Care of the Late Preterm Infant

(LPI)

Resources and Information

Quick Question………
Who is using a car seat
technician to install car seats
at the time of discharge?
(Please raise your hand if you are using
one)
UNC LPI Protocol
AWHONN Late Preterm Baby
LPI Crib Card Help Me Grow & Stay Healthy
My name is: ______________________________ My parents’ names are:___________________________________________

Always wash your hands right before holding me. I need:

Keep me warm by: • To be placed on my back while I am
• Holding me skin-to-skin as much as possible sleeping
• Swaddling me in a blanket when I am not skin-to-skin • Low lights and quiet time
• Removing my hat once I am able to maintain my • Limited amount of people holding me
temperature • You to watch me, so you know when I’m
hungry, want to spend time with you, or
Before I go home, I will need: need a break
• A car seat test in the right-sized car seat • My diaper changes and assessments
• My jaundice level checked around the time of my feedings
• An appointment scheduled with my provider • My blood sugar checked (as needed)

©2023 AWHONN. All rights reserved.

My feeding plan:
q My parent(s) prefer I am fed human milk. I need to be fed at least every 2–3 hours
q My parent pumps after I eat. (Pump both breasts at the same time for 15 minutes)
q Supplements after feeding if needed:
q Human milk q Donor human milk q Formula as ordered__________________
q My parent(s) prefer to formula feed me. Please feed me every 3–4 hours with: ___________________
q Use special feeding tools per my feeding plan
q Other: _______________________________________________________________________________________________

Sponsorship for this resource was provided through an educational grant from Kenvue. .org
AWHONN Warning Signs for Your Late Preterm Baby
Call your provider if your baby has:

LPI Warning Signs TEMPERATURE INSTABILITY

•
•
Fever (greater than 100°F or 37.8°C)
Low temperature (less than 97.7°F or 36.5°C)

SKIN COLOR CHANGES

• Skin looks pale and patchy or has unusual coloring
• Skin or white of eyes are more yellow

LETHARGIC
• Sleepier than normal or not waking up

IRRITABILITY
• Crying more than usual or difficult to console

TREMORS OR JITTERINESS
• Shakey or shivering when resting

BREATHING DIFFICULTY
• Pause in breathing that worries you
• Fast breathing: breathing more than 60 breaths per minute (babies have uneven breathing so count each
breath with your hand on their chest for a full minute)
• Noisy breathing: wheezing or whistling sounds while breathing
• Muscles are pulling in below or between the ribs and/or in the neck with each breath

FEEDING DIFFICULTIES
• Frequently goes longer than four hours between feedings
• Regularly needs to be awakened to feed
• Refuses several feedings
• Unable to suck and swallow well
• Eating for shorter periods of time or taking less from a bottle than normal

PEEING AND POOPING

• Unusual vomiting
• Blood in the diaper
• Stomach seems rounder and harder than usual
• Less than 5–6 wet diapers in a 24-hour period (after the first week) or no urine during the first 24 hours
after going home. It is normal to have:
o Day 4 of life: at least 4 wet diapers
o Day 5-6 of life: at least 5 wet diapers

CALL 911 IF BABY:

• Is floppy, like a rag doll, limp, or can’t wake up
• Has a seizure
• Has trouble breathing
• Looks blue, pale, or grey in their skin color (especially around the mouth/lips/tongue)

Every baby is different. Trust your knowledge of your baby and call your baby’s provider if you see signs that are worrisome to you.

©2023 AWHONN. All rights

reserved. Unlimited print copies
permitted for patient education only.
For all other permissions requests,
contact permissions@awhonn.org.

Sponsorship for this resource was provided through an educational grant from Kenvue.
AWHONN Your Late Preterm Baby and What You Need to Know
A late preterm baby is born three to six weeks early (before 37 weeks). Babies born a few weeks early are commonly smaller

LPI Parent Handout

and more fragile than full-term babies. They often require additional attention and have their own health needs. It is import-
ant for everyone caring for the baby to be aware of needs that may arise in babies born early.

