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McBride GM, Rumbold AR, Keir AK, Kunnel A, Buxton M, Jones S, Summers L, Stark M, Grzeskowiak LE. Longitudinal trends in domperidone dispensing to mothers of very preterm infants and its association with breast milk feeding at infant discharge: a retrospective study. BMJ Paediatr Open 2023; 7:e002195. [PMID: 37923344 PMCID: PMC10626788 DOI: 10.1136/bmjpo-2023-002195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVE This study aims: (a) to evaluate patterns of domperidone dispensing to mothers of very preterm (<32 weeks gestation) infants born before and after 2014 when international recommendations were made to limit its use and (b) to examine characteristics associated with domperidone dispensing and impacts on breast milk feeding rates at infant hospital discharge. DESIGN Retrospective audit using linked electronic medical records and hospital pharmacy records. SETTING Tertiary-referral neonatal intensive care unit at the Women's and Children's Hospital in South Australia. PATIENTS Mothers of preterm infants admitted to neonatal intensive care from January 2004 to December 2018. MAIN OUTCOME MEASURES Rate of domperidone dispensing compared pre-2014 and post-2014 recommendations using interrupted time series analyses, and breast milk feeding rates at infant discharge based on domperidone treatment status, adjusted for other factors known to influence breast milk production. RESULTS Overall, domperidone was dispensed to 691 (41%) of 1688 mothers. Prior to 2014 recommendations, the proportion of women dispensed domperidone was stable. Following the recommendations, there was a significant reduction in trend (-2.55% per half year, 95% CI -4.57% to -0.53%;), reflecting less domperidone dispensing.Breast milk feeding rates at discharge remained consistently lower in infants of women dispensed domperidone than those who were not (adjusted OR 0.58, 95% CI 0.45 to 0.75). CONCLUSION Domperidone dispensing in mothers of hospitalised very preterm infants has declined over time following international regulatory warnings. Breast milk feeding rates remain lower in mothers prescribed domperidone, suggesting further research is needed to optimise lactation support for mothers of very preterm infants.
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Affiliation(s)
- Grace McKenzie McBride
- The University of Adelaide, Robinson Research Institute, North Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
| | - Alice R Rumbold
- The University of Adelaide, Robinson Research Institute, North Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
| | - Amy K Keir
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
- Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Aline Kunnel
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
| | - Michael Buxton
- SA Pharmacy, SA Health, Adelaide, South Australia, Australia
| | - Susanne Jones
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
- Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Laura Summers
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
- Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Michael Stark
- The University of Adelaide, Robinson Research Institute, North Adelaide, South Australia, Australia
- Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Luke E Grzeskowiak
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
- Flinders Health and Medical Research Institute, Adelaide, South Australia, Australia
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McBride GM, Stevenson R, Zizzo G, Rumbold AR, Amir LH, Keir A, Grzeskowiak LE. Women's experiences with using domperidone as a galactagogue to increase breast milk supply: an australian cross-sectional survey. Int Breastfeed J 2023; 18:11. [PMID: 36750944 PMCID: PMC9903405 DOI: 10.1186/s13006-023-00541-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/07/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Domperidone is one of the most commonly utilised pharmacological galactagogues, with evidence of increasing use in clinical practice. However, the use of domperidone as a galactagogue remains controversial, with mixed evidence on safety and efficacy, leading to variable clinical practice recommendations. We sought to evaluate contemporary patterns of domperidone use and examine maternal experiences related to perceived safety and effectiveness. METHODS In 2019, we conducted an online, cross-sectional survey of Australian breastfeeding women to examine individual experiences related to domperidone use, in addition to perceptions of safety and effectiveness. RESULTS Among 1876 survey responses, 19% (n = 355) reported using domperidone. Domperidone use was significantly higher in women who were primiparous, gave birth preterm, delivered by caesarean section, had self-perceived low milk supply, and saw a lactation consultant. Nearly 20% of women commenced domperidone use in the first week postpartum (19%, n = 67). The median duration of use was six weeks (interquartile range 3-16 weeks). Maximum reported doses of domperidone used ranged from 20 mg/day to 160 mg/day. Half (n = 178, 50%) of women reported using a dose of 