A network of support systems for infants, symbolizing public policy initiatives.

Leveling the Playing Field: How Public Policy Can Boost Development in Late Preterm Infants

Rhea Morgan monogram
Rhea Morgan in Health & Wellness October 2026 • 4 min read.

"Late preterm infants often face developmental challenges. Discover how targeted public policies can provide crucial support and improve long-term outcomes."


Late preterm infants, born between 34 and 36 weeks gestation, represent a significant portion of births. While they may appear relatively healthy, they often face unique developmental challenges compared to full-term babies. A study in Pediatric Research by Sammallahti and colleagues reveals that faster growth in weight and head circumference during the first five months of corrected age is linked to higher IQ, better executive functioning in adulthood, improved academic performance, and a reduced risk of needing special education.

These findings underscore the critical importance of optimal growth during this early period. What can be done to ensure these vulnerable infants receive the support they need to thrive? Public policy plays a crucial role in creating a safety net and providing access to essential resources.

This article examines how current public policies, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), are making a difference, and explores potential avenues for future policy development to further support the healthy development of late preterm infants.

AI Search Multiple angles on this topic

Late Preterm Birth Remains Common

The percentage of U.S. infants born late preterm, at 34–36 completed weeks, rose from 6.8% in 2013 to 7.7% in 2021, then was 7.6% in 2023. Overall preterm births, before 37 completed weeks, increased from 9.6% in 2013 to 10.4% in 2023. CDC guidance says additional developmental screening may be needed for children at high risk because of preterm birth or low birth weight. (Reference URL 1; Reference URL 2)

Coordinated Care and Follow-Up

Multidisciplinary guidelines recommend care across multiple points, including newborn stability, screening, safety, and support from inpatient to outpatient care. They also call for short- and long-term follow-up and strategies for healthcare teams and family education. A 2024 review emphasizes that late preterm infants have physiologic limitations and challenges that can increase their risk for complications.

WIC: A Cornerstone of Support for Infants and Mothers

A network of support systems for infants, symbolizing public policy initiatives.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been a vital resource since 1974, safeguarding the health of low-income women, infants, and children up to age five who are at nutritional risk. WIC's impact is substantial; it serves 53% of all infants in the United States, reaching over 1.8 million babies annually.

The program provides breastfeeding promotion and support, as well as infant formula for those who do not fully breastfeed. WIC has demonstrably improved breastfeeding rates, doubling them over the past two decades (from 21% in 1994/1995 to 42% in 2013). Moreover, WIC participation is linked to improved growth rates and cognitive development.

  • Provides nutrition support and education.
  • Promotes and supports breastfeeding.
  • Improves access to healthcare and social services.
  • Positively impacts growth and cognitive development.
AI Search Multiple angles on this topic

Flexible Follow-Up in the BRISA Cohort

The BRISA cohort source describes potential ways to improve follow-up of late preterm infants in the Brazilian context. It suggests active follow-up with shorter intervals between assessments and more flexible evaluation methods, including home visits or remote interviews. The source says these approaches may improve participant engagement and reduce travel-related barriers to assessment.

Limits in the Long-Term Evidence

A systematic review of cognitive and learning outcomes says developmental risk among late preterm or moderate-to-late preterm children without neonatal morbidity needs further assessment. It calls for better control of confounding factors and longer follow-up to support more robust conclusions about learning and academic outcomes. A separate review notes that many breastfeeding studies recruited infants born before 2010, and only two reported neurodevelopmental outcomes beyond 24 months, limiting assessment of long-term effects.

Policy and Care Guidelines

The article examines current public policies such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), as well as possible future policy development to support late preterm infants. Separately, multidisciplinary guidelines aim to increase uniformity of care, with the stated hope of increasing survival and decreasing morbidity in this population. These sources describe policy support and standardized clinical care as distinct approaches.

WIC's success underscores the power of targeted public policy to positively influence the health and development of vulnerable infants. However, it's crucial to explore additional avenues to provide comprehensive support.

Looking Ahead: Expanding Support Through Paid Leave and Healthcare Access

While WIC provides crucial support, other policy initiatives can further enhance the well-being of late preterm infants. Paid family leave is one such area. The lack of paid leave presents a significant barrier to sustained breastfeeding and can impact maternal mental health, indirectly affecting infant development.

AI Search Multiple angles on this topic

Research Priorities Alongside WHO Guidelines

While developing new World Health Organization (WHO) guidelines for care of preterm or low-birth-weight infants, researchers conducted a complementary research-prioritisation exercise. The source presents this exercise alongside the guideline-development process. The supplied source description does not specify the research questions or priorities identified.

Growing Attention to Late Preterm Infants

Late preterm infants are defined in one source as those born between 34 0/7 and 36 6/7 weeks of gestation, and the source says they account for a significant proportion of preterm births. It notes that attention is increasingly shifting toward this group, while the risks associated with extremely preterm infants are already well documented. A 2020 review examines late preterm birth trends, common morbidities, and long-term outcomes, with special attention to neurodevelopment, and notes the financial burden of care on health systems.

Health-System Costs and Outcomes

A 2020 review describes care for late preterm infants as contributing a significant financial burden to health systems. It reviews recent trends in late preterm birth rates and common morbidities. The review also covers long-term outcomes, with special attention to neurodevelopment.

Supporting Infants and Families in Care

Late preterm and low-birth-weight infants are populations at increased risk for NICU admission, partly because of feeding-related conditions. A 2023 quality-improvement study aimed to increase the percentage of these infants receiving exclusive nursery care. A separate 2017 study aimed to determine a program’s effects on infant growth and collected retrospective longitudinal anthropometric data for 906 WIC and 1,001 non-WIC infants.