Do not be surprised if your late preterm baby is not ready to come home from the hospital with you. Smaller babies may
need a few extra days of care to help prepare them for the outside world.

We (your nurses and healthcare team) will work together with you to address the following:

SKIN-TO-SKIN CONTACT
Skin-to-skin is when you hold the baby with their chest to your chest, supported with their head turned
to the side, with their mouth and nose visible. It can help you bond with your baby, help stabilize your
baby’s vital signs, help the baby cry less, and help them feed.

FEEDING
Late preterm babies may feed slower, tire easily, and may have a hard time coordinating sucking,
swallowing, and breathing. Your baby may take smaller amounts, need to be woken up to eat, need to
be fed often, and need extra calories to help them grow. Watch for your baby’s hunger cues (such as
baby putting their hands to their mouth, moving around more and looking or fussing to be fed). If you’re
feeding baby human milk, it is important to express the milk early and often, by either hand or pump.

LOW BLOOD SUGAR (HYPOGLYCEMIA)

When your baby is small and has fewer fat stores, it can be hard to keep blood sugar levels stable. Your
baby may not show any symptoms of a low blood sugar level. We may take a small amount of blood
from your baby’s heel to check the blood sugar. If the blood sugar is too low, we may need to give extra
feedings, sugar gel in the mouth, or sugar through your baby’s veins.

SAFE SLEEP RECOMMENDATIONS

Use a firm sleep surface and remove any soft bedding, including pillows, blankets, toys, and bumper pads.
Your baby should sleep in their own bed on their back. Co-sleeping or bedsharing is not recommended.

BREATHING
Your baby may have a higher risk of breathing problems and infections in the airway and lungs. We will be
watching your baby’s breathing closely in the hospital. Your baby will need to have a test in their car seat
before discharge to monitor their breathing.

TEMPERATURE
The normal temperature for your baby should be 97.7º to 99.5ºF (36.5–37.5ºC) when taken under the
arm. Late preterm babies have less body fat and can have trouble staying warm. Keep the room warm
enough to maintain your baby’s normal temperature and keep your baby away from drafts.

JAUNDICE
You may see a yellow hue in your baby’s eyes or skin; that’s jaundice. This is from the liver not being fully
developed and a higher amount of red blood cells in babies after birth. Jaundice is usually seen in the
first few days after birth and goes away within a few weeks. Your baby will be monitored for jaundice to
decide if further monitoring or phototherapy (a specialized light source) is needed.

IMMUNITY AND INFECTIONS

Late preterm babies have not had the time to develop a full immune system. This makes it easier for them
to get infections. Protect your baby by limiting visitors, washing hands frequently, providing human milk,
and getting recommended vaccines.

For more advice from nurses,

go to Healthy Mom&Baby
online at Health4Mom.org.

Sponsorship for this resource was provided through an educational grant from Kenvue.
©2023 AWHONN. All rights reserved. Unlimited print copies permitted for patient education only.`For all other permissions requests, contact permissions@awhonn.org.
LPI Crib Card – UNC Rex
An idea written down with a date
becomes a GOAL…

A goal broken down into steps becomes a

PLAN…

A plan backed by ACTION makes your

change efforts successful!
Project Planning Form
 Monthly Leadership Report
Care of the Late Preterm Infant
Hospital Name, Date 2024

Charter Team Members Lessons Learned / Anecdotes

Aim: (include your numeric goals)
Team names and roles
Why is this important? - (facility Key Stakeholders
elevator speech)

Changes Graphs of Measures Senior Role /

Proposed (P), Tested (T), Implemented (I) Recommendations /
Insert data graph to highlight Next Steps

Patient / Family Engagement IHI Rating Scale

0 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5
(Share examples of parent involvement)
Before you leave today….
1. Give me your name badge

2. Let me take a photo of your project planning sheet so I will know

what you decided to work on starting TOMORROW!!