Early Initiation of Milk Expression in Mothers of Very Low Birth Weight Infants
Study Details
Study Description
Brief Summary
Compelling evidence exists that breast milk helps protect very premature infants from prematurity-specific morbidities. Unfortunately, mothers of premature infants often exhibit delayed lactogenesis stage II (when the milk "comes in") and decreased breast milk production. Several studies have linked earlier initiation of breast milk expression following delivery with a greater milk production. However, none conclusively determined the optimal timing of breast milk expression. As a result these mothers continue to struggle with inadequate breast milk production. This study will follow 180 mothers of premature infants for 6 weeks following delivery to test
Earlier initiation of breast milk expression following delivery is associated with (1) an earlier lactogenesis stage II, (2) greater volume of breast milk production during the first 6 weeks, (3) improved short-term infant health outcomes and (4) women who deliver at an earlier gestation will have decreased milk production and a later lactogenesis stage II. Following stratification according to the gestational age of the infant (23-27 weeks vs. 28-32 weeks), eligible women will be randomly assigned to one of three groups and instructed to start mechanically expressing their r breasts, either in the first hour, 1-3 hours or 3-6 hours following delivery. The timing of lactogenesis stage II will be documented, and the volume of breast milk produced will continue to be measured for the first 6 weeks following delivery and at discharge. Infant nutritional outcomes will be measured throughout the 6-week study. The impact of the differences in timing of initiation of milk expression following delivery on timing of lactogenesis stage II, milk volume, short term nutritional outcomes, amount of breast milk feedings at discharge, and impact of gestational age on milk volume and lactogenesis stage II will be determined.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Mothers will be randomly assigned to one of three groups. Group 1 will begin pumping their breasts with the assistance of medical or nursing personnel within 60 minutes following delivery. Group 2 will begin pumping their breasts with the assistance of medical or nursing personnel within 1- less than 3 hours following delivery. Group 3 will begin pumping their breasts with the assistance of medical or nursing personnel 3-6 hours following delivery. Mothers will also do the following
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Complete a log with information about their daily breast pumping sessions for 6 weeks.
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Bring your breast milk to the neonatal intensive care unit when they visit and the milk will be weighed to determine the volume of milk.
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Episodes of kangaroo care (placing the infant on your bare chest) will be collected.
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Receive a call beginning the day after you delivery and then daily until their milk comes in to ask about a feeling of fullness in their breasts.
In addition the following will be done
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If their infant breastfeeds, he/she will be weighed before and after feeding to collect data on how much milk he/she ate from the breast
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Information regarding infant's weekly breast milk intake and breast milk intake at discharge will be collected
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Early initiation Initiation of breast milk expression <1 hour following delivery. |
Behavioral: Early initiation
Initiation of breast milk expression <1 hour following delivery.
Other Names:
|
| Experimental: Intermediate expression Initiation of milk expression 1-<3 hours following delivery. |
Behavioral: Intermediate expression
Initiation of milk expression 1-<3 hours following delivery.
Other Names:
|
| Other: Late initiation Initiation of milk expression >3-6 hours following delivery. |
Behavioral: Late initiation
Initiation of milk expression >3-6 hours following delivery.
Other Names:
|
Outcome Measures
Primary Outcome Measures
- The volume of breast milk [Change in baseline to 6 weeks]
Volume of breast milk will be measured at days 1-7, 14,21,28,35 and 42
Secondary Outcome Measures
- Timing of lactogenesis stage 2 [Change from baseline to week 2]
Mothers will be asked daily concerning a feeling of fullness in their breasts
- Weekly percentage of infant breast milk intake [Change in baseline to 6 weeks]
The percentage of breast milk consumed by the infant weekly will be calculated
- Percentage of breast milk feedings of infant at discharge [Day 42]
The percentage of breast milk the infant receives on day of discharge will be calculated
Eligibility Criteria
Criteria
Inclusion Criteria:
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- at least 18 years of age,
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- English or Spanish-speaking,
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- stated intent to breastfeed,
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- anticipating the birth of a very low birth weight infant (≤1500 grams) between 23-32 weeks gestation.
Exclusion Criteria:
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- known illicit maternal drug use,
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- history of breast reduction or augmentation,
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- positive HIV status,
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- mother not transported to recovery by 45 minutes following delivery or
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- infant not expected to live over 2 weeks following delivery.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | University of Florida Shands | Gainesville | Florida | United States | 32605 |
Sponsors and Collaborators
- University of Florida
- National Institute of Nursing Research (NINR)
Investigators
- Principal Investigator: Leslie A Parker, PhD, University of Florida
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 2012-00071-N
- 1R15NR013566-01A1
- IRB201200071