Breastfeeding Medicine最新文献

Objective: Mother's own milk (MOM) sodium (Na) is an objective measure of secretory activation (SA), which is often delayed or impaired after preterm delivery. We sought to determine in pump-dependent mothers of preterm infants, impacts of maternal comorbidities on lactation outcomes using objective measures, including MOM Na, pumping frequency and MOM volumes for the first 14 postpartum days. Study Design: In this secondary analysis of four prospective cohorts, we examined outcomes using logistic and linear regression, survival analysis, and mediation and moderation sub-analyses. Results: A total of 143 mothers (57.3% Black, 30.8% Hispanic; 35.0% with hypertensive disorders of pregnancy [HDP]; 9.8% diabetic; 73.8% high body mass index [BMI]) delivered at 29.1 ± 2.8 weeks. Mothers pumped 4.7 ± 1.8 times/daily. Daily pumping frequency was a significant independent predictor of all modeled outcomes (p < 0.001 SA achievement, maintenance, and time to SA achievement; daily MOM volume; coming to volume [CTV; 500 mL/day]). 88.1% achieved SA by MOM Na ≤16 mM at postpartum day 5.6 ± 2.5. Only 41.3% of this subset continuously maintained SA until postpartum day 14. HDP was negatively associated with time to SA (p = 0.039). BMI values were negatively associated with MOM volume (p = 0.017) and CTV achievement (p = 0.02). Effects of daily pumping frequency were moderated by BMI (SA achievement and time to SA) and diabetes (CTV), with worse outcomes for higher BMI or diabetes despite similar pumping frequencies. Conclusion: Daily pumping frequency was the significant independent predictor for early lactation outcomes in a breast pump-dependent cohort of mothers of preterm infants. Further research on the interplay between modifiable and unmodifiable lactation risks in high-risk populations is needed.

Background: Point-of-care (POC) measures of mothers' own milk (MOM) sodium (Na) concentration are inexpensive, objective measure of secretory activation (SA) achievement with the potential to personalize lactation care, especially among breast pump-dependent mothers with risks for delayed/impaired SA. It is unknown whether POC Na should be measured once or twice daily for research and practice. Objectives: To determine the need and feasibility of twice- versus once-daily MOM Na measures and examine whether there are differences in MOM Na concentration between morning (AM) versus evening (PM) samples. Methods: Secondary analysis of a dataset with 312 matched pairs of AM and PM MOM Na measures collected over the first 14 days postpartum in 38 breast pump-dependent mothers of preterm (<33 weeks) infants. Analyses included general linear mixed and regression models, paired rank tests, and descriptive statistics. Result: Fewer than 50% of subjects had paired samples prior to postpartum day 5 due to MOM being prioritized for infant feedings. Differences between twice-daily measures were significant over postpartum days 1-5, with Na concentrations higher in AM versus PM samples (p < 0.0001), a trend that continued (nonsignificant) during postpartum days 6-14. Over postpartum days 1-14, our modeling revealed 80% of the variance in AM measures was predicted by PM measures (p < 0.0001). Conclusions: Feasibility of twice-daily sampling is limited prior to the first 5 postpartum days. Analyses suggest once-daily Na concentrations can be used in research and practice, especially after postpartum day 5. Research priorities include determining the effects of interpump interval and interbreast differences on MOM Na concentrations.

Objective: To summarize the evidence and identify gaps in the use of point-of-care (POC) techniques that hold potential to mitigate early, unplanned lactation cessation in term mother/infant dyads. Methods: An integrative review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search was conducted in the following electronic databases: MEDLINE (through PubMed), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Web of Science. Results: Of the 2,888 articles retrieved, 19 met the eligibility criteria and were included in this review. POC techniques included infant scales and a bedside ketone meter to measure infant weight change (n = 4); infant scales to measure mothers' own milk (MOM) transfer (test-weight) (n = 15); and ion-selective electrode probes and somatic cell counter to measure mammary gland function and health (n = 2). MOM transfer, as measured with infant scales, was the most frequent POC technique and was used in four primary ways: outcome variable, accurate standard to test other measures of MOM transfer, personalize intake of MOM components, and predict later lactation outcomes. Commercially available ion-selective electrode probes provide accurate and objective measures of paracellular pathway patency in the mammary gland, and have relevance for measurement of secretory activation achievement. Conclusion: Infant scales to measure weight change and MOM transfer and ion-selective electrodes are ideal POC measures to identify and mitigate lactation risk in the early postpartum period for term dyads. Translational studies that inform risk detection algorithms and novel models of lactation care that include these POC techniques are needed.

Background: An estimated 60% of mothers experience early, unplanned lactation cessation and do not meet their breastfeeding goals, increasing the risk of maternal and infant health problems and their associated costs. Perceived or real insufficient mothers' own milk (MOM) during the first 14 postpartum days is a frequently reported reason for early, unplanned lactation cessation. These first 14 postpartum days include the lactation phases of secretory activation (SA) and coming to volume (CTV; ≥500 mL MOM daily) achievements and are affected by biological, behavioral, and economic factors. Methods: A framework for studying early, unplanned lactation cessation was developed by researchers with expertise in lactation science, neonatal research, healthy population research, public health, basic sciences, and economics. Results: Current research and clinical models primarily address behavioral factors, including maternal perceptions of insufficient MOM volume and social support from family or peers. While important, these models do not include biological and economic factors known to affect early, unplanned lactation cessation. The proposed integrated framework incorporates biological, behavioral, and economic factors with the centrality of mammary gland stimulation and MOM removal. Conclusion: This framework may be used to develop and test innovative research and clinical models and may especially be useful in addressing inequities among populations at higher risk for early, unplanned lactation cessation.

