Milk Volume at 2 Weeks Predicts Mother's Own Milk Feeding at Neonatal Intensive Care Unit Discharge for Very Low Birthweight Infants

Hoban, Rebecca; Bigger, Harold R.; Schoeny, Michael; Engstrom, Janet L.; Meier, Paula P.; Patel, Aloka L.

doi:10.1089/bfm.2017.0159

Cited by 77 publications

(69 citation statements)

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“…Lactation support is vital in the first few days after birth, especially for mothers of premature infants ( 5 ). The volume of feeds required by premature infants are minimal, Even a small amount of DHM per infant could provide enough volume to allow the mother the time to come-to-volume, resulting in her own milk being available for her infant ( 22 ).…”

Section: Background For the Development Of This Decision Treementioning

confidence: 99%

“…Systems are needed that support mothers to develop their own milk supply and prioritize their milk for their infants. Research has shown that mothers who reach full volume by 14 days post-delivery, estimated as 500 mL of breast milk per day, are more likely to be able to continue breastfeeding at discharge ( 22 ). Robust hospital policies and guidelines are needed to ensure all efforts have been made to prioritize mother's own milk and support maternal lactation, not only prior to the allocation of DHM, but routinely during the infant's hospitalization.…”

Section: Background For the Development Of This Decision Treementioning

confidence: 99%

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A Decision Tree for Donor Human Milk: An Example Tool to Protect, Promote, and Support Breastfeeding

et al. 2018

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Despite decades of breastfeeding promotion, exclusive breastfeeding rates for the first 6 months of life remain low: around 40% globally. Infants that are admitted to a neonatal ward are even less likely to be exclusively breastfed. Lactogenesis is frequently delayed in mothers that deliver early, with the added burden of separation of the unstable newborn and mother. For such vulnerable infants, donor human milk is recommended by the World Health Organization, UNICEF, and professional organizations as the next best alternative when mother's own milk is unavailable and can serve as a bridge to full feeding with mother's own milk. Hospital support of optimal breastfeeding practices is essential with thoughtful integration of donor human milk policies for those infants that need it most. We propose a decision tree for neonatal wards that are considering the use of donor human milk to ensure donor human milk is used to replace formula, not to replace mothers' own milk. By first evaluating barriers to full feeding with mother's own milk, healthcare workers are encouraged to systematically consider the appropriateness of donor human milk. This tool also seeks to prevent overuse of donor human milk, which has the potential to undermine successful lactation development. In settings where donor human milk supplies are limited, prioritization of infants by medical status is also needed. Readily available and easy-to-use tools are needed to support healthcare staff and mothers in order to improve lactation development and neonatal nutrition.

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Section: Background For the Development Of This Decision Treementioning

confidence: 99%

Section: Background For the Development Of This Decision Treementioning

confidence: 99%

A Decision Tree for Donor Human Milk: An Example Tool to Protect, Promote, and Support Breastfeeding

et al. 2018

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“…Early and frequent expression also increases the probability of establishing a full milk supply adequate to meet the infants’ needs. There is strong evidence that the frequency of breast expressions per day is positively related to both daily and weekly milk production 6–9. Therefore, the common advice is to encourage mothers of preterm infants to expression 8–10 times day and double pumping when possible.…”

Section: Introductionmentioning

confidence: 99%

Short-term rate of milk synthesis and expression interval of preterm mothers

Lai

Rea

Mitoulas

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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AimTo determine the impact of the pumping regimes of women with preterm infants on the daily milk production, and on the short-term rate of milk synthesis during early lactation to support evidence-based recommendations for optimising milk production.MethodsMothers of preterm infants (n=25) recorded start time, finish time and expression volumes from every breast expression on days 10, 15–20 postpartum.ResultsExpressing more often than five times per day did not result in a significant increase in daily milk production. Milk volume per expression per breast increased for intervals between expressions of between 2and6 hours then reached a plateau when the interval between expression was 7 hours or longer. The short-term rate of milk synthesis decreased as the interval between expressions increased until about 7.5 hours at which point it begun to increase (p value associated with interval between expressions^2<0.001).ConclusionThe strong inverse association between the short-term rate of milk synthesis and the interval between expressions for intervals up to 7 hours suggest that the maximum interval between expressions should be 7 hours. Data suggest that, on average, the mothers should express at least five times a day to maximise daily milk production. Considering inter-individual variation, determination of an individual mother’s maximum interval between expressions that does not compromise the short-term rate of milk synthesis will help to optimise daily milk production while minimising the demands on the mother’s time.

