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Percent mother’s own milk feedings for preterm neonates predicts discharge feeding outcomes

Journal of Perinatology volume 41, pages 2766–2773 (2021)Cite this article

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Abstract

Introduction

No studies have determined if there is a threshold whereby use of mother’s own milk (MOM) during hospitalization predicts exclusive MOM feeding at discharge.

Methods

Among 113 very low birthweight neonates, the ratio of MOM to enteral feeds was measured in the first 14 days, 28 days, and overall hospital stay. The primary outcome was exclusive MOM feeding at discharge.

Results

For every 1% increase in MOM consumption in the first 14 and 28 days, the odds of being discharge home on an exclusive MOM diet increased nearly 7-fold (OR 7.01, 95% CI: 2.09–23.50) and 17-fold (OR 17.46, 95% CI 4.67–63.31), respectively. A threshold of >50%, >83%, and >85% MOM consumption compared to overall enteral feeds in the first 14 days, 28 days, and throughout hospitalization, respectively, is recommended.

Conclusions

Promotion of MOM consumption in the first 2–4 weeks is of paramount importance, with negligible impact of increasing MOM consumption after 28 days.

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Fig. 1: Receiver operator characteristic curve (ROC) and fit plot.

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References

  1. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129:e827–41. https://doi.org/10.1542/peds.2011-3552.

    Article  Google Scholar 

  2. Gartner LM, Morton J, Lawrence RA, Naylor AJ, O’Hare D, Schanler RJ, et al. Breastfeeding and the use of human milk. Pediatrics. 2005;115:496–506. https://doi.org/10.1542/peds.2004-2491

    Article  PubMed  Google Scholar 

  3. Zutavern A, Brockow I, Schaaf B, Bolte G, von Berg A, Diez U, et al. Timing of solid food introduction in relation to atopic dermatitis and atopic sensitization: results from a prospective birth cohort study. Pediatrics. 2006;117:401–11. https://doi.org/10.1542/peds.2004-2521

    Article  PubMed  Google Scholar 

  4. Barclay AR, Russell RK, Wilson ML, Gilmour WH, Satsangi J, Wilson DC. Systematic review: the role of breastfeeding in the development of pediatric inflammatory bowel disease. J Pediatr. 2009;155:421–6. https://doi.org/10.1016/j.jpeds.2009.03.017.

    Article  PubMed  Google Scholar 

  5. Rosenbauer J, Herzig P, Giani G. Early infant feeding and risk of type 1 diabetes mellitus-a nationwide population-based case-control study in pre-school children. Diabetes Metab Res Rev. 2008;24:211–22. https://doi.org/10.1002/dmrr.791

    Article  CAS  PubMed  Google Scholar 

  6. Das UN. Breastfeeding prevents type 2 diabetes mellitus: but, how and why? Am J Clin Nutr. 2007;85:1436–7. https://doi.org/10.1093/ajcn/85.5.1436

    Article  CAS  PubMed  Google Scholar 

  7. Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep). 2007:1–186.

  8. Ip S, Chung M, Raman G, Trikalinos TA, Lau J. A summary of the Agency for Healthcare Research and Quality’s evidence report on breastfeeding in developed countries. Breastfeed Med. 2009;4(Suppl 1):S17–30. https://doi.org/10.1089/bfm.2009.0050.

    Article  PubMed  Google Scholar 

  9. Committee on Nutrition; Section on Breastfeeding; Committee on Fetus and Newborn. Donor human milk for the high-risk infant: preparation, safety, and usage options in the United States. Pediatrics. 2017;139:e20163440 https://doi.org/10.1542/peds.2016-3440

    Article  Google Scholar 

  10. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129:e827–41. https://doi.org/10.1542/peds.2011-3552.

