, are positive indicators. Stable vital signs, including consistent heart rate, breathing, and temperature, from the outset suggest the baby is adapting well to the outside environment.
The ability to demonstrate successful feeding skills, such as effective latching, suck-swallow-breathe coordination, and consistent milk intake, is crucial. Adequate weight gain and proper hydration are closely monitored to ensure the baby is receiving sufficient nutrition. The absence of significant jaundice requiring phototherapy or other interventions also helps avoid NICU admission. If no underlying medical conditions are detected, a 35-week baby can often bypass the NICU entirely.
NICU Care for Late Preterm Infants
If a 35-week baby is admitted to the NICU, the care focuses on supportive measures to support their development. Continuous monitoring of vital signs, blood sugar, and bilirubin levels is standard to track progress and identify issues. Respiratory support, such as supplemental oxygen or continuous positive airway pressure (CPAP), may be provided if breathing difficulties are present.
Feeding support is common, often involving gavage feeding through a small tube if the baby cannot feed adequately by mouth. Lactation consultants assist with breastfeeding and establishing milk supply for mothers. Babies are placed in incubators to help maintain a stable body temperature. For jaundice, phototherapy is often used, where special lights help break down bilirubin in the baby’s skin. Parental involvement, including skin-to-skin contact, is highly encouraged to support bonding and development.
Transitioning Home and Beyond
Before discharge, whether from the NICU or directly from the birth hospital, specific criteria must be met to ensure the baby’s safety and well-being at home. These criteria typically include maintaining a stable body temperature in an open crib, consistent weight gain, and demonstrating successful feeding by mouth. Babies should also be free from apnea, which are pauses in breathing, or bradycardia, a slow heart rate.
Follow-up care is important for late preterm infants. A pediatrician visit is usually recommended within 24 to 48 hours of discharge. Subsequent check-ups may be scheduled more frequently than for full-term babies to monitor growth, feeding progress, and overall development. Parents are also educated on subtle signs of illness, feeding issues, or developmental concerns.