Background: Delayed and/or impaired secretory activation (SA) achievement is a risk factor for early unplanned lactation cessation. This pilot study (1) evaluated the feasibility of in-home daily milk collection; (2) compared daily maternal self-report of breast fullness with mother's own milk (MOM) biomarkers of SA; and (3) examined SA patterns in association with lactation outcomes through 3 months postpartum. Methods: Twelve mother-infant dyads were enrolled at term (median gestational age (GA) = 39.9 weeks, range = 38.3-41.1 weeks). After birth, participants self-reported breast fullness and collected milk samples daily for a week. Infant weight gain and milk intake by test-weights were assessed postpartum during a week 1 routine infant outpatient visit and again during a week 2 home visit. Milk samples were tested for sodium (Na) and potassium (K) using portable ion selective electrodes. Timing of SA achievement was denoted as the first day breast fullness was self-rated ≥ 3, Na concentration was < 12 mmol/L, or the Na/K ratio was < 0.6. Breastfeeding duration and exclusivity were measured at 1, 2, and 3 months postpartum. Results: By day 6, all mothers self-reported SA achievement, while only 72-82% achieved SA using MOM biomarkers. Cohen's kappa between the timing of SA by maternal self-report and MOM biomarkers showed lack of agreement (κ = 0.05 and 0.08), but was high between MOM Na and Na/K ratio (κ = 0.87). Three patterns of SA by MOM biomarkers emerged (mature and stable, impermanent, and delayed) with implications for infant weight loss/gain at 1 week postpartum. These patterns were not associated with breastfeeding exclusivity through 3 months postpartum in this highly motivated sample. Conclusion: MOM biomarkers of SA achievement are feasible and have significant potential for use in community settings.

Objective: To determine if cumulative measures of pumping behaviors over the first 5 days postpartum predicted lactation outcomes by postpartum days 7 (achievement of secretory activation [SA] and pumped milk volume) and 14 (achievement of coming to volume [CTV ≥500 mL of pumped milk]) in breast pump-dependent mothers. Methods: This observational study had usable data for 29 mothers. Predictor and outcome variables were measured via Smart Pump technology (Medela, AG). Pumping behaviors were measured electronically. SA was measured using mothers' own milk (MOM) sodium (Na ≤16 Mmol). Pumped MOM volume was measured to the nearest 0.1 g. Cumulative pumping behaviors were calculated from birth to postpartum day 5. Breast pump use was standardized during two pumping sessions. Results: In this diverse sample (48% Black, 34% Hispanic, 18% other), each additional 1-hour spent pumping between postpartum days 1-5 increased odds of achieving SA by day 7 by 2.8 (p = 0.01) and translated into an additional 1,278 mL of pumped MOM volume. Each additional inter-pump interval >5 hours between birth and postpartum day 5 was associated with a decrease of 242 mL of pumped MOM volume by postpartum day 7 (p = NS). Achievement of CTV by day 14 was not significantly related to pumping behaviors during the first 5 days postpartum. Conclusions: The first 5 days postpartum are a critical window when breast pump use significantly affects achievement of SA and pumped MOM volume. The lack of effect on later CTV achievement suggests that effective breast pump use is essential to transition to the autocrine/paracrine control of lactation.

Objectives: Describe pumping behaviors and pumped mother's own milk (MOM) volume by achievement of secretory activation (SA; MOM sodium [Na] concentration ≤16 mM), coming to volume (CTV; ≥500 mL pumped MOM/day), SA maintenance (continued daily Na ≤16 mM), and opportunity costs in the first 14 postpartum days for pump-dependent mothers of preterm infants in the neonatal intensive care unit. Methods: A secondary analysis of two prospective cohorts. Mothers recorded pumping and MOM volume for each pumping session during the first 14 postpartum days. Daily MOM Na concentration was measured to determine SA. The opportunity cost was the dollar value of time spent pumping. Regression models evaluated pumping behaviors, pumped MOM volume, and opportunity cost by SA and CTV achievement and SA maintenance. Results: Of 66 mothers, 94% and 41% achieved SA and CTV, respectively, and 44% of mothers who achieved SA maintained it through 14 days postpartum. Mothers who achieved SA had more pumping sessions (5.6 versus 4.3/day, p < 0.001), longer pumping duration (108 versus 83 minutes/day, p < 0.001), and higher pumped MOM volume (349 versus 218 mL/day, p < 0.001). Mothers who achieved versus did not achieve CTV pumped 5.6 versus 4.9 times/day (p = 0.050). Opportunity costs were $376 for mothers achieving SA, $155 higher than not achieving, and $441 for mothers maintaining SA, $94 higher than not maintaining SA. Conclusion: Pumped MOM volume and opportunity costs were higher for mothers who achieved and maintained SA. Strategies offsetting opportunity costs during the stressful early postpartum period for breast pump-dependent mothers of preterm infants are needed.