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Levene I, O'Brien F, Fewtrell M, Quigley MA. The relationship of early expressed milk quantity and later full breastmilk feeding after very preterm birth: A cohort study. MATERNAL & CHILD NUTRITION 2024:e13719. [PMID: 39239700 DOI: 10.1111/mcn.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 07/18/2024] [Accepted: 08/21/2024] [Indexed: 09/07/2024]
Abstract
When infants cannot directly breastfeed after birth, mothers are advised to initiate lactation through mechanical expression. Families are recommended to target an expression volume of at least 500-750 mL by Day 14 after birth, as this is considered a 'critical window' to establish milk supply. This is challenging for many mothers after a very preterm birth. This article explores the relationship of early milk quantity and later full breastmilk feeding as a 'gold standard' outcome, using statistical techniques designed for diagnostic tests. A cohort of 132 mothers of infants born at 23 + 0 to 31 + 6 weeks' gestational age submitted expressing logs on Day 4, 14 and 21 after birth and provided later feeding outcome. Using receiver operating characteristic (ROC) analysis, the following 24-h milk quantities were identified as associated with high probability of full breastmilk at 36 weeks' post-menstrual age (PMA): on Day 4, ≥250 g (specificity 88%; positive predictive value 88%) and on Day 21 ≥650 g (specificity 88%; positive predictive value 91%). The following values were identified as associated with low probability of full breastmilk at 36 weeks' PMA: on Day 4 <50 g (sensitivity 92%; negative predictive value 72%) and on Day 21 <250 g (sensitivity 90%; negative predictive value 70%). Participants exceeding the high thresholds had 3-4 times increased likelihood of full breastmilk, whereas those below the low thresholds had 3-5 times lower likelihood. These thresholds have potential as targets for families, to provide individualised prognostic information and to help clinicians target more intensive lactation support.
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Affiliation(s)
- Ilana Levene
- National Perinatal Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford, UK
| | | | - Mary Fewtrell
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford, UK
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Devi U, B A. Pumping Strategies to Improve Exclusive Breastfeeding. Indian J Pediatr 2024; 91:883-884. [PMID: 38884922 DOI: 10.1007/s12098-024-05188-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Usha Devi
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Adhisivam B
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India.
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Idei Y, Ochiai Y, Yoshibe K, Kuroishi S, Takase M, Mizuno K. Evaluating milk flow patterns using the high flow rate period during breast pumping. Midwifery 2024; 136:104039. [PMID: 38909553 DOI: 10.1016/j.midw.2024.104039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/16/2024] [Accepted: 05/28/2024] [Indexed: 06/25/2024]
Abstract
PROBLEM Breast pumping practices have scope for improvement. BACKGROUND Breast milk weight measurement can be used to evaluate milk flow pattern dynamics during breast pumping. AIM To determine inter-individual differences in milk flow patterns and their practical implications based on high milk flow rate period (HFP) data among Japanese women expressing breast milk using an electric pump. METHODS This cross-sectional, observational study analysed data from 19 women (33.0 ± 3.9 years) nursing 1-6-month-old infants and with previous breast milk expression experience. Breast milk was weighed continuously during a 15-min single-breast electric pumping session. The HFP features and flow rate time (≥0.1 g/s) were analysed to determine each individual's milk flow pattern. FINDINGS The total expressed breast milk was 69.8 ± 42.5 g with a maximum individual flow rate of 0.5 ± 0.2 g/s. The breast milk yielded during the HFPs was 43.1 (34.4-81.3) g, accounting for 82.5 % (69.9-89.5 %) of the total expressed breast milk. HFP occurred 0-3 times during the 15-min session. Multiple discrete and continuous milk flow patterns were observed. Among those with discrete HFP, the HFP interval was 221 (68-371) s. Breast milk fat content changes and subjective residual milk measurements implied sufficient milk removal. A strong positive correlation was noted between HFP length and total breast milk expression volume. DISCUSSION Individual differences in milk flow patterns were observed among the women using HFP. Milk flow patterns were consistent with previous reports. CONCLUSION Milk flow pattern data can be used to guide individualised lactation support.
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Affiliation(s)
- Yoko Idei
- Research & Development Division, Pigeon Corporation, 6-20-4, Kinunodai, Tsukubamirai, Ibaraki 300-2495, Japan.