30 mg/day or less, 44% (n = 155) reported using a dose between 31 and 60 mg/day, and 6% (n = 22) reported using a dose greater than 61 mg/day. Nearly half of the respondents reported domperidone as 'very' or 'extremely effective' (45%, n = 161), with only 8% (n = 27) reporting it was 'not at all effective'. Almost half (n = 172, 48%) of all women using domperidone reported side effects, including weight gain (25%), headaches (17%) and dry mouth (13%). Higher doses were associated with an increased likelihood of any side effects (≤ 30 mg/day, 38%; >31-≤60 mg/day, 48%, > 61 mg/day 73%; P < 0.004), with 31 (9%) stopping domperidone because of side effects. CONCLUSION We identified widespread variation in domperidone utilisation patterns, with domperidone broadly perceived to be effective in increasing breast milk supply. Side effects associated with domperidone treatment were common, appeared to be dose-related, and were frequently associated with treatment cessation. These findings highlight the importance of improved clinical practice recommendations and generation of evidence from additional high-quality clinical trials evaluating the efficacy and safety of domperidone. More conclusive clinical trials are needed to determine the efficacy, as well as optimal dose and duration, of domperidone use.
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Affiliation(s)
- Grace M. McBride
- grid.1010.00000 0004 1936 7304Adelaide Medical School, Robinson Research Institute, University of Adelaide , Adelaide, Australia ,grid.430453.50000 0004 0565 2606SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Robyn Stevenson
- grid.1010.00000 0004 1936 7304Adelaide Medical School, Robinson Research Institute, University of Adelaide , Adelaide, Australia
| | - Gabbie Zizzo
- grid.1010.00000 0004 1936 7304Adelaide Medical School, Robinson Research Institute, University of Adelaide , Adelaide, Australia
| | - Alice R. Rumbold
- grid.1010.00000 0004 1936 7304Adelaide Medical School, Robinson Research Institute, University of Adelaide , Adelaide, Australia ,grid.430453.50000 0004 0565 2606SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Lisa H. Amir
- grid.1018.80000 0001 2342 0938Judith Lumley Centre, La Trobe University, Melbourne, Australia ,grid.416259.d0000 0004 0386 2271Breastfeeding Service, Royal Women’s Hospital, Parkville, Australia
| | - Amy Keir
- grid.1010.00000 0004 1936 7304Adelaide Medical School, Robinson Research Institute, University of Adelaide , Adelaide, Australia ,grid.430453.50000 0004 0565 2606SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Luke E. Grzeskowiak
- grid.1010.00000 0004 1936 7304Adelaide Medical School, Robinson Research Institute, University of Adelaide , Adelaide, Australia ,grid.430453.50000 0004 0565 2606SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia ,grid.467022.50000 0004 0540 1022SA Pharmacy, SA Health, Adelaide, Australia ,grid.1014.40000 0004 0367 2697College of Medicine and Public, Flinders Health and Medical Research Institute Flinders University, GPO Box 2100, SA 5001 Adelaide, Australia
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Panda SK, Sahoo K, Jena PK, Dhanawat A. Availability of Breast Milk for Preterm Neonates by Gestational Age during NICU Stay. JOURNAL OF CHILD SCIENCE 2021. [DOI: 10.1055/s-0041-1735534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractThe objective of this study was to explore the availability of expressed breast milk (EBM) volume for the premature neonates born from mothers in different gestational age groups during neonatal intensive care unit (NICU) stay. All preterm infants (extreme-preterm infant [EPTI, <28 weeks], very-preterm infant [VPTI, 28–316/7 weeks], and moderate-preterm infant [MPTI, 32–336/7 weeks]) and their mothers were included in the study. Infants not receiving mother's own milk and neonates deceased or discharged against medical advice, and the mother with illness during postpartum period were excluded from the study. A predesigned tool was used to collect information on maternal characteristics, neonatal characteristics, and milk diary for preterm neonates from the NICU case records. The primary outcome variable EBM volume available on day 7 was compared across three gestational groups. Logistic regression was used to predict EBM availability. A total of 78 preterm neonates, including 10 EPTI, 37 VPTI, and 31 MPTI, had average birth weight of 962.5 ± 228.25, 1,185.1 ± 183.14, and 1,293.2 ± 182.92 g, respectively. Receipt of exclusive breast milk among EPTI, VPTI, and MPTI was 80, 94, and 83.8%, respectively. Maternal characteristics were similar except for the mode of conception (p = 0.001), mode of delivery (p = 0.04), and antenatal steroid exposure (p = 0.02) among three gestational categories. The median (Q1–Q3) volume of EBM on day 7 were 160 (136.3–202.5), 150 (140–187.5), and 160 (150–220) mL for EPTI, VPTI, and MPTI neonates, respectively, without any statistical significance. Regression analysis suggests no effect of gestational age on EBM availability. The feasibility of mother's own milk use for extremely preterm neonates is similar to higher gestational preterm neonates.
