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Validity of Hourly Breast Milk Expression in Estimating Maternal Milk Production and Infant Breast Milk Intake

Roznowski, Dayna M
http://orcid.org/0000-0003-2934-3683
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1554211389510255

Abstract Details

2019, MS, University of Cincinnati, Allied Health Sciences: Nutrition.
Background: An efficient method for measuring milk production is needed to improve research evaluation and clinical management of early postpartum milk supply concerns. Objective: 1) Confirm steady state is reached by hour 2 of the Lai et al. hourly breast expression protocol, and externally validate milk production rate (MPR) can be estimated from the mean of hour 2 and hour 3 milk yield; 2) Determine if an increase in MPR is detectible following 48 hours of increased breast emptying; 3) Assess agreement between maternal milk production estimated by MPR compared to infant test-weighing, and 4) Characterize MPR mean and variance in a sample of mothers exclusively breastfeeding infants achieving appropriate weight gain. Design: Eligible mothers were 4-10 weeks postpartum and exclusively breastfeeding their term infants. In a research clinic, mothers emptied both breasts at baseline (h0), and hourly over 3 subsequent hours (h1, h2, h3) using a hospital-grade pump. We estimated mother’s steady-state MPR as mean (h2, h3). “Study A’ subset completed MPR measurements before and after 48 hours of increased breast emptying. “Study B” subset test-weighed their infant before and after breastfeeding for 48 hours (1-7 days before clinic visit). We used paired t-test for within-participant comparisons and used the Bland-Altman approach to compare 24-hour milk production (g/24h) measured using TW versus MPRx24h. Results: Among 23 mothers 54±14 days postpartum, milk output was 185±55, 60±26, 47±13, 44±13 g/h at h0, h1, h2, and h3, respectively. Mean paired difference (vs. h3) was significant at h0 and h1 (p<0.05), but not h2 (p>0.05, h3-h2=3±10 g/h). In Study A (n=5), mean MPR declined from 50±13 g/h to 43±16g/h (p=0.003) following increased breast emptying. In Study B (n=16), mean TW milk output=717±119 g/24h, and mean MPRx24h=1085±300 g/24h. Mean difference [95% limits of agreement] was 368 [±468] g/24h; and mean ratio was 1.5[±0.4]; difference and ratio significantly increased as MPR increased (p<0.05). For infants with adequate weight gain velocity of >20g/d (n=12) mean MPR was 48±12g/h, and ranged from 35 to 78 g/h. Conclusions: Hourly milk production reaches steady state at h2; thus MPR is a valid measure of current maternal milk production capacity but is not feasible for evaluating infant intake in early lactation. After 48 hours of increased breast emptying MPR declined, indicating a deeper level of hourly breast emptying may have been reached. An MPR =35g/h is consistent with successful exclusive breastfeeding in early lactation.
Laurie Nommsen-Rivers, Ph.D. (Committee Chair)
Sarah Riddle, MD FAAP IBCLC (Committee Member)
35 p.
Nutrition
human lactation; milk production; breastfeeding; breast expression; maternal milk supply; infant weight gain

Recommended Citations

Citations

  • Roznowski, D. M. (2019). Validity of Hourly Breast Milk Expression in Estimating Maternal Milk Production and Infant Breast Milk Intake [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1554211389510255

    APA Style (7th edition)

  • Roznowski, Dayna. Validity of Hourly Breast Milk Expression in Estimating Maternal Milk Production and Infant Breast Milk Intake. 2019. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1554211389510255.

    MLA Style (8th edition)

  • Roznowski, Dayna. "Validity of Hourly Breast Milk Expression in Estimating Maternal Milk Production and Infant Breast Milk Intake." Master's thesis, University of Cincinnati, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1554211389510255

    Chicago Manual of Style (17th edition)

ucin1554211389510255
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This open access ETD is published by University of Cincinnati and OhioLINK.