| | - Yukifumi Ochiai
- Research & Development Division, Pigeon Corporation, 6-20-4, Kinunodai, Tsukubamirai, Ibaraki 300-2495, Japan
| | - Kanae Yoshibe
- Research & Development Division, Pigeon Corporation, 6-20-4, Kinunodai, Tsukubamirai, Ibaraki 300-2495, Japan
| | - Sumiko Kuroishi
- Research & Development Division, Pigeon Corporation, 6-20-4, Kinunodai, Tsukubamirai, Ibaraki 300-2495, Japan
| | - Mariko Takase
- Department of Paediatrics, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa, Tokyo 142-8555, Japan
| | - Katsumi Mizuno
- Department of Paediatrics, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa, Tokyo 142-8555, Japan
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Levene I, Quigley MA, Fewtrell M, O'Brien F. Does extremely early expression of colostrum after very preterm birth improve mother's own milk quantity? A cohort study. Arch Dis Child Fetal Neonatal Ed 2024; 109:475-480. [PMID: 38442953 PMCID: PMC11347236 DOI: 10.1136/archdischild-2023-326784] [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: 12/19/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE Assess the relationship of time to first expression after very preterm birth and mothers' own milk quantity. DESIGN A cohort study (nested within a randomised trial). SETTING Four neonatal units in the UK. PATIENTS 132 mothers of single or twin infants born at 23+0 to 31+6 weeks postmenstrual age. EXPOSURES Time to the first attempt to express after birth. PRIMARY OUTCOMES 24-hour mother's own milk yield on days 4, 14 and 21 after birth. RESULTS Median time to first expression attempt was 6 hours. 51.7% expressed within 6 hours of birth (62/120) and 48.3% expressed more than 6 hours after birth (58/120). Expressing within 6 hours of birth was associated with higher milk yield on day 4 (88.3 g, 95% CI 7.1 to 169.4) and day 14 (155.7 g, 95% CI 12.2 to 299.3) but not on day 21 (73.6 g, 95% CI -91.4 to 238.7). There was an interaction between expressing frequency and time to first expression (p<0.005), with increased expressing frequency being associated with higher yield only in those who expressed within 6 hours. Expressing within 2 hours of birth was not associated with further milk yield increase. CONCLUSIONS Mothers who expressed within 6 hours of birth had higher milk yield, and a greater yield per expressing session, in the first 3 weeks after birth. This information will be highly motivating for families and the clinicians supporting them. There was no evidence of further benefit of extremely early expression (first 2 hours after birth). TRIAL REGISTRATION NUMBER ISRCTN 16356650.
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Affiliation(s)
- Ilana Levene
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK
| | - Mary Fewtrell
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Frances O'Brien
- Neonatal Unit, John Radcliffe Hospital, Oxford, Oxfordshire, UK
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Levene I, Fewtrell M, Quigley MA, O'Brien F. The relationship of milk expression pattern and lactation outcomes after very premature birth: A cohort study. PLoS One 2024; 19:e0307522. [PMID: 39074108 DOI: 10.1371/journal.pone.0307522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/07/2024] [Indexed: 07/31/2024] Open
Abstract
INTRODUCTION Mothers of very premature infants often have difficulties expressing breastmilk, which can cause distress and potential negative impact on infant health. Clinical recommendations on breastmilk expression are extrapolated from term infants' breastfeeding patterns. This study's objective was to analyse the association of expressing pattern with lactation outcomes after very premature birth. METHODS 132 participants were recruited after birth between 23+0 and 31+6 weeks' gestation. Participants recorded the milk expressed in several 24-hour periods in the three weeks after birth. RESULTS Expressing frequency was positively associated with 24-hour milk yield, with an adjusted 30.5g increase per expressing session on day four (95% CI 15.7 to 45.3) and 94.4g on day 21 (95% CI 62.7 to 126.2). Expressing ≥8 times per day was associated with higher adjusted milk yield than expressing <6 times (on day four, 146.8g, 95% CI 47.4 to 246.1), but not in comparison to expressing 6-7 times (on day four, 82.1g, 95% CI -25.9 to 190.1). Participants with six months or more prior breastmilk feeding experience had a higher adjusted milk yield than others (on day four, 204.3g, 95% CI 125.2 to 283.3). Night-time (2300-0700 hours) expressing sessions were not associated with increased milk yield after adjustment for time since the prior session. On average, participants who had a longest gap between expressions of less than six hours achieved the UK target of 750g breastmilk, whereas those with a longer gap did not. CONCLUSION Expressing frequency was an important determinant of milk yield. Clinical recommendations to express ≥8 times per day were supported but for some, 6-7 times was sufficient. This was particularly likely for those with six months or more of prior breastmilk feeding experience. A need to express during the night-time hours appeared to be related to minimising the gap between expressions rather than an inherent value of night-time expression.