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“…In conclusion, health care professionals should be educated on the important role of human milk in reducing the risk for developing comorbidities in preterm infants and should promote and protect breastfeeding, supporting the mothers particularly in the first 14 days after delivery. Indeed, during this window of time, the preterms' mothers are at higher risk for producing an insufficient volume of milk, thus experiencing the so called "impaired coming to volume", which negatively affects the long term lactation outcomes [10] in the broadest context possible. Future research on how tp implement the starting and the duration of human milk feeding in preterm infants is needed.…”

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confidence: 99%

Human Milk Feeding in Preterm Infants: What Has Been Done and What Is to Be Done

2019

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Keywords: breastfeeding; human milk; human donor milk; promotion of breastfeeding; preterm infant; VLBW Human milk is recommended as the natural feeding for both term and preterm infants for the several health benefits associated with its consumption. The importance of human milk is not only limited to its nutritional value but it also includes the provision of bioactive factors involved in the optimization of infants' growth and neurodevelopment. A huge amount of researches indicates that the biological effects of human milk are dose dependent. Moreover, an increasing number of studies are showing that breast milk contains stem cells whose implications in infant neurodevelopment are under study. Hence, it is mandatory to promote initiation of breastfeeding as well as to support its duration [1][2][3][4].When taking into consideration feeding options for preterm infants, it should be highlighted that there is a biological hierarchy with milk of own mothers' being the first choice. When own mothers' milk is not available, donor human milk is recommended, whereas formula feeding should be the last choice [2].Human milk feeding represents a cost-effective strategy to reduce disease impact and associated costs in preterm infants, during the neonatal intensive care unit hospitalization [5]. Colaizy estimated that suboptimal feeding of extremely low birth weight infants would cost $27.1 million (CI $24 million, $30.4 million) in direct medical costs, $563,655 (CI $476,191, $599,069) in indirect nonmedical costs, and $1.5 billion (CI $1.3 billion, $1.6 billion) in cost attributable to premature death [6].The systematic review and meta-analysis published by Miller [7] summarized the available evidence in relation to the dose-dependent effect of human milk feeding on decreasing morbidity in infant born <28 weeks' gestation and/or birth weight <1500 g. Recent studies have assessed the different impact of human milk and preterm infant formula (PTF) feeding on one single outcome, thus limiting the in-depth analysis of the synergic protective co-effects led by the different nutritional and non-nutritional components of human milk against the most frequent comorbidities that affect premature infants. Remarkably, Miller considered the combination of five major morbidities (necrotizing enterocolitis, late onset sepsis, bronchopulmonary dysplasia, retinopathy of prematurity and neurodevelopment), pointing out the clear protective effect of human milk against necrotizing enterocolitis and possible reduction in late onset sepsis, severe retinopathy of prematurity and severe necrotizing enterocolitis. The comparison between various combinations of mixed feeding, human milk and preterm infant formula allowed for a specific investigation on the dose effect associated with human milk feeding.However, no conclusive evidence has been drawn on the incidence of bronchopulmonary dysplasia and on neurodevelopment, thus underlining the need for implementing research towards this direction.This systematic review allows for gaining further ins...

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Milk Volume at 2 Weeks Predicts Mother's Own Milk Feeding at Neonatal Intensive Care Unit Discharge for Very Low Birthweight Infants

Cited by 77 publications

References 40 publications

A Decision Tree for Donor Human Milk: An Example Tool to Protect, Promote, and Support Breastfeeding

A Decision Tree for Donor Human Milk: An Example Tool to Protect, Promote, and Support Breastfeeding

Short-term rate of milk synthesis and expression interval of preterm mothers

Human Milk Feeding in Preterm Infants: What Has Been Done and What Is to Be Done

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