Lack of mother's own milk (MOM) at discharge from the neonatal intensive care unit (NICU) is a global problem and is often attributable to inadequate MOM volume. Evidence suggests that the origins of this problem are during the first 14 days postpartum, a time period that includes secretory activation (SA; lactogenesis II, milk coming in).
Objectives:
To describe and summarize evidence regarding use of MOM biomarkers (MBMs) as a measure of SA in pump-dependent mothers of preterm infants in the NICU and to identify knowledge gaps requiring further investigation.
Methods:
An integrative review was conducted using Whittemore and Knafl methodology incorporating the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. A search using electronic databases MEDLINE (through PubMed) and CINAHL (Cumulative Index to Nursing and Allied Health Literature) and reference lists of included articles was conducted.
Results:
Of the 40 articles retrieved, 6 met the criteria for inclusion. Results revealed the following five findings: (1) Achievement of SA defined by MBMs is delayed and/or impaired in mothers of preterm infants. (2) MBMs are associated with pumped MOM volume. (3) Achievement of SA defined by MBMs is associated with pumping frequency. (4) Delayed and/or impaired achievement of SA defined by MBMs may be exacerbated by maternal comorbidities. (5) There is a lack of consensus as to which MBM(s) and analysis techniques should be used in research and practice.
Conclusions:
MBMs hold tremendous potential to document and monitor achievement of SA in mothers of preterm infants, with multiple implications for research and clinical practice.
Get full access to this article
View all access options for this article.
References
1.
Center for Disease Control. Breastfeeding Among U.S. Children Born 2011–2018, CDC National Immunization Survey CfD. National Vital Statistics Report. 2018. Available from: https://www.cdc.gov/breastfeeding/data/nis_data/results.html [Last accessed: March15, 2022].
2.
BoundyEO, PerrineCG, NelsonJM, et al.Disparities in hospital-reported breast milk use in neonatal intensive care units—United States, 2015. MMWR Morb Wkly Rep, 2017; 66(48):1313–1317; doi: 10.15585/mmwr.mm6648a1
3.
ParkerMG, StellwagenLM, NobleL, et al.Promoting human milk and breastfeeding for the very low birth weight infant. Pediatrics, 2021; 148(5):e2021054272; doi: 10.1542/peds.2021-054272
4.
ParkerMG, GreenbergLT, EdwardsEM, et al.National trends in the provision of human milk at hospital discharge among very low-birth-weight infants. JAMA Pediatr, 2019; 173(10):961–968; doi: 10.1001/jamapediatrics.2019.2645
5.
FleurantE, SchoenyM, HobanR, et al.Barriers to human milk feeding at discharge of very-low-birth-weight infants: Maternal goal setting as a key social factor. Breastfeed Med, 2017; 12:20–27; doi: 10.1089/bfm.2016.0105
6.
JohnsonTJ, PatraK, GreeneMM, et al.NICU human milk dose and health care use after NICU discharge in very low birth weight infants. J Perinat, 2019; 39(1):120–128; doi: 10.1038/s41372-018-0246-0
7.
JohnsonTJ, PatelAL, SchoenyME, et al.Cost savings of mother's own milk for very low birth weight infants in the neonatal intensive care unit. Pharmacoecon Open, 2022; 6(3):451–460; doi: 10.1007/s41669-022-00324-8
8.
MiracleDJ, MeierPP, BennettPA. Mothers' decisions to change from formula to mothers' milk for very-low-birth-weight infants. J Obstet Gynecol Neonatal Nurs, 2006; 33(6):692–703; doi: 10.1177/0884217504270665
9.
SiskPM, LoveladyCA, DillardRG, et al.Lactation counseling for mothers of very low birth weight infants: Effect on maternal anxiety and infant intake of human milk. Pediatrics, 2006; 117(1):e67–e75; doi: 10.1542/peds.2005-0267
10.
HobanR, BiggerH, PatelAL, et al.Goals for human milk feeding in mothers of very low birth weight infants: How do goals change and are they achieved during the NICU hospitalization?. Breastfeed Med, 2015; 10(6):305–311; doi: 10.1089/bfm.2015.0047
11.
PatelAA, JohnsonTJ, MeierPP. Racial and socioeconomic disparities in breast milk feedings in US neonatal intensive care units. Pediatr Res, 2021; 89(2):344–352; doi: 10.1038/s41390-020-01263-y
12.
ParkerLA, KruegerC, SullivanS, et al.Demographic, social, and personal factors associated with lactation cessation by 6 weeks in mothers of very low birth weight infants. J Hum Lact, 2021; 37(3):511–520; doi: 10.1177/0890334420940239
13.