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Affiliation(s)
- Ilana Levene
- Nuffield Department of Public Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Mary Fewtrell
- Institute of Child Health, University College London, London, United Kingdom
| | - Maria A Quigley
- Nuffield Department of Public Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Frances O'Brien
- Newborn Care, John Radcliffe Hospital, Oxford, United Kingdom
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Kappel SS, Maastrup R, Iyore EO, Greisen G, Egeskov M, Lando A, Hansen BM. Time intervals between pumping did not affect breastmilk protein produced by mothers of preterm infants. Acta Paediatr 2024; 113:1534-1539. [PMID: 38530084 DOI: 10.1111/apa.17219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Abstract
AIM Few studies investigate factors that might influence the content of expressed breastmilk. This study aims to investigate the influence of the intervals between breastmilk pumping and the time of the day on protein and fat concentration in breastmilk. METHODS Mothers of very preterm infants in a neonatal ward who expressed more than 400 mL per day were included. Expressed breastmilk was obtained from each mother over 30 h who were pumping at strictly planned and varying intervals: 2, 3, 4 and 6 h. All samples were analysed using infrared transmission spectroscopy. RESULTS Ten mothers participated at a median of 22 days postpartum. A total of 176 milk samples were analysed, and the average protein and fat concentrations in g/100 mL were 1.1 ± 0.23 and 4.2 ± 1.3, respectively. The time intervals between breast pumping sessions did not impact protein content, but fat content decreased by longer intervals (p < 0.01). The time of the day for milk pumping did not influence the protein or fat content. CONCLUSION A single milk sample collected after any 2-6 h interval, at any time during the day, represents the protein content in the breastmilk, but not the fat content which decreased with longer intervals.
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Affiliation(s)
- Susanne S Kappel
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth O Iyore
- Department of Neonatology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Merete Egeskov
- Department of Clinical Metabolomics Core Facility, Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Ane Lando
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Bo M Hansen
- Department of Neonatology, Copenhagen University Hospital Hillerød, Hillerød, Denmark
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Manshanden TMN, Prime DK, Scheele F, Velzel J. An evaluation of patient comfort levels during expression with a modified pumping program: a prospective proof of concept study. Front Glob Womens Health 2024; 5:1378263. [PMID: 38707635 PMCID: PMC11066290 DOI: 10.3389/fgwh.2024.1378263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/08/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction This study aimed to assess if the implementation of a gentle transition of vacuum mode into a breast pump suction pattern commonly used to initiate milk production would improve user comfort while expressing during the first four days postpartum. Methods This prospective study was conducted at OLVG hospital in the Netherlands in two sequential phases. Breastfeeding patients delivering >36 weeks gestation with an infant aged ≤96 h old and a clinical indication to express milk with a breast pump were recruited. Intervention group 1 (n = 40) used a hospital-grade electric breast pump with a standard breast pump suction pattern. Intervention group 2 used a hospital-grade electric breast pump with a modified breast pump suction pattern (n = 40). The primary outcome was an objective assessment of comfort as measured by participants' need to reduce vacuum level during the 20 min test session. Secondary outcomes included the total expression volume (ml) in 20 min pumping. Results The study found that the primary outcome of comfort was significantly improved with the modified breast pump suction pattern compared to the standard pattern (OR 1.29, 95% CI 1.08 to 1.6) with 86% vs. 67% of participants not needing to reduce applied vacuum levels. The amount of milk expressed did not differ significantly between phases (group 1: 7.6 ml (2.7-25.5 ml), group 2: 12.0 ml (1.2-31.5 ml), p = 0.43). Discussion This study is the first to demonstrate an improvement in user comfort driven by the implementation of gentle transitions in vacuum modes in a commonly used breast pump suction pattern. Research into this novel population combining both pumping and breastfeeding in the first days after birth offers new unique insights on the requirements of breast pump suction patterns. Trial registration Registered on clinical trials.gov NCT04619212. Date of registration November 6, 2020.
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Affiliation(s)
| | | | - Fedde Scheele
- Department of Obstetrics & Gynaecology, OLVG Hospital, Amsterdam, Netherlands
- Faculty of Science, Athena Institute, VU University, Amsterdam, Netherlands
| | - Joost Velzel
- Department of Obstetrics & Gynaecology, Northwest Clinics, Alkmaar, Netherlands
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Patel AL, Tan A, Bucek A, Janes J, McGee K, Mulcahy D, Meier P, Johnson TJ. Where does the time go? Temporal patterns of pumping behaviors in mothers of very preterm infants vary by sociodemographic and clinical factors. Front Nutr 2024; 11:1278818. [PMID: 38352705 PMCID: PMC10861725 DOI: 10.3389/fnut.2024.1278818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
Background Mothers of very preterm (<32 weeks gestational age [GA]) infants are breast pump dependent and have shorter duration of milk provision than mothers of term infants. The opportunity (i.e., time) cost of pumping and transporting mother's own milk (MOM) from home to the NICU may be a barrier. There is a paucity of data regarding how much time mothers actually spend pumping. Objective To investigate the variation in pumping behavior by postpartum week, maternal characteristics, and infant GA. Methods Prospectively collected pump log data from mothers enrolled in ReDiMOM (Reducing Disparity in Mother's Own Milk) randomized, controlled trial included pumping date and start time and end time of each pumping session for the first 10 weeks postpartum or until the infant was discharged from the NICU, whichever occurred first. Outcomes included number of daily pumping sessions, number of minutes spent pumping per day, and pumping behaviors during 24-h periods, aggregated to the postpartum week. Medians (interquartile ranges) were used to describe outcomes overall, and by maternal characteristics and infant GA. Results Data included 13,994 pump sessions from 75 mothers. Maternal characteristics included 55% Black, 35% Hispanic, and 11% White and 44% <30 years old. The majority (56%) of infants were born at GA 28-31 weeks. Mothers pumped an average of less than 4 times per day, peaking in postpartum week 2. After accounting for mothers who stopped pumping, there was a gradual decrease in daily pumping minutes between postpartum weeks 2 (89 min) and 10 (46 min). Black mothers pumped fewer times daily than non-Black mothers after the first 2 weeks postpartum. Conclusion On average mothers pumped less intensively than the minimum recommendation of 8 times and 100 min per day. However, these pumping behaviors represent significant maternal opportunity costs that should be valued by the institution and society at large.
