A daily threshold amount of at least 50 mL/kg of maternal milk through week 4 of life is needed to decrease the rate of sepsis in very low-birth-weight infants, but maternal milk does not affect other neonatal morbidities.

ABSTRACT. Objective. We sought to determine the correlates of intent to breastfeed and of successful lactation and nursing at the breast in mothers of very low birth weight (VLBW; <1.5 kg) infants.Methods. We conducted a prospective observational study of 119 mothers of singleton VLBW infants (mean birth weight: 1056 g; mean gestational age: 28 weeks), 87 (73%) of whom intended to breastfeed. Mothers completed questionnaires at 3 weeks' postnatal age and at 35 and 40 weeks' (term) and 4 months' corrected ages (CAs).Results. Of the 87 mothers who intended to breastfeed, 30 mothers (34%) continued lactation beyond 40 weeks' CA (postmenstrual plus postnatal age). Compared with mothers who discontinued lactation before this time, those who continued were older (31 vs 26 years), more were married (80% vs 39%), they had more than a high school education (70% vs 42%), and they were white (63% vs 35%). There were no significant differences in their infants' birth data or rates of neonatal morbidity. Significant correlates of lactation beyond 40 weeks' CA included beginning milk expression before 6 hours postdelivery, expressing milk >5 times per day, and kangaroo care. These correlates remained significant after controlling for maternal age, race, marital status, and education beyond high school. At 4 months' CA, 14 mothers (16%) were still lactating, 12 of whom were nursing at the breast.Conclusions. Increased maternal support specifically directed toward behavioral factors, including early and more frequent milk expression and kangaroo care, may improve the rates of successful lactation among mothers of VLBW infants who choose to breastfeed. Pediatrics 2002;109(4). URL: http://www.pediatrics.org/cgi/content/ full/109/4/e57; lactation, very low birth weight infant, breastfeeding.

Late preterm infants (34 0/7-36 6/7 weeks of gestation) are often cared for in general maternity units by clinicians who have limited experience with the specific needs of these newborns. Although the benefits of human milk are well documented, mothers and their late preterm infants are at risk for poor lactation outcomes. These include early breastfeeding cessation and lactation-associated morbidities, including poor growth, jaundice, and dehydration. Late preterm infants are more likely than term infants to develop temperature instability, hypoglycemia, respiratory distress, jaundice, feeding problems, and to require rehospitalization in the first 2 weeks postbirth. Breastfeeding can exacerbate these problems, because late preterm infants often lack the ability to consume an adequate volume of milk at breast, and their mothers are at risk for delayed lactogenesis. This article reviews strategies to protect breastfeeding for the late preterm infant and mother dyad by establishing and maintaining maternal milk volume while facilitating adequate infant intake.