    Article  Google Scholar 

  11. Demers-Mathieu V, Huston RK, Markell AM, McCulley EA, Martin RL, Spooner M, et al. Differences in maternal immunoglobulins within mother’s own breast milk and donor breast milk and across digestion in preterm infants. Nutrients. 2019;11:920 https://doi.org/10.3390/nu11040920

    Article  CAS  PubMed Central  Google Scholar 

  12. García-Lara NR, Vieco DE, De la Cruz-Bértolo J, Lora-Pablos D, Velasco NU, Pallás-Alonso CR. Effect of Holder pasteurization and frozen storage on macronutrients and energy content of breast milk. J Pediatr Gastroenterol Nutr. 2013;57:377–82. https://doi.org/10.1097/MPG.0b013e31829d4f82

    Article  CAS  PubMed  Google Scholar 

  13. García-Lara NR, Escuder-Vieco D, García-Algar O, De la Cruz J, Lora D, Pallás-Alonso C. Effect of freezing time on macronutrients and energy content of breastmilk. Breastfeed Med. 2012;7:295–301. https://doi.org/10.1089/bfm.2011.0079.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Silvestre D, Miranda M, Muriach M, Almansa I, Jareño E, Romero FJ. Antioxidant capacity of human milk: effect of thermal conditions for the pasteurization. Acta Paediatr. 2008;97:1070–4. https://doi.org/10.1111/j.1651-2227.2008.00870.x.

    Article  CAS  PubMed  Google Scholar 

  15. Meier P, Patel A, Esquerra-Zwiers A. Donor human milk update: evidence, mechanisms, and priorities for research and practice. J Pediatr. 2017;180:15–21. https://doi.org/10.1016/j.jpeds.2016.09.027.

    Article  PubMed  Google Scholar 

  16. Hair AB, Rechtman DJ, Lee ML, Niklas V. Beyond necrotizing enterocolitis: other clinical advantages of an exclusive human milk diet. Breastfeed Med. 2018;13:408–11. https://doi.org/10.1089/bfm.2017.0192.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hair AB, Peluso AM, Hawthorne KM, Perez J, Smith DP, Khan JY, et al. Beyond necrotizing enterocolitis prevention: improving outcomes with an exclusive human milk-based diet. Breastfeed Med. 2016;11:70–4. https://doi.org/10.1089/bfm.2015.0134. Erratum in: Breastfeed Med. 2017;12:663

    Article  PubMed  PubMed Central  Google Scholar 

  18. Herrmann K, Carroll K. An exclusively human milk diet reduces necrotizing enterocolitis. Breastfeed Med. 2014;9:184–90. https://doi.org/10.1089/bfm.2013.0121.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Tyson JE, Parikh NA, Langer J, Green C, Higgins RD, National Institute of Child Health and Human Development Neonatal Research Network. Intensive care for extreme prematurity—moving beyond gestational age. N Engl J Med. 2008;358:1672–81. https://doi.org/10.1056/NEJMoa073059

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Lee HC, Green C, Hintz SR, Tyson JE, Parikh NA, Langer J, et al. Prediction of death for extremely premature infants in a population-based cohort. Pediatrics. 2010;126:e644–50. https://doi.org/10.1542/peds.2010-0097.

    Article  PubMed  Google Scholar 

  21. Boland RA, Davis PG, Dawson JA, Doyle LW; Victorian Infant Collaborative Study Group. Predicting death or major neurodevelopmental disability in extremely preterm infants born in Australia. Arch Dis Child Fetal Neonatal Ed. 2013;98:F201–4. https://doi.org/10.1136/archdischild-2012-301628.

  22. Ford SL, Lohmann P, Preidis GA, Gordon PS, O’Donnell A, Hagan J, et al. Improved feeding tolerance and growth are linked to increased gut microbial community diversity in very-low-birth-weight infants fed mother’s own milk compared with donor breast milk. Am J Clin Nutr. 2019;109:1088–97. https://doi.org/10.1093/ajcn/nqz006.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Whichelow MJ. Factors associated with the duration of breast feeding in a privileged society. Early Hum Dev. 1982;7:273–80. https://doi.org/10.1016/0378-3782(82)90090-1.