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Affiliation(s)
- Aloka L. Patel
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States
| | - Amelia Tan
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States
| | - Amelia Bucek
- Northwestern University, Chicago, IL, United States
| | - Judy Janes
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States
| | - Katie McGee
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States
| | - Delaney Mulcahy
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States
| | - Paula Meier
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States
| | - Tricia J. Johnson
- Department of Health Systems Management, Rush University, Chicago, IL, United States
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Gomez-Juge C, Scarpelli V, Yellayi D, Cerise J, Weinberger B, Brewer M, Maffei D. Breast Milk Production Variability Among Mothers of Preterm Infants. Breastfeed Med 2023; 18:571-578. [PMID: 37615564 DOI: 10.1089/bfm.2023.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Introduction: Mothers of preterm infants are at risk for inadequate milk production. Pumping logs are often used to both encourage lactation in the first week and track its efficacy. Our objectives were to determine whether mothers of preterm infants who keep pumping logs are demographically different from those who do not and to determine whether this practice affects the amount of mother's own milk (MOM) fed to their infants. We also aimed at determining whether there is a correlation between: (1) time to first breast milk expression, (2) cumulative frequency of expression in the first week, and (3) milk volume on day 7 with subsequent milk volumes and percent of infant diet consisting of MOM. Methods: Mothers of infants born ≤32 weeks and ≤1,500 g were enrolled within 48 hours of birth and encouraged to keep a pumping log. Data were collected on maternal characteristics, patterns of milk expression, and milk volumes on days 7, 14, 21, and 28 after delivery. Infant data were collected via chart review. Results: Mothers who kept pumping logs provided their own milk for a greater percentage of their infant's feeds at the time of achieving full feeds (p = 0.017). The total number of expressions in the first week was correlated with milk volume on day 21 (p = 0.016) and the provision of a higher percentage of MOM feeds at discharge (p = 0.03). Milk volume on day 7 correlated with volumes obtained at days 14, 21, and 28 (p < 0.001). Conclusions: Pumping logs may affect the availability of MOM for preterm infants. Frequency of pumping in the first week and milk volume on day 7 may impact long-term lactation success for these women.
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Affiliation(s)
- Christina Gomez-Juge
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center of New York, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Victoria Scarpelli
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center of New York, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Disha Yellayi
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Jane Cerise
- Biostatistics Unit, Office of Academic Affairs at Northwell Health, New Hyde Park, New York, USA
| | - Barry Weinberger
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center of New York, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Mariana Brewer
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center of New York, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Diana Maffei
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center of New York, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Yuan S, Li Q, Wang H, Xu X. The Utilization of Sodium Concentration in Human Milk from Pump-Dependent Mothers of Preterm Infants as a Measure of Milk Production. Breastfeed Med 2023. [PMID: 37327383 DOI: 10.1089/bfm.2022.0263] [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] [Indexed: 06/18/2023]
Abstract
Objective: This study investigated changes in sodium concentrations in human milk from mothers of premature infants using different breast pumps for 14 days postpartum, and the correlation between the sodium concentration in mother's own milk (MOM) and the volume pumped. Study Design: This randomized controlled study recruited 66 mothers of premature infants delivered in our hospital from February to December 2018, and we assigned them to three groups using an envelope method. In intervention group 1, a hospital-grade electric breast pump was used from postpartum day 1 to 14; in intervention group 2, a hospital-grade electric breast pump was used on postpartum days 1 to 5 and a normal personal electric breast pump on postpartum days 6 to 14; in the control group, a personal normal electric breast pump was used from postpartum day 1 to 14. Data recorded included the breast milk volume pumped and milk sodium concentration. Results: The average daily volume of MOM pumped differed statistically (p < 0.05) between the intervention and control groups at postpartum days 7 and 14. The average daily volume pumped did not differ between intervention groups 1 and 2 by postpartum day 14 (p > 0.05). However, the time taken for the sodium concentrations to normalize differed significantly (p < 0.01). At postpartum day 5, the sodium concentrations of 73% of intervention group 1 and 2 mothers were within normal limits, and they were maintained until day 14. In comparison, only 41% of the controls had normal MOM sodium levels on day 5, and they were still high on day 7 in 27.3% of controls. Conclusions: In the early stage of lactation initiation (within 5 days postpartum), using a hospital-grade electric breast pump promotes lactation in mothers who deliver prematurely and the sodium concentrations normalize more quickly. Sodium can be used as an objective biomarker of MOM to evaluate the possibility of delayed lactation in mothers of premature infants, and it could assist interventions in the early postpartum period. Trial Registration: Chinese Clinical Trial Registry, ChiCTR2200061384.