BendixenMM, IapiccaLC, ParkerLA, et al.Nonpharmacologic factors affecting milk production in pump-dependent mothers of critically ill infants: State of the science. Adv Neonatal Care, 2023; 23(1):51–63; doi: 10.1097/ANC.0000000000000990
14.
PatelAL, SchoenyME, HobanR, et al.Mediators of racial and ethnic disparity in mother's own milk feeding in very low birth weight infants. Pediatr Res, 2019; 85(5):662–670; doi: 10.1038/s41390-019-0290-2
15.
MeierPP, JohnsonTJ, PatelAL, et al.Evidence-based methods that promote human milk feeding of preterm infants: An expert review. Clin Perinatol, 2017; 44(1):1–22; doi: 10.1016/j.clp.2016.11.005
16.
JohnsonTJ, MeierPP, SchoenyME, et al.Study protocol for reducing disparity in receipt of mother's own milk in very low birth weight infants (ReDiMOM): A randomized trial to improve adherence to sustained maternal breast pump use. BMC Pediatr, 2022; 22(1):27; doi: 10.1186/s12887-021-03088-y
17.
HobanR, BiggerH, SchoenyM, et al.Milk volume at 2 weeks predicts mother's own milk feeding at neonatal intensive care unit discharge for very low birthweight infants. Breastfeed Med, 2018; 13(2):135–141; doi: 10.1089/bfm.2017.0159
18.
HobanR, Medina PoelinizC, SomersetE, et al.Mother's own milk biomarkers predict coming to volume in pump-dependent mothers of preterm infants. J Pediatr, 2021; 228:44–52.e43; doi: 10.1016/j.jpeds.2020.09.010
19.
ParkerLA, SullivanS, CachoN, et al.Indicators of secretory activation in mothers of preterm very low birth weight infants. J Hum Lact, 2020:890334420980424; doi: 10.1177/0890334420980424
20.
PangWW, HartmannPE. Initiation of human lactation: Secretory differentiation and secretory activation. J Mammary Gland Biol Neoplasia, 2007; 12(4):211–221; doi: 10.1007/s10911-007-9054-4
21.
Medina PoelinizC, EngstromJL, HobanR, et al.Measures of secretory activation for research and practice: An integrative review. Breastfeed Med, 2020; 15(4):191–212; doi: 10.1089/bfm.2019.0247
22.
MeierPP, EngstromJL, JanesJE, et al.Breast pump suction patterns that mimic the human infant during breastfeeding: Greater milk output in less time spent pumping for breast pump-dependent mothers with premature infants. J Perinatol, 2012; 32(2):103–110; doi: 10.1038/jp.2011.64
23.
MeierPP, PatelAL, HobanR, et al.Which breast pump for which mother: An evidence-based approach to individualizing breast pump technology. J Perinatol, 2016; 36(7):493–499; doi: 10.1038/jp.2016.14
24.
Medina PoelinizC, HobanR, SchoenyME, et al.Prepregnancy body mass index is associated with time-dependent changes in secretory activation measures during the first 7 days postpartum in breast pump-dependent mothers of premature infants. Breastfeed Med, 2022; 17(2):173–181; doi: 10.1089/bfm.2021.0167
25.
NevilleMC, AllenJC, ArcherPC, et al.Studies in human lactation: Milk volume and nutrient composition during weaning and lactogenesis. Am J Clin Nutr, 1991; 54(1):81–92; doi: 10.1093/ajcn/54.1.81
26.
GreeneMM, SchoenyM, RossmanB, et al.Infant, maternal, and neighborhood predictors of maternal psychological distress at birth and over very low birth weight infants' first year of life. J Dev Behav Pediatr, 2019; 40(8):613–621; doi: 10.1097/DBP.0000000000000704
27.
LeeS, KelleherSL. Biological underpinnings of breastfeeding challenges: The role of genetics, diet, and environment on lactation physiology. Am J Physiol Endocrinol Metab, 2016; 311(2):E405–E422; doi: 10.1152/ajpendo.00495.2015
CreganMD, De MelloTR, KershawD, et al.Initiation of lactation in women after preterm delivery. Acta Obstet Gynecol Scand, 2002; 81(9):870–877; doi: 10.1034/j.1600-0412.2002.810913.x
30.
HobanR, PatelAL, Medina PoelinizC, et al.Human milk biomarkers of secretory activation in breast pump-dependent mothers of premature infants. Breastfeed Med, 2018; 13(5):352–360; doi: 10.1089/bfm.2017.0183
31.