    Article  CAS  PubMed  Google Scholar 

  24. Chapman DJ, Pérez-Escamilla R. Identification of risk factors for delayed onset of lactation. J Am Diet Assoc. 1999;99:450–4. https://doi.org/10.1016/S0002-8223(99)00109-1. quiz455–6

    Article  CAS  PubMed  Google Scholar 

  25. Hurst NM. Recognizing and treating delayed or failed lactogenesis II. J Midwifery Womens Health. 2007;52:588–94. https://doi.org/10.1016/j.jmwh.2007.05.005

    Article  PubMed  Google Scholar 

  26. Hurst N, Engebretson J, Mahoney JS. Providing mother’s own milk in the context of the NICU: a paradoxical experience. J Hum Lact. 2013;29:366–73. https://doi.org/10.1177/0890334413485640.

    Article  PubMed  Google Scholar 

  27. Tshamala D, Pelecanos A, Davies MW. Factors associated with infants receiving their mother’s own breast milk on discharge from hospital in a unit where pasteurised donor human milk is available. J Paediatr Child Health. 2018;54:1016–22. https://doi.org/10.1111/jpc.14062.

    Article  PubMed  Google Scholar 

  28. Hill PD, Aldag JC. Milk volume on day 4 and income predictive of lactation adequacy at 6 weeks of mothers of nonnursing preterm infants. J Perinat Neonatal Nurs. 2005;19:273–82. https://doi.org/10.1097/00005237-200507000-00014

    Article  PubMed  Google Scholar 

  29. Parker LA, Sullivan S, Kruger C, Mueller M. Timing of milk expression following delivery in mothers delivering preterm very low birth weight infants: a randomized trial. J Perinatol. 2020;40:1236–45. https://doi.org/10.1038/s41372-020-0688-z.

    Article  PubMed  Google Scholar 

  30. Kent JC, Prime DK, Garbin CP. Principles for maintaining or increasing breast milk production. J Obstet Gynecol Neonatal Nurs. 2012;41:114–21. https://doi.org/10.1111/j.1552-6909.2011.01313.x.

    Article  PubMed  Google Scholar 

  31. Meier PP, Engstrom JL, Patel AL, Jegier BJ, Bruns NE. Improving the use of human milk during and after the NICU stay. Clin Perinatol. 2010;37:217–45. https://doi.org/10.1016/j.clp.2010.01.013

    Article  PubMed  PubMed Central  Google Scholar 

  32. Meier PP, Engstrom JL. Evidence-based practices to promote exclusive feeding of human milk in very low-birthweight infants. NeoReviews. 2007;8:e467–77. https://doi.org/10.1542/neo.8-11-e467

    Article  Google Scholar 

  33. Patel AL, Schoeny ME, Hoban R, Johnson TJ, Bigger H, Engstrom JL, et al. Mediators of racial and ethnic disparity in mother’s own milk feeding in very low birth weight infants. Pediatr Res. 2019;85:662–70. https://doi.org/10.1038/s41390-019-0290-2. Erratum in: Pediatr Res. 2019.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

Evangelina “Evie” Whitlock Grant at Texas Children’s Hospital, Clinical Research Center, Texas Children’s Hospital.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, WA, USA

    Gregory Valentine

  2. Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA

    Gregory Valentine & Kjersti Aagaard

  3. Department of Pediatrics, Division of Neonatology, University of South Florida, Tampa, FL, USA

    Steven Ford

  4. Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Houston, TX, USA

    Joseph Hagan, Heeju Yang, Nancy Hurst & Amy Hair

  5. Baylor College of Medicine School of Medicine, Houston, TX, USA

    Jeffery Chen

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  1. Gregory Valentine
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  8. Amy Hair
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Contributions

GV conceptualized the manuscript, performed the literature search, revised the drafted manuscript, and approved the final manuscript for submission. SF collected the data and reviewed and edited the final manuscript for submission. JH, NH, KA, and AH conceptualized the study and manuscript, revised the drafted manuscript, and approved the final manuscript for submission. JC and HY performed data extraction, revised the manuscript, and approved the final manuscript for submission. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Gregory Valentine.

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The authors declare no competing interests.

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Valentine, G., Ford, S., Hagan, J. et al. Percent mother’s own milk feedings for preterm neonates predicts discharge feeding outcomes. J Perinatol 41, 2766–2773 (2021). https://doi.org/10.1038/s41372-021-01205-4

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