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Affiliation(s)
- Shuiqin Yuan
- NICUs, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qiufang Li
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hua Wang
- NICUs, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xinfen Xu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Haining Maternal and Child Health Hospital, Branch of Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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11
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Mago-Shah DD, Athavale K, Fisher K, Heyward E, Tanaka D, Cotten CM. Early pumping frequency and coming to volume for mother's own milk feeding in hospitalized infants. J Perinatol 2023; 43:629-634. [PMID: 37037987 DOI: 10.1038/s41372-023-01662-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/08/2023] [Accepted: 03/21/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To identify daily pumping frequencies associated with coming to volume (CTV: producing > 500 milliliters of milk per day by postnatal day 14) for mothers of infants in the neonatal intensive care unit (NICU). STUDY DESIGN We compared demographics and daily pumping frequencies for mothers who did and did not experience CTV. RESULTS Of 427 mothers who produced milk, 201 (50.1%) experienced CTV. Race, insurance, delivery type and birthweight were associated with CTV. For mothers who experienced CTV, average pumping episodes increased daily, stabilizing at 5 pumping episodes per day by postnatal day 5 (5 × 5). Women who experienced CTV were also more likely to have pumped between 0100 and 0500 (AM pumping). In multivariable analysis birthweight, 5 × 5 and AM pumping were each independently associated with CTV. CONCLUSION Supporting mothers of NICU infants to achieve 5 or more daily pumping sessions by postnatal day 5 could improve likelihood of achieving CTV.
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Affiliation(s)
- Deesha D Mago-Shah
- Duke University Hospital, Department of Pediatrics, Division of Neonatology, Durham, NC, USA.
| | - Kamlesh Athavale
- Duke University Hospital, Department of Pediatrics, Division of Neonatology, Durham, NC, USA
| | - Kimberley Fisher
- Duke University Hospital, Department of Pediatrics, Division of Neonatology, Durham, NC, USA
| | - Elizabeth Heyward
- Duke University Hospital, Department of Pediatrics, Division of Neonatology, Durham, NC, USA
| | - David Tanaka
- Duke University Hospital, Department of Pediatrics, Division of Neonatology, Durham, NC, USA
| | - C Michael Cotten
- Duke University Hospital, Department of Pediatrics, Division of Neonatology, Durham, NC, USA
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Bendixen MM, Iapicca LC, Parker LA. Nonpharmacologic Factors Affecting Milk Production in Pump-Dependent Mothers of Critically Ill Infants: State of the Science. Adv Neonatal Care 2023; 23:51-63. [PMID: 36700680 PMCID: PMC9883598 DOI: 10.1097/anc.0000000000000990] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Improved health outcomes for critically ill infants including neurodevelopmental, immunological, and cost benefits are dependent upon the dose and duration of mother's own milk feedings. However, mothers of infants admitted to the neonatal intensive care unit (NICU) must express their milk (pump-dependent) and often struggle with milk production. PURPOSE To examine the state of the science on nonpharmacologic modifiable expression factors that may influence milk production in pump-dependent mothers of critically ill infants admitted to the NICU. DATA SOURCES PubMed, Embase, and CINAHL databases from 2005 to 2020. SEARCH STRATEGY Guided by the lactation conceptual model, the authors searched for peer-reviewed studies with terms related to milk volume, pump dependency, critically ill infants, and modifiable factors, which may influence milk volume and assessed 46 eligible studies. DATA EXTRACTION Data were extracted by 3 reviewers with a systematic staged review approach. RESULTS Evidence from 26 articles found expressed milk volume may be influenced by multiple potentially modifiable factors. Simultaneous expression with a hospital-grade electric pump at least 5 times per day beginning 3 to 6 hours after delivery, and adding complementary techniques including hand expression, hands-on-pumping, music, breast massage, warm compresses, skin-to-skin care, and the mother expressing near her infant may promote increased milk volume. IMPLICATIONS FOR PRACTICE AND RESEARCH Healthcare providers should assist pump-dependent mothers with early initiation and frequent milk removal with a hospital-grade breast pump. Further research is needed to explore optimal frequency of expressions, dose and timing of skin-to-skin care, and other targeted strategies to improve expressed milk volume.