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Affiliation(s)
- Santosh Kumar Panda
- Department of Paediatrics, Kalinga Institute of Medical Sciences, Kalinga Institute of Industrial Technology, Bhubaneswar, Odisha, India
| | - Kalpita Sahoo
- Department of Paediatrics, Institute of Medical Sciences and Sum Hospital, Siksha 'O' Anusandhan, Bhubaneswar, Odisha, India
| | - Pratap Kumar Jena
- School of Public Health, Kalinga Institute of Industrial Technology, Bhubaneswar, Odisha, India
| | - Avantika Dhanawat
- Department of Paediatrics, Kalinga Institute of Medical Sciences, Kalinga Institute of Industrial Technology, Bhubaneswar, Odisha, India
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Maternal and Neonatal Hair Cortisol Levels and Psychological Stress Are Associated With Onset of Secretory Activation of Human Milk Production. Adv Neonatal Care 2019; 19:E11-E20. [PMID: 31764138 DOI: 10.1097/anc.0000000000000660] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several factors can influence the production of mothers' own milk. PURPOSE To assess the influence of maternal psychological stress, maternal cortisol levels, and neonatal hair cortisol levels on timing of secretory activation. METHODS A prospective study was conducted at 2 public health centers in Andalusia, Spain. Participants were 60 pregnant women and their 60 neonates. Hair cortisol levels and psychological stress (pregnancy-specific stress [Prenatal Distress Questionnaire, PDQ] and perceived stress [Perceived Stress Scale, PSS]) were evaluated during the third trimester and the postpartum period. This study was part of the GESTASTRESS cohort study on the effects of stress during pregnancy. RESULTS Higher PDQ and PSS scores (P < .05) in the third trimester were associated with later onset of secretory activation. Higher postpartum maternal hair cortisol levels were associated with a delayed secretory activation of mother's own milk (P < .05). IMPLICATIONS FOR RESEARCH Future studies should look at the influence of psychological stress and cortisol levels on hormones involved in mother's own milk production. IMPLICATIONS FOR PRACTICE Neonatal nurses and other healthcare providers should be familiar with levels of neonates' exposure to maternal prenatal stress prior to birth.
