title: Predictors of low milk volume among mothers who delivered preterm.
abstract: BACKGROUND
  Factors associated with successful provision of mother's own milk (MOM) for premature infants in a Japanese neonatal intensive care unit (NICU) context are not well known.
  
  
  OBJECTIVE
  We determined the independent risk factors for low milk volume at day 4 postpartum and formula feeding at the time of NICU discharge.
  
  
  METHODS
  We reviewed the medical records of mothers who delivered at < 32 weeks' gestation. We determined maternal, premature infant, and milk expression variables predictive of (1) day 4 postpartum milk volume being less than the cohort median and (2) formula feeding at the time of NICU discharge, reported as adjusted odds ratios (95% confidence interval).
  
  
  RESULTS
  Among 85 dyads, median (quartile range) milk volume on day 4 postpartum was 153 (34-255) mL. The rate of formula feeding at discharge was 42%. Mothers delivering by cesarean (vs vaginal) delivery had 4.3-fold (1.5-12.4) greater odds of day 4 milk volume < median (P < .01). Pregnancy-induced hypertension, delayed milk expression initiation, and low pumping frequency were strongly associated with cesarean delivery. Subsequently, mothers with day 4 milk volume < median (vs ≥ median) had 7.1-fold (2.6-19.5) greater odds of formula feeding at discharge (P < .01).
  
  
  CONCLUSIONS
  Cesarean delivery is associated with lower milk volume on day 4 but may represent a composite of underlying risk factors for low milk volume in the early postpartum period. Further, low milk volume on day 4 is a strong correlate of lack of exclusive breast milk feeding at NICU discharge.
authors: Showa University School of Medicine, Department of Pediatrics, Tokyo, Japan Cincinnati Children's Hospital Medical Center, Division of Neonatology, Center for Interdisciplinary Research in Human Milk and Lactation, Cincinnati, OH, USA masahiko.murase@cchmc.org.
authors: Masahiko
authors: M
authors: Murase
authors: Cincinnati Children's Hospital Medical Center, Division of Neonatology, Center for Interdisciplinary Research in Human Milk and Lactation, Cincinnati, OH, USA.
authors: Laurie
authors: L
authors: Nommsen-Rivers
authors: Cincinnati Children's Hospital Medical Center, Division of Neonatology, Center for Interdisciplinary Research in Human Milk and Lactation, Cincinnati, OH, USA.
authors: Ardythe L
authors: AL
authors: Morrow
authors: Showa University School of Medicine, Department of Pediatrics, Tokyo, Japan.
authors: Misato
authors: M
authors: Hatsuno
authors: Showa University School of Medicine, Department of Pediatrics, Tokyo, Japan.
authors: Katsumi
authors: K
authors: Mizuno
authors: Showa University School of Medicine