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Longitudinal Follow-up of Preterm Breastfeeding to 12 Weeks Corrected Gestational Age. Adv Neonatal Care 2022; 22:571-577. [PMID: 34743110 DOI: 10.1097/anc.0000000000000925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Preterm infants have shorter breastfeeding duration than that of term infants. Details of postdischarge feeding methods and difficulties are needed to inform the care of preterm breastfeeding dyads. PURPOSE To describe postdischarge breastfeeding characteristics of mother-preterm infant dyads up to 12 weeks corrected gestational age (CGA). METHODS A prospective observational study of preterm dyads (birth 24-33 weeks' gestation) that fed their mother's own milk (MOM) at discharge from a neonatal unit in Perth, Western Australia. Feeding method and frequency, breastfeeding duration, difficulties, and nipple shield use were recorded at 2, 6, and 12 weeks CGA. RESULTS Data were obtained for 49 mothers (singleton infant n = 39, twins n = 10). At 12 weeks CGA, 59% fed any MOM with 47% exclusively fed MOM and 31% fully breastfed. Nipple shield use reduced from 42% at 2 weeks CGA to 11% at 12 weeks CGA. Compared with mothers who exclusively fed MOM at discharge (n = 41) those who fed both MOM and infant formula (n = 8) were more likely to wean before 12 weeks CGA ( P < .001). Weaning occurred before 2 weeks CGA in 12/19 (63%), with low milk supply the most frequently cited reason. IMPLICATIONS FOR PRACTICE Most mothers with a full milk supply at discharge successfully transition to predominant breastfeeding. Frequent milk removal needs to be prioritized throughout the preterm infant's hospital stay. IMPLICATIONS FOR RESEARCH Examination of facilitators and barriers to early and continued frequent milk removal across the postpartum period is required to identify strategies to optimize lactation after preterm birth.
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Abstract
INTRODUCTION Mother's own milk improves health outcomes in infants of all gestational ages. Although pump-dependent mothers of extremely premature infants are at risk of insufficient milk production, whether mother's milk production is impacted by gestational age and pump dependency in mothers of more mature critically ill infants is unknown. PURPOSE To determine whether there is a relationship between gestational age, milk production, and time to secretory activation in mothers delivering a critically ill infant. METHODS A convenience sample of 136 pump-dependent mothers whose infants were admitted to the neonatal intensive care unit was enrolled between 2013 and 2016 as part of a quality improvement project. Group 1 (early preterm) delivered infants at 30 to 33 weeks of gestation (n = 41), group 2 (late preterm) 34 to 36 weeks (n = 48), and group 3 (term) 37 weeks and more (n = 47). Milk volume on days 1 to 7 was measured by weighing each vial of expressed milk and compared using general linear mixed-model analysis. Time to the onset of secretory activation was compared using censored regression analysis. RESULTS Main effect for gestational age controlling for day was statistically significant (P = .0234). The early preterm group produced more milk over the 7-day study than the term (P = .01) and late preterm (P = .02) groups. The early preterm group achieved secretory activation earlier than the late preterm group (adjusted P = .039). IMPLICATIONS FOR PRACTICE Pump-dependent mothers of all infants admitted to the neonatal intensive care unit may be at risk of inadequate milk production and delayed secretory activation and may therefore benefit from early milk production monitoring and lactation support. IMPLICATIONS FOR RESEARCH Further studies should examine targeted interventions to increase milk production in pump-dependent mothers.
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Scholten N, Mause L, Horenkamp-Sonntag D, Klein M, Dresbach T. Initiation of lactation and the provision of human milk to preterm infants in German neonatal intensive care units from the mothers' perspective. BMC Pregnancy Childbirth 2022; 22:158. [PMID: 35216574 PMCID: PMC8881865 DOI: 10.1186/s12884-022-04468-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background If infants with a very low birth weight (VLBW) are to be fed exclusively with human milk, it is essential to focus on lactation initiation. The aim of the study is to learn more about the current state of lactation initiation and human milk provision in neonatal intensive care units in Germany from the mothers' perspective. Methods Written surveys were conducted with mothers of VLBW infants to learn more about the timing of initiation of lactation, pumping frequency during the first three days postpartum and feeding of the preterm infant during hospitalisation. Results The data of 437 mothers (response rate: 44.7%) were included in the analyses. Of these, only 7.8% stated that they had initiated lactation immediately after delivery and 38.2% within 6 h. In terms of pumping frequency, 50.1% pumped 7–9 times a day within the first 3 days postpartum; 60.9% reported that their infant received formula feedings during the hospital stay. Conclusion Overall, deficits were still evident with regard to the initiation of lactation in mothers of VLBW infants in Germany, resulting in a large proportion of VLBW infants receiving formula in the hospital. Trial registration German Clinical Trial Register: DRKS00017755.