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Asztalos EV, Kiss A, daSilva OP, Campbell-Yeo M, Ito S, Knoppert D. Role of days postdelivery on breast milk production: a secondary analysis from the EMPOWER trial. Int Breastfeed J 2019; 14:21. [PMID: 31171928 PMCID: PMC6547502 DOI: 10.1186/s13006-019-0215-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/02/2019] [Indexed: 11/10/2022] Open
Abstract
Background With an increasing demand for mother's own milk to be viewed as a primary source of nutritional support in the care of very small and preterm infants, mothers of preterm infants may be at risk of expressing suboptimal amounts of milk. The use of a galactogogue is often considered when these mothers are still having challenges in breast milk production. Methods For this analysis, the study participants were the 90 mothers who participated in the EMPOWER trial and, at the time of randomization, were stratified by days post-delivery, 8-14 days and 15-21 days. The primary outcome measure was the proportion of mothers in each of the days post-delivery groups who achieved a 50% increase in breast milk volume on day 14 of the study treatment period. Results There was no significant difference in the proportion of mothers in the 8-14 days group (75.0%) who achieved a 50% increase in breast milk volume on day 14 of the study treatment period.compared to those in the 15-21 days group (60.9%), OR 1.93 (95% CI 0.78, 4.76; p = 0.15). Because comorbidities and exposure to antenatal corticosteroids between the groups of mothers were viewed as potential confounders, a logistic regression was performed after controlling for these two variables with the adjusted OR being 1.84 (0.73, 4.64; p = 0.19). Conclusions This secondary analysis was able to demonstrate that mothers of very preterm infants, < 30 weeks gestation at birth, were able to respond to the study treatment in a similar fashion regardless of timing of entry and exposure to domperidone. In the presence of a suboptimal breast milk production by the end of the first week postpartum, below 250 ml/kg/d based on infant birth weight, a 14 day treatment of domperidone could be considered to augment breast milk production. Trial registration EMPOWER has been registered at http://www.clinicaltrials.gov (identifier NCT01512225) on January 10, 2012.
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Affiliation(s)
- Elizabeth V Asztalos
- 1Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, University of Toronto, M4-230, 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada
| | - Alex Kiss
- 2Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON Canada
| | - Orlando P daSilva
- 3Perinatal and Women's Health, London Health Sciences Centre, Western University, London, ON Canada
| | - Marsha Campbell-Yeo
- 4School of Nursing, Departments of Pediatrics, Psychology and Neuroscience, Dalhousie University and Izaak Walton Killam Health Centre, Halifax, NS Canada
| | - Shinya Ito
- 5Division of Clinical Pharmacology & Toxicology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | - David Knoppert
- 6School of Pharmacy (D.K.), University of Waterloo, Kitchener, ON Canada
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Grzeskowiak LE, Wlodek ME, Geddes DT. What Evidence Do We Have for Pharmaceutical Galactagogues in the Treatment of Lactation Insufficiency?-A Narrative Review. Nutrients 2019; 11:nu11050974. [PMID: 31035376 PMCID: PMC6567188 DOI: 10.3390/nu11050974] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/23/2022] Open
Abstract
Inadequate breast milk supply is a frequently reported reason for early discontinuation of breastfeeding and represents a critical opportunity for intervening to improve breastfeeding outcomes. For women who continue to experience insufficient milk supply despite the utilisation of non-pharmacological lactation support strategies, pharmacological intervention with medications used to augment lactation, commonly referred to as galactagogues, is common. Galactagogues exert their pharmacological effects through altering the complex hormonal milieu regulating lactation, particularly prolactin and oxytocin. This narrative review provides an appraisal of the existing evidence regarding the efficacy and safety of pharmaceutical treatments for lactation insufficiency to guide their use in clinical practice. The greatest body of evidence surrounds the use of domperidone, with studies demonstrating moderate short-term improvements in breast milk supply. Evidence regarding the efficacy and safety of metoclopramide is less robust, but given that it shares the same mechanism of action as domperidone it may represent a potential treatment alternative where domperidone is unsuitable. Data on remaining interventions such as oxytocin, prolactin and metformin is too limited to support their use in clinical practice. The review provides an overview of key evidence gaps and areas of future research, including the impacts of pharmaceutical galactagogues on breast milk composition and understanding factors contributing to individual treatment response to pharmaceutical galactagogues.
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Affiliation(s)
- Luke E Grzeskowiak
- Adelaide Medical School, Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia.
- SA Pharmacy, Flinders Medical Centre, SA Health, Bedford Park, Adelaide, SA 5042, Australia.
| | - Mary E Wlodek
- Department of Physiology, The University of Melbourne, Melbourne, VIC 3010, Australia.
| | - Donna T Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, Perth, WA 6009, Australia.
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