Volume of Foremilk,Hindmilk,and Total Milk Produced by Mothers of Very Preterm Infants Born at Less Than 28 Weeks of Gestation

Abstract

The purpose of this study is to describe foremilk volume (milk produced in the first 3 minutes of pumping), hindmilk volume (remainder of milk produced), and total milk volume produced by mothers of very preterm infants at 3 weeks postpartum and associated factors. Mothers (n = 24) mechanically pump their breasts a median (minimum, maximum) of 7 times (5, 9 times) per 24 hours for a total of 15 minutes (9.4, 23.9 minutes) each time. Foremilk, hindmilk, and total milk volumes are 183 mL per 24 hours (80, 810), 318 mL per 24 hours (98, 1007), and 545 mL per 24 hours (224, 1817), respectively. Milk volumes are not associated with mother's age, race or ethnic background, education, parity, reported prepregnancy body mass index, previous breastfeeding experience, frequency of milk pumping, longest time between pumps, infant birth weight, or multiple births. The degree of pre-maturity (<26 weeks vs 26^0/7-27^6/7 weeks) is significantly related to the relative proportion of foremilk/hindmilk volumes (45:55 vs 36:65, respectively). J Hum Lact. 25(3):272-279.

Keywords

very low birth weight preterm infant hindmilk milk volume human milk

Get full access to this article

View all access options for this article.

References

Canadian Paediatric Society (CPS), Nutrition Committee. Nutrient needs and feeding of premature infants . Can Med Assoc J. 1995;152:1765-1785.

American Academy of Pediatrics (AAP), Work Group on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 1997;100:1035-1039.

Sapsford AL Human milk and enteral nutrition products. In: Groh-Wargo S , Thompson M , Cox J , eds. Nutritional Care for High-Risk Newborns. 3rd ed. Chicago, Ill : Precept Press; 2000 :265-302.

Anderson DM Nutritional implications of premature birth, birth weight, and gestational age classification. In: Groh-Wargo S , Thompson M , Cox J , eds. Nutritional Care for High-Risk Newborns. 3rd ed. Chicago, Ill: Precept Press ; 2000:3-10.

Vohr BR , Poindexter BB , Dusick AM , et al; NICHD Neonatal Research Network. 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:e115-e123.

Meier P. , Brown LP , Hurst NM Breastfeeding the preterm infant. In: Riordan J , Auerbach K , eds. Breastfeeding and Human Lactation. 2nd ed. Boston, Mass: Jones & Bartlett ; 1999:449-481.

Lawrence RA , Lawrence RM Breastfeeding: A Guide for the Medical Profession. 5th ed. St. Louis, Mo: Mosby; 1999.

Furman L. , Minich NM , Hack M. Breastfeeding of very low birth weight infants. J Hum Lact . 1998;14:29-34.

Chatterton RT Jr , Hill PD , Aldag JC , Hodges KR , Belknap SM , Zinaman MJ 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.

10.

Neville MC Physiology of lactation. Clin Perinatol. 1999 ;26:251-279.

11.

Meier PP , Brown LP , Hurst NM Breastfeeding the preterm infant. In: Riordant J , Auerback K , eds. Breastfeeding and Human Lactation. Boston, Mass : Jones & Bartlett; 1999:449-481.

12.

Hill PD , Aldag JC , Chatterton RT Effects of pumping style on milk production in mothers of non-nursing preterm infants. J Hum Lact. 1999;15:209-216.

13.

Furman L. , Minich N. , Hack M. Correlates of lactation in mothers of very low birth weight infants. Pediatrics. 2002;109:E57.

14.

Schanler RJ Fortified human milk: nature's way to feed premature infants. J Hum Lact. 1998;14:5-11.

15.

Valentine CJ , Hurst NM , Schanler RJ Hindmilk improves weight gain in low-birth-weight-infants fed human milk. J Pediatr Gastroenterol Nutr. 1994;18:474-477.

16.

Neville MC , Keller RP , Seacat J. , et al. Studies on human lactation, I: within-feed and between-breast variation in selected components of human milk. Am J Clin Nutr. 1984;40:635-646.

17.

Kirsten D. , Bradford L. Hindmilk feedings. Neonatal Netw. 1999;18:68-70.

18.

Ogechi AA , William O. , Fidelia BT Hindmilk and weight gain in preterm very low-birthweight infants. Pediatr Int. 2007;49:156-160.

19.

Wang CD , Chu PS , Mellen BG , Shenai JP Creamatocrit and the nutrient composition of human milk. J Perinatol. 1999;19:343-346.

20.

