Association of Timing of Initiation of Breastmilk Expression on Milk Volume and Timing of Lactogenesis Stage II Among Mothers of Very Low-Birth-Weight Infants
Abstract
Background: Feeding breastmilk to premature infants decreases morbidity but is often limited owing to an insufficient milk supply and delayed attainment of lactogenesis stage II. Early initiation of milk expression following delivery has been shown to increase milk production in mothers of very low-birth-weight (VLBW) infants. Although recommendations for milk expression in this population include initiation within 6 hours following delivery, little evidence exists to support these guidelines. This study compared milk volume and timing of lactogenesis stage II in mothers of VLBW infants who initiated milk expression within 6 hours following delivery versus those who initiated expression after 6 hours.
Subjects and Methods: Forty mothers of VLBW infants were grouped according to when they initiated milk expression following delivery. Group I began milk expression within 6 hours, and Group II began expression after 6 hours. Milk volume was measured daily for the first 7 days and on Days 21 and 42. Timing of lactogenesis stage II was determined through mothers' perceptions of sudden breast fullness.
Results: Group I produced more breastmilk during the initial expression session and on Days 6, 7, and 42. No difference in timing of lactogenesis stage II was observed. When mothers who began milk expression prior to 1 hour following delivery were removed from analysis, benefits of milk expression within 6 hours were no longer apparent.
Conclusions: Initiation of milk expression within 6 hours following delivery may not improve lactation success in mothers of VLBW infants unless initiated within the first hour.
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References
1.
American Academy of Pediatrics, Section of Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2013;129:e827–e841.
2.
Ronnestad A, Abrahamsen TG, Medbo S, et al. Late-onset septicemia in a Norwegian national cohort of extremely premature infants receiving very early human milk feedings. Pediatrics 2005;15:269–276.
3.
Sisk PM, Lovelady CA, Dillard RG, et al. Early human milk feedings is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants. J Perinatol 2007;27:428–433. Erratum in J Perinatol 2007;27:808.
4.
Sisk PM, Lovelady CA, Gruber KJ, et al. Human milk consumption and full enteral feeding among infants who weigh <1250 grams. Pediatrics 2008;121:1528–1533.
5.
Schanler RJ, Shulman RJ, Lau C. Feeding strategies for premature infants: Beneficial outcome of feeding fortified human milk versus preterm formula. Pediatrics 1999;103:1150–1157.
6.
Vohr BR, Poindexter BB, Dusick AM, et al. Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. Pediatrics 2006;118:115–123.
7.
Lee TY, Lee TT, Kuo SC. The experiences of mothers in breastfeeding their very low birth weight infants. J Adv Nurs 2009;65:2523–2531.
8.
Sweet L. Expressed breast milk as 'connection' and its influence on the construction of 'motherhood' for mothers of preterm infants: A qualititative study. Int Breastfeed J 2008;3:30–42.
9.
Ryan A, Wenjun Z, Acosta A. Breastfeeding continues to increase into the new millennium. Pediatrics 2002;110:1103–1109.
10.
Hill PD, Ledbetter RJ, Kavanaugh KL. Breastfeeding patterns of low-birth-weight infants after hospital discharge. J Obstet Gynecol Neonatal Nurs 1997;26:189–197.
11.
Neville MC, Morton J, Umemora S. Lactogenesis: The transition from pregnancy to lactation. Pediatr Clin North Am 2001;48:35–52.
12.
Dewey KG, Nommsen-Rivers LA, Heinig MJ, et al. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics 2003;112:607–619.
13.
Chapman DJ, Perez-Escamilla R. Identification of risk factors for delayed onset of lactation. J Am Diet Assoc 1999;99:450–454.
14.
Sievers E, Haase S, Oldigs HD, et al. The impact of peripartum factors on the onset and duration of lactation. Biol Neonate 2003;83:246–252.
15.
Cregan MD, de Mello TR, Kershaw D. Initiation of laction in women after preterm delivery. Acta Obstet Gynecol Scand 2002;81:870–877.
16.
Henderson JJ, Hartmann PE, Newnham JP, et al. Effect of preterm birth and antenatal corticosteriod treatment on lactogenesis II in women. Pediatrics 2008;121:92–100.
17.
Hill PD, Aldag JC, Chatterton RT, et al. Primary and secondary mediator's influence on milk output in lactating mothers of preterm and term infants. J Hum Lact 2005;21:138–150.
18.
Larkin T, Kiehn T, Murphy PK, et al. Examining the use and outcomes of a new hospital-grade breast pump in exclusively pumping NICU mothers. Adv Neonatal Care 2013;13:75–82.
19.
Morton J, Hall JY, Wong RJ, et al. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. J Perinatol 2009;29:757–764.
20.
Chatterton RT, Hill PD, Aldag JC, et al. Relation of plasma oxytocin and prolactin concentrations to milk production in mothers of preterm infants: Influence of stress. J Clin Endocrinol Metab 2000;85:3661–3668.
21.
Chen DC, Nommsen-Rivers LA, Dewey KG, et al. Stress during labor and delivery and early lactation performance. Am J Clin Nutr 1998;68:355–344.
22.
Murray EK, Ricketts S, Dellaport J. Hospital practices that increase bresatfeeding duration: Results from a population-based study. Birth 2007;34:202–211.
23.
Furman L, Minich N, Hack M. Correlates of lactation in mothers of very low birth weight infants. Pediatrics 2002;109:57–62.
24.
Hill PD, Aldag JC, Chatterton RT. Effects of pumping style on milk production in mothers of non-nursing preterm infant. J Hum Lact 1999;15:209–216.
25.
Hill PD, Aldag JC, Chatterton RT, et al. Comparison of milk output between mothers of preterm and term infants: The first 6 weeks after birth. J Hum Lact 2005;21:22–30.
26.
Hopkinson JM, Schanler RJ, Garza C. Milk production by mothers of premature infant. Pediatrics 1988;81:815–820.
27.
Hill PD, Brown LP, Harker RL. Initiation and frequency of breast expression in breastfeeding mothers of LBW and VLBW infants. Nurs Res 1995;44:352–355.
28.
Parker LA, Sullivan S, Krueger C, et al. Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: A pilot study. J Perinatol 2012;32:H205–H209.
29.
Meier PP, Brown LP, Hurst NM. Breastfeeding the Preterm Infant, 2nd ed. Jones and Barlett, Boston, 1999.
30.
Hause B, Barreira J, Murphy PK, et al. The development of an accurate test weighing technique for preterm and high-risk hospitalized infants. Breastfeed Med 2009;4:1–6.
31.
Chapman DJ, Perez-Escamilla R. Maternal perception of the onset of lactation is a valid, public health indicator of lactogenesis stage II. J Nutr 2000;130:2972–2980.
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Copyright 2015, Mary Ann Liebert, Inc.
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Published online: 6 March 2015
Published in print: March 2015
Published ahead of print: 6 February 2015
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