Access to healthcare is another critical factor. Programs like Medicaid and the Children's Health Insurance Program (CHIP) provide essential coverage for millions of children. However, ongoing discussions about healthcare financing models create uncertainty. Protecting and strengthening these programs is vital to ensure all children have access to necessary medical care and supervision.

By advocating for policies that support families, promote breastfeeding, and ensure access to healthcare, we can create a more equitable playing field and help all late preterm infants reach their full potential. Continued research and advocacy are essential to inform and shape effective public policies that prioritize the health and development of our most vulnerable population.

How the comparisons put developmental differences in perspective

  • 1.52 and 1.56 odds ratiosAfter adjustment for relevant characteristics, late preterm infants had higher odds of mental developmental delay (1.52) and physical developmental delay (1.56) than term infants.[1]
  • 2.5 GCA score pointsBreastfeeding for at least three months was associated with a 2.5-point increase in GCA score, described as 0.17 standard deviations; the source says the clinical significance is likely greater at the population than individual level.[2]Caveat: The clinical significance is likely greater at the population than individual level.
  • 0.4 effect sizeIn a breastfeeding relaxation intervention, the intervention group had a greater change in weight-for-age Z-score than the comparison group, with an effect size of 0.4.[3]

What the evidence can and cannot establish

A single-center cohort may overrepresent children who were sicker at birth, making its developmental findings less representative of all children born moderately or late preterm.[4]

National breastfeeding surveillance describes initiation and continuation, but the listed data could not account for several factors that may shape those patterns, including leave policies and lactation support.[5]

How care guidance and family support fit the findings

Multidisciplinary guidance describes a prompt community follow-up visit after hospital transition as a point to review stability, screening, safety, and family support.[6]

Feeding difficulties linked to immature coordination or sleepiness may become apparent only after milk supply increases, so early feeding can give an incomplete picture of later feeding challenges.[6]

A national breastfeeding source frames families’ difficulty meeting duration and exclusivity goals in terms of structural, social, and policy barriers, rather than individual choice alone.[7]

WIC is federally funded and state-administered, a governance structure that distinguishes the program from the clinical-care guidance discussed separately.[8]

Breast milk is described as containing nutrients, bioactive components, and immune factors that support physical and neurological growth; this provides biological context, not proof of a particular long-term outcome.[2]

What remains unresolved for late preterm infants

  • Would developmental patterns observed in a single tertiary-center cohort also appear in broader groups of children born moderately or late preterm?[4]
  • How much do leave policies, regional context, lactation support, and breast-pump access contribute to differences in breastfeeding continuation across gestational-age groups?[5]

Sources

  1. Late preterm infants have worse 24-month neurodevelopmental outcomes than term infants. (pubmed.ncbi.nlm.nih.gov)
  2. Association between breastfeeding and neurodevelopmental outcomes after late preterm birth (pmc.ncbi.nlm.nih.gov)
  3. A Breastfeeding Relaxation Intervention Promotes Growth in Late Preterm and Early Term Infants: Results from a Randomized Controlled Trial (pmc.ncbi.nlm.nih.gov)
  4. Neurodevelopment at Age 9 Years Among Children Born at 32 to 36 Weeks’ Gestation (pmc.ncbi.nlm.nih.gov)
  5. National Trends in Breastfeeding by Gestational Age Category (pmc.ncbi.nlm.nih.gov)
  6. Multidisciplinary guidelines for the care of late preterm infants (pmc.ncbi.nlm.nih.gov)
  7. The National Academies Press | Breastfeeding in the United States: Strategies to Support Families and Achieve National Goals (nap.nationalacademies.org)
  8. A Quasi-Experimental Assessment of the Effect of the 2009 WIC Food Package Revisions on Breastfeeding Outcomes (pmc.ncbi.nlm.nih.gov)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

Everything You Need To Know

1

What challenges do late preterm infants face?

Late preterm infants, born between 34 and 36 weeks gestation, often face developmental challenges despite appearing relatively healthy. These challenges underscore the need for public policies that specifically address their unique needs. The article emphasizes that faster growth in weight and head circumference during the first five months of corrected age is linked to higher IQ, better executive functioning in adulthood, improved academic performance, and a reduced risk of needing special education for the Late preterm infants.

2

What is the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and what does it do?

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been a vital resource since 1974. WIC provides nutrition support and education. WIC promotes and supports breastfeeding. Furthermore, WIC improves access to healthcare and social services. It also positively impacts growth and cognitive development. The article highlights that WIC serves 53% of all infants in the United States, reaching over 1.8 million babies annually, and has demonstrably improved breastfeeding rates, doubling them over the past two decades.

3

Why is early growth important for late preterm infants?

The impact of faster growth in weight and head circumference during the first five months of corrected age on outcomes for late preterm infants is substantial. A study in Pediatric Research by Sammallahti and colleagues found a direct correlation to higher IQ, better executive functioning in adulthood, improved academic performance, and a reduced risk of needing special education. This emphasizes the critical need for public policies that support optimal growth during this early period.

4

Why is paid family leave important in the context of infant development?

Paid family leave is a significant factor because it facilitates sustained breastfeeding, which is beneficial for infant development. The article highlights that the lack of paid leave can hinder sustained breastfeeding and can impact maternal mental health, indirectly affecting infant development, highlighting the interconnectedness of public policy and infant well-being.

5

Why is public policy important for late preterm infants?

Public policy is essential for late preterm infants because these infants often face developmental challenges. Public policies create a safety net and provide access to essential resources. The article specifically highlights the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) as a cornerstone of support. Additionally, it suggests expanding support through paid leave and healthcare access to further enhance the well-being of late preterm infants.

Newsletter Subscribe

Subscribe to get the latest articles and insights directly in your inbox.