Griffin TL , Meier PP , Bradford LP , Bigger HR , Engstrom JL Mother's performing creamatocrit measures in the NICU: accuracy, reactions, and cost. J Obstet Gynecol Neonatal Nurs. 2000;29:249-257.

21.

Vasan U. , Meier W. , Kerstin D. , Meier R. Lactoengineering of own mothers' milk: effects on weight gain for preterm infants <1000 g at birth [abstract]. Hot Topics . 1997;2:401-402.

22.

Slusher T. , Hampton R. , Bode-Thomas F. , Pam S. , Akor F. , Meier P. Promoting the exclusive feeding of own mother's milk through the use of hindmilk and increased maternal milk volume for hospitalized, low birth weight infants (<1800 grams) in Nigeria: a feasibility study. J Hum Lact. 2003;19:191-198.

23.

Meier PP , Murtaugh M. , Vasan U. , Meier W. , Schanler RJ Modification of the lipid concentration in own mothers' milk (OMM) feedings in the neonatal intensive care unit (NICU): clinical application of the creamatocrit (CRCT) technique [abstract #1689]. Pediatr Res. 1999;287A.

24.

Bigger HR , Griffin T. , Meier PP , Engstrom JL Breast feeding in the neonatal intensive care unit (NICU): a comparison of mothers' and nurses' creamatocrit (CRCT) measurements [abstract #1632] . Pediatr Res. 1999;277A.

25.

Jennings T. , Meier W. , Meier P. High lipid and caloric content in milk from mothers of preterm infants [abstract]. Pediatr Res. 1997;41:233A.

26.

Bishara R. , Dunn MS , Merko SE , Darling P. Nutrient composition of hindmilk produced by mothers of very low birth weight infants born at less than 28 weeks' gestation. J Hum Lact . 2008;24:159-167.

27.

Ballard JL , Khoury JC , Wedig K. , Wang L. , Eilers-Walsman BL , Lipp R. New Ballard score, expanded to include extremely premature infants. J Pediatr. 1991;119:417-425.

28.

O'Connor DL , Jacobs J. , Hall R. , et al. Growth and development of premature infants fed predominantly human milk, predominantly premature infant formula, or a combination of human milk and premature formula. J Pediatr Gastroenterol Nutr. 2003;37:437-446.

29.

Morton J. , Hall JY , Thairu L. , et al. Early hand expression affects breastmilk production in pump-dependent mothers of preterm infants. E-PAS 2007;61:77720.9. http://www.pas-meeting.org.

30.

Neville MC Lactogenesis in women: a cascade of events revealed by milk composition . In: RG Jensen , ed. Handbook of Milk Composition. San Diego, Calif: Academic Press; 1995:87-97.

31.

Schanler RJ , Oh W. Composition of breast milk obtained from mothers of premature infants as compared to breast milk obtained from donors. J Pediatr. 1980;96:679-681.

32.

Anderson GH , Atkinson SA , Bryan MH Energy and macronutrient content of human milk during early lactation from mothers giving birth prematurely and at term . Am J Clin Nutr. 1981;34:258-265.

33.

Lemons JA , Moye L. , Hall D. , Simmons M. Differences in the composition of preterm and term human milk during early lactation. Pediatr Res. 1982;16:113-117.

34.

Maas YGH , Gerritsen J. , Hart AAM , et al. Development of macronutrient composition of very preterm human milk. Br J Nutr. 1998 ;80:34-40.

35.

Anderson DM , Williams FH , Merkatz RB , Schulman PK , Kerr DS , Pittard WB III. Length of gestation and nutritional composition of human milk. Am J Clin Nutr. 1983;37:810-814.

36.

Hill PD , Aldag JC , Chatterton RT Initiation and frequency of pumping and milk production in mothers of non-nursing preterm infants. J Hum Lact. 2001;17:9-13.

37.

Hill PD , Aldag JC , Chatterton RT , Zinaman M. Comparison of milk output between mothers of preterm and term infants: the first 6 weeks after birth. J Hum Lact. 2005 ;21:22-30.

38.

Wight NE Management of common breastfeeding issues. Pediatr Clin North Am. 2001;48:321-344.

39.

Zuppa AA , Tornesello A. , Papacci P. , et al. Relationship between maternal parity, basal prolactin levels and neonatal breast milk intake. Biol Neonate. 1988;53:144-147.

40.

Hartmann PE , Cregan MD , Ramsay DT , Simmer K. , Kent JC Physiology of lactation in preterm mothers: Initiation and maintenance. Pediatr Ann . 2003 ;32:351-355.