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Affiliation(s)
- N Scholten
- Institute of Medical Sociology Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany.
| | - L Mause
- Institute of Medical Sociology Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | | | - M Klein
- DAK Gesundheit, Hamburg, Germany
| | - T Dresbach
- Department of Neonatology and Pediatric Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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Dong D, Ru X, Huang X, Sang T, Li S, Wang Y, Feng Q. A prospective cohort study on lactation status and breastfeeding challenges in mothers giving birth to preterm infants. Int Breastfeed J 2022; 17:6. [PMID: 35012631 PMCID: PMC8751123 DOI: 10.1186/s13006-021-00447-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Mothers of preterm infants face many challenges in breastfeeding, especially regarding lactation. This study aimed to investigate the lactation status and challenges in breastfeeding faced by preterm infants’ mothers. Methods We approached 124 mothers who gave birth to preterm infants between 26 May and 31 October 2018 in a tertiary hospital in China. Lactation status and challenges in breastfeeding on day 7 postpartum, at discharge of infants, 2 weeks post-discharge, and 3 months of corrected age were collected using questionnaires. The area under the receiver operating characteristic (ROC) curve for expressed milk volume on day 7 postpartum for predicting expressed milk volume ≥ 300 mL/d at discharge was calculated. Logistic regression analyses were performed to identify factors associated with delayed lactogenesis II onset and continuation of breastfeeding at 3 months of corrected age. Results Seventy mothers were enrolled, and 51.4% had delayed lactogenesis II. Multivariate logistic regression analysis revealed that older maternal age (aOR = 1.19; 95% CI: 1.01, 1.40) and first live birth (aOR = 4.81; 95% CI 1.43, 16.18) were significant independent predictors of delayed lactogenesis II. Mothers with delayed lactogenesis II had significantly lower expressed milk volume (day 7 postpartum: 160.0 mL vs. 300.0 mL, U = 328.50, p = 0.001; at discharge: 425.0 mL vs. 612.5 mL, U = 372.00, p = 0.005), with a lower proportion of exclusive breastfeeding in their infants (at discharge: 33.3% vs. 69.8%, χ2 = 12.39, df = 1, p < 0.001; 3 months of corrected age: 17.8% vs. 52.8%, χ2 = 11.03, df = 1, p = 0.001). The ROC showed that expressed milk volume > 190 mL/d on day 7 postpartum significantly predicted expressed milk volume ≥ 300 mL/d at discharge. Insufficient human milk was the main reason for breastfeeding discontinuation at 3 months of corrected age. Twins were less likely to continue breastfeeding at 3 months of corrected age (aOR = 0.27; 95% CI 0.09, 0.86). In singleton infants, mother’s own milk ≥50% of total milk uptake at 2 weeks post-discharge (aOR = 32.66; 95% CI 3.00, 355.25) was an independent predictor of continuous breastfeeding at 3 months of corrected age. Feeding complications in infants, poor breastfeeding technique, and low milk output are the main challenges in breastfeeding. Conclusion Interventions to improve early postpartum lactation and breastfeeding techniques may increase breastfeeding adoption in mothers of preterm infants. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-021-00447-4.
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Affiliation(s)
- Dingding Dong
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China
| | - Xifang Ru
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China
| | - Xiaofang Huang
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China
| | - Tian Sang
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China
| | - Shan Li
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China
| | - Ying Wang
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China
| | - Qi Feng
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China.
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Jiang C, Chu X, Yu Z, Chen X, Zhang J, Han S. Effects of a WeChat Mini-Program on Human Milk Feeding Rates in a Neonatal Intensive Care Unit During the COVID-19 Pandemic. Front Pediatr 2022; 10:888683. [PMID: 35799691 PMCID: PMC9253379 DOI: 10.3389/fped.2022.888683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We investigated changes in maternal daily milk pumping frequency and milk volume per expression and their derived lactation indicators, as well as human milk (HM) feeding status with a focus on amount and rates in preterm infants admitted to the neonatal intensive care unit (NICU) after using a WeChat mini-program during the 2019 coronavirus (COVID-19) pandemic. METHODS The study was conducted with 482 mothers and their 544 babies. We prospectively enrolled mothers and infants with birth weight <1,500 g or gestational age <32 weeks born in 2020, and retrospectively included the same population in 2019. All study subjects were classified into three subgroups: pre-pandemic (PP, 2019), early pandemic (EP, January to April 2020), and late pandemic (LP, May to December 2020). From 1 January 2020, mothers recorded in an online pumping diary using the WeChat mini-program. We obtained the infants' feeding information from an online database for analysis. RESULTS Maternal lactation indicators did not change significantly. However, 56.7% (139/245) of mothers achieved milk volume ≥500 ml/day (CTV) in PP, 58.9% (33/156) in EP, and a slight increase to 60.7% (91/150) in LP. Maternal pumping frequency remained about eight times/day. In LP, daily milk volume was higher than the other two periods from day 4, and mothers achieved CTV by day 12, which was achieved in the other two groups by 13-14 days. There were several statistical differences in the amount and rates of feeding between the groups, particularly about HM and donor milk feeding, with the vast majority being decreased during EP, while during LP they returned to PP levels. Pleasingly, the median average daily dose of HM at 1-28 days was highest in LP (LP, 87.8 vs. PP, 75.5 or EP, 52.6 ml/kg/day, P corrected < 0.001). In addition, most categorical feeding indicators decreased in EP and recovered in LP. CONCLUSION An education model based on the WeChat program could aid lactation education and management in mothers of preterm infants to maintain healthy lactation. The model, together with optimized management strategies, can ensure that the HM feeding rate is not compromised in vulnerable high-risk infants during NICU hospitalization in a public health emergency, like the COVID-19 pandemic.
