Maternal production of milk for infants in the neonatal intensive care unit

Hoban, Rebecca; Bowker, Rakhee M.; Gross, Megan E.; Patel, Aloka L.

doi:10.1016/j.semperi.2020.151381

Cited by 16 publications

(12 citation statements)

References 99 publications

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“…Overall, the lack of disparities in more direct measures of inflammation, such as cytokines, is reassuring. It is likely that the robust benefits of MOM far outweigh any potential risks, especially given that formula is well known to lead to a higher risk of NEC and donor milk lacks many of the benefits of MOM ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

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Associations of maternal inflammatory states with human milk composition in mothers of preterm infants

Landau-Crangle,

O’Connor,

Unger

et al. 2024

Front. Nutr.

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IntroductionOverweight/obesity (ow/ob) is increasing in prevalence in pregnant women, and it is associated with other pro-inflammatory states, such as pre-eclampsia, gestational diabetes, and preterm labor. Data are lacking if mothers experiencing inflammatory states who deliver preterm have mother’s own milk (MOM) with differing inflammatory markers or pro-inflammatory fatty acid (FA) profiles.MethodsThe aim was to explore associations of maternal pre- and perinatal inflammatory states with levels of inflammatory markers and/or FAs in longitudinal samples of MOM from mothers of preterm infants born <1,250 g. Inflammatory states included pre-pregnancy ow/ob, diabetes, chorioamnionitis (chorio), preterm labor (PTL), premature rupture of membranes (PROM), pre-eclampsia, and cesarian delivery. In MOM, inflammatory markers studied included c-reactive protein (CRP), free choline, IFN-Ɣ, IL-10, IL-1β, IL-1ra, IL-6, IL-8, and TNF-α, and FAs included omega-6:omega-3 ratio, arachidonic acid, docosahexaenoic acid, linoleic acid, monounsaturated FAs, and saturated FAs. The above inflammatory states were assessed individually, and the healthiest mothers (normal BMI, no chorio, and ± no pre-eclampsia) were grouped. Regression analysis tested associations at baseline (day 5) and over time using generalized estimating equations.ResultsA total of 92 infants were included who were delivered to mothers (42% ow/ob) at a median gestational age of 27.7 weeks and birth weight of 850 g. MOM CRP was 116% higher (relative change 2.16) in mothers with ow/ob at baseline than others (p = 0.01), and lower (relative change 0.46, 0.33, respectively) in mothers in the two “healthy groups” at baseline (both p < 0.05) than others. MOM IL-8 levels were lower with chorio and PTL at baseline. No significant associations were found for other individual or grouped inflammatory states nor for other MOM inflammatory markers nor FA profiles at baseline.DiscussionIn conclusion, MOM CRP levels are positively associated with inflammatory states, such as ow/ob. Reassuringly, there was no association between FA profiles or most other inflammatory markers and maternal inflammatory states. Further studies are needed to determine potential associations or ramifications of MOM CRP in vulnerable preterm infants.

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Section: Discussionmentioning

confidence: 99%

“…Mother’s own milk (MOM) is the gold standard for feeding preterm infants, improving neurodevelopment and lowering rates of co-morbidities, including necrotizing enterocolitis ( 10 ). Like many other biomolecules, cytokines from the maternal serum, or potentially the mammary gland, pass into MOM.…”

Section: Introductionmentioning

confidence: 99%

Associations of maternal inflammatory states with human milk composition in mothers of preterm infants

Landau-Crangle,

O’Connor,

Unger

et al. 2024

Front. Nutr.

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“…Standard lactation recommendations given to mothers of VPT infants include pumping 8–12 times/day in the early postpartum period to mimic a healthy term newborn ( 47 , 48 , 57 ), although the actual minimum pumping frequency requirement is unknown ( 7 ). A recent study by Mago-Shah et al suggested that pumping at least 5 times per day by day 5 and pumping once in the early morning were independently associated with CTV ( 43 ), which is in turn associated with continued MOM provision at NICU discharge ( 35 , 58 ).…”

Section: Discussionmentioning

confidence: 99%

“…Stimulation of the mammary gland by the infant or breast pump during the transition from secretory differentiation to secretory activation is critical, with programming effects on lactocytes ( 38 , 39 , 46 ). Recommendations for pump-dependent women include pumping 8–12 times daily, especially in the first 14 days postpartum ( 47 , 48 ). Furthermore, studies suggest a minimum of 5–6 pumping sessions per day during the first 1–3 weeks postpartum is associated with establishing appropriate MOM volume, called coming to volume (CTV, pumping ≥500 mL/day MOM) by 14 days postpartum, or continued MOM provision to NICU discharge ( 35 , 40 , 41 , 43 , 49 ).…”

Section: Introductionmentioning

confidence: 99%

Where does the time go? Temporal patterns of pumping behaviors in mothers of very preterm infants vary by sociodemographic and clinical factors

Patel,

Tan,

Bucek

et al. 2024

Front. Nutr.

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BackgroundMothers 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.ObjectiveTo investigate the variation in pumping behavior by postpartum week, maternal characteristics, and infant GA.MethodsProspectively 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.ResultsData 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.ConclusionOn 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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“…is often propagated [ 14 , 15 ] although recent studies assume that an initial expression within the first 181–360 min p.p. should be aimed for [ 16 , 17 ]. Premature birth complicates the onset of secretory activation, which is relevant to producing a sufficient amount of milk [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Initiation of lactation and the provision of human milk to preterm infants in German neonatal intensive care units from the mothers’ perspective

Scholten

Mause

Horenkamp-Sonntag

et al. 2022

BMC Pregnancy Childbirth

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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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Maternal production of milk for infants in the neonatal intensive care unit

Cited by 16 publications

References 99 publications

Associations of maternal inflammatory states with human milk composition in mothers of preterm infants

Associations of maternal inflammatory states with human milk composition in mothers of preterm infants

Where does the time go? Temporal patterns of pumping behaviors in mothers of very preterm infants vary by sociodemographic and clinical factors

Initiation of lactation and the provision of human milk to preterm infants in German neonatal intensive care units from the mothers’ perspective

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