Breastmilk cultures and infection in extremely premature infants.

OBJECTIVE: As expressed mother's milk (MM) is known to be colonized by microbial species, it is occasionally considered as a source of infection in premature infants, prompting some clinicians to obtain milk bacterial culture results before infant feeding. To determine whether serial microbial cultures of MM predict infection in premature infants. STUDY DESIGN: Milk microbial flora was determined by plate counts from aliquots of MM obtained from 161 mothers of infants born <30 weeks gestation (n = 209). Pathogens isolated from the same infant were tabulated. RESULT: Milk samples (n = 813) yielded 1963 isolates. There were no relationships between microbial counts and maternal age, ethnicity, education, skin-to-skin contact and infant infection. In 64 infants, milk and pathological isolates had presumptively the same Gram-positive organism, yet the odds of infection before or after exposure to milk containing that Gram-positive organism were not significant (1.18; 95% confidence interval=0.51, 2.76). In eight infants, milk and pathological isolates had presumptively the same Gram-negative organism, which appeared sporadically in milk, either before or after isolation in the infant. CONCLUSION: Results of initial milk cultures do not predict subsequent culture results. Random milk cultures, even if obtained at any time during hospitalization, are not predictive of infection in premature infants. The sporadic nature of the appearance of certain isolates, however, suggests common exposure of both mother and infant. Routine milk cultures do not provide sufficient data to be useful in clinical management.

Ethnic/racial diversity, maternal stress, lactation and very low birthweight infants.

OBJECTIVE: (1) To compare maternal characteristics and psychological stress profile among African-American, Caucasian and Hispanic mothers who delivered very low birthweight infants. (2) To investigate associations between psychosocial factors, frequency of milk expression, skin-to-skin holding (STS), and lactation performance, defined as maternal drive to express milk and milk volume. STUDY DESIGN: Self-reported psychological questionnaires were given every 2 weeks after delivery over 10 weeks. Milk expression frequency, STS, and socioeconomic variables were collected. RESULT: Infant birthweight, education, and milk expression frequency differed between groups. Trait anxiety, depression and parental stress in a neonatal intensive care unit (PSS:NICU) were similar. African-American and Caucasian mothers reported the lowest scores in state anxiety and social desirability, respectively. Maternal drive to express milk, measured by maintenance of milk expression, correlated negatively with parental role alteration (subset of PSS:NICU) and positively with infant birthweight and STS. Milk volume correlated negatively with depression and positively with milk expression frequency and STS. CONCLUSION: Differences between groups were observed for certain psychosocial factors. The response bias to self-reported questionnaires between groups may not provide an accurate profile of maternal psychosocial profile. With different factors correlating with maintenance of milk expression and milk volume, lactation performance can be best enhanced with a multi-faceted intervention program, incorporating parental involvement in infant care, close awareness and management of maternal mental health, and encouragement for frequent milk expression and STS.

Nipple shields for preterm infants: effect on milk transfer and duration of breastfeeding.

This study reports breastfeeding outcomes for 34 preterm infants whose mothers used ultrathin silicone nipple shields to increase milk transfer. Mean milk transfer was compared for 2 consecutive breastfeedings without and with the nipple shield. Total duration of breastfeeding was calculated for a maximum of 365 days. Mean milk transfer was significantly greater for feedings with the nipple shield (18.4 ml vs. 3.9 ml), with all 34 infants consuming more milk with the nipple shield in place. Mean duration of nipple shield use was 32.5 days, and mean duration of breastfeeding was 169.4 days; no association between these variables was noted. The nipple shield was used for 24.3% of the total breastfeeding experience, with no significant association between the percentage of time the shield was used and total duration of breastfeeding. These findings are the first to indicate that nipple shield use increases milk intake without decreasing total duration of breastfeeding for preterm infants.

The use of human milk and breastfeeding in premature infants.

Human milk is beneficial in the management of premature infants. The beneficial effects generally relate to improvements in host defenses, digestion, and absorption of nutrients, gastrointestinal function, neurodevelopment, and maternal psychological well-being. The use of fortified human milk generally provides the premature infant adequate growth, nutrient retention, and biochemical indices of nutritional status when fed at approximately 180 mL/kg/day compared with unfortified human milk. Human milk can only support the needs of the premature infant if adequate milk volumes are produced. Intensive efforts at lactation support are desirable. Therefore, neonatal centers should encourage the feeding of fortified human milk for premature infants along with skin-to-skin contact as a reasonable method to enhance milk production and promote success with early breastfeeding, while potentially facilitating the development of an enteromammary response.

Growth and development of a hospital-based lactation program and mother's own milk bank.

This article describes the development and characteristics of a hospital-based lactation program and mother's own milk bank in a large pediatric hospital in the southwestern United States. Professional and technical staffing, physical space of the milk bank area, and the program's services and special features are outlined. Quality control issues about human milk preparation, fortification, storage, and transport are discussed.

Skin-to-skin holding in the neonatal intensive care unit influences maternal milk volume.

OBJECTIVES: To evaluate the effect of early initiation of skin-to-skin (STS) holding on lactation, we compared 24-hour milk volumes of mothers of ventilated low birth weight infants in an STS group to mothers in a non-STS control group. STUDY DESIGN: Mean 24-hour milk volumes at 2, 3, and 4 weeks after delivery of mothers participating in STS holding were compared with those of a retrospective control group from the 12-month period immediately preceding the introduction of STS holding in the neonatal intensive care unit. A repeated-measures analysis of variance adjusting for baseline volumes (1 week after delivery) was used to evaluate the difference in milk volumes between STS and control groups. RESULTS: Sixteen mothers initiated STS holding during the 2-month study period. Eight mothers met study criteria by initiating STS holding during the first 4 weeks after delivery. During a 2-week period the study group had a strong linear increase in milk volume in contrast to no indicative change of the control group's milk volume. CONCLUSION: STS holding of low birth weight infants initiated in the early intensive care phase can result in a significant increase in maternal milk volume, thereby overcoming the frequently seen insufficient lactation experienced by these mothers.

Lactation after augmentation mammoplasty.

OBJECTIVE: To compare the lactation outcomes of breast-augmented women and nonaugmented women. METHODS: This study used a retrospective, comparative design. Demographic and descriptive data were obtained from client records maintained by a lactation support program at a large children's hospital in the southwest United States. The association between breast augmentation and lactation outcome in the two groups was investigated by obtaining data from these existing records. RESULTS: A significantly greater incidence of lactation insufficiency was found in augmented women compared with nonaugmented women (P < .001). Among 42 augmented women, 27 (64%) had insufficient lactation, compared with only three (less than 7%) of the 42 nonaugmented women. Augmented women who experienced sufficient lactation were equivalent in age, ethnicity, type of delivery, smoking, previous breast-feeding experience, and lactation course compared to augmented women with lactation insufficiency. However, the type of breast incision was significantly associated with lactation outcome. More specifically, it was the periareolar approach that was most significantly associated with lactation insufficiency (P < .01). The incidence of lactation insufficiency with the submammary-axillary approach was only statistically significant when compared with nonaugmented women. CONCLUSION: A significantly greater incidence of insufficient lactation was found among augmented women compared with nonaugmented women. The periareolar approach was most significantly associated with lactation insufficiency.