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Affiliation(s)
- Chengyao Jiang
- Department of Paediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Xue Chu
- Department of Paediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Zhangbin Yu
- Department of Paediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Xiaohui Chen
- Department of Paediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Jun Zhang
- Department of Paediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Shuping Han
- Department of Paediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
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Çınar N, Karakaya Suzan Ö, Kaya Ö, Karataş H, Duken ME. Investigation of the Effect of Human Milk Expression Techniques on Milk Content: A Systematic Review. J Trop Pediatr 2021; 67:6490899. [PMID: 34971400 DOI: 10.1093/tropej/fmab108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND If the mother and infant cannot meet after birth, it is recommended to express milk and give it to the infant. There was evidence indicating that there might be decrease in essential nutrient values in human milk content depending on the expression technique in literature. The goal of this systematic review was to investigate the effect of human milk expression techniques on the macronutrient milk content and establish an evidence base for future studies. METHODS Studies investigating the effect of human milk expression techniques on milk content were reviewed without year limitations. A literature review was conducted in six electronic databases (MEDLINE, Web of Science, PubMed, ScienceDirect, CINAHL and Cochrane) until 30 May 2021, using the keywords of breast milk expression techniques, milk content and breast milk pumping. RESULTS From 258 articles initially screened, we included 6 articles in the systematic review. The fat, protein and lactose content of human milk was analyzed in the studies reviewed. It was concluded that there was no significant effect on the protein (9.7-9.8 g/dl and 2.1-2.1 g/dl, respectively) and lactose (6.50-6.53% and 6.1-6.1 g/dl, respectively) content of milk. However, the fat (58.30, 48.81g/l; 2.6-2.2 g/dl) content was affected. CONCLUSIONS This study investigated the effect of milk expression techniques on the macronutrient content of human milk, and it was concluded that there was no significant effect on the protein and carbohydrate content of milk. However, the fat content was affected. Limitation of this study is that some factors that might affect the content of human milk were not standardized sufficiently in the included studies.
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Affiliation(s)
- Nursan Çınar
- Faculty of Health Sciences, Department of Nursing, Esentepe Campus, Sakarya University, Serdivan, Sakarya 54187, Turkey
| | - Özge Karakaya Suzan
- Faculty of Health Sciences, Department of Nursing, Esentepe Campus, Sakarya University, Serdivan, Sakarya 54187, Turkey
| | - Özge Kaya
- Istanbul Yeni Yuzyil University, Health Care Vocational School, Department of Anesthesia, Topkapi Campus, Zeytinburnu, Istanbul 34010, Turkey
| | - Hülya Karataş
- Faculty of Health Sciences, Department of Nursing, Harran University, Urfa 63300, Turkey
| | - Mehmet Emin Duken
- Faculty of Health Sciences, Department of Nursing, Harran University, Urfa 63300, Turkey
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19
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Abstract
Mother's own milk provides personalized nutrition and immune protection to the developing infant. The presence of healthy microbes plays an important role in the infant's gut by programming the microbiota and excluding potential pathogens. This review describes the important components in mother's own milk that contribute to its superiority for infant nutrition and suggest potential strategies to replicate these factors in alternative feedings when sufficient milk is unavailable. Current strategies to supplement, substitute and replicate mother's own milk including microbial restoration, use of unpasteurized donor human milk, probiotics and fortification are discussed. Critical work remains to be done in understanding the human milk microbiome and metabolome and in improving lactation support for mothers of preterm infants. Increasing delivery of mother's own milk and milk components to infants would likely positively impact infant mortality and health worldwide.
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Affiliation(s)
- Evon DeBose-Scarlett
- Department of Microbiology and Cell Science, Genetics Institute, Institute of Food and Agricultural Sciences, University of Florida, 2033 Mowry Road Rm 307, Gainesville, FL 32610 USA.
| | - Marion M Bendixen
- College of Nursing, University of Florida, PO Box 100197, Gainesville, FL 32610-0197 USA.
| | - Graciela L Lorca
- Department of Microbiology and Cell Science, Genetics Institute, Institute of Food and Agricultural Sciences, University of Florida, 2033 Mowry Road Rm 307, Gainesville, FL 32610 USA.
| | - Leslie Ann Parker
- College of Nursing, University of Florida, PO Box 100197, Gainesville, FL 32610-0197 USA.
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