HendersonJJ, HartmannPE, NewnhamJP, et al.Effect of preterm birth and antenatal corticosteroid treatment on lactogenesis II in women. Pediatrics, 2008; 121(1):e92–e100; doi: 10.1542/peds.2007-1107
32.
MortonJA. The clinical usefulness of breast milk sodium in the assessment of lactogenesis. Pediatrics, 1994; 93(5):802–806; PMID: 8165082
33.
HumenickSS, HillPD, ThompsonJ, et al.Breast-milk sodium as a predictor of breastfeeding patterns. Can J Nurs Res, 1998; 30(3):67–81; PMID: 10030186
34.
HobanR, BowkerRM, GrossME, et al.Maternal production of milk for infants in the neonatal intensive care unit. Semin Perinatol, 2021; 45(2):151381; doi: 10.1016/j.semperi.2020.151381
35.
Nommsen-RiversLA, WagnerEA, RoznowskiDM, et al.Measures of maternal metabolic health as predictors of severely low milk production. Breastfeed Med, 2022; 17(7):566–576; doi: 10.1016/j.semperi.2020.151381
36.
WalkerRA, HarvatineKJ, RossAC, et al.Fatty acid transfer from blood to milk is disrupted in mothers with low milk production, obesity, and inflammation. J Nutr, 2023; 152(12):2716–2726; doi: 10.1093/jn/nxac220
PeakerM, LinzellJL. Citrate in milk: A harbinger of lactogenesis. Nature, 1975; 253(5491):464; doi: 10.1038/253464a0
39.
MuraseM, WagnerEA, ChantryJC, et al.The relation between breast milk sodium to potassium ratio and maternal report of a milk supply concern. J Pediatr, 2017; 181:294–297; doi: 10.1016/j.jpeds.2016.10.044
40.
Esquerra-ZwiersA, VroomA, GeddesD, et al.Use of a portable point-of-care instrumentation to measure human milk sodium and potassium concentrations. Breastfeed Med, 2022; 17(1):46–51; doi: 10.1089/bfm.2021.0046
41.
LaiCT, GardnerH, GeddesD. Comparison of inductively coupled plasma optical emission spectrometry with an ion selective electrode to determine sodium and potassium levels in human milk. Nutrients, 2018; 10(9); doi: 10.3390/nu10091218
42.
HobanRM, SignorileCM, JamesJ, et al.Pumping behaviours in mothers of preterm infants are associated with mother's own milk biomarkers of secretory activation. In: Poster presented at: 21st Conference of the International Society for Research and Human Milk and Lactation. Panama City, Panama; 2022.
43.
Medina PoelinizC, SignorileM, HobanR, et al.Secretory activation is impermanent during the first 14 days postpartum in breast pump-dependent mothers of hospitalized preterm infants. In: Poster presented at: Human milk feeding as a complex system. 21st Conference of the International Society for Research and Human Milk and Lactation. Panama City, Panama; 2022.
44.
MeierPP, EngstromJL, PatelAL, et al.Improving the use of human milk during and after the NICU stay. Clin Perinatol, 2010; 37(1):217–245; doi: 10.1016/j.clp.2010.01.013
45.
MeierPP, EngstromJL, FlemingBA, et al.Estimating milk intake of hospitalized preterm infants who breastfeed. J Hum Lact, 1996; 12(1):21–26; doi: 10.1177/089033449601200106
46.
MeierPP, EngstromJL, CrichtonCL, et al.A new scale for in-home test-weighing for mothers of preterm and high risk infants. J Hum Lact, 1994; 10(3):163–168; doi: 10.1177/089033449401000312
47.
HurstNM, MeierPP, EngstromJL, et al.Mothers performing in-home measurement of milk intake during breastfeeding of their preterm infants: maternal reactions and feeding outcomes. J Hum Lact, 2004; 20(2):178–187; doi: 10.1177/0890334404264168
48.
GriffinTL, MeierPP, BradfordLP, et al.Mothers' performing creamatocrit measures in the NICU: accuracy, reactions, and cost. J Obstet Gynecol Neonatal Nurs, 2000; 29(3):249–257; doi: 10.1111/j.1552-6909.2000.tb02046.x
49.
ParkerLA, SullivanS, KrugerC, et al.Timing of milk expression following delivery in mothers delivering preterm very low birth weight infants: A randomized trial. J Perinatol, 2020; 40(8):1236–1245; doi: 10.1038/s41372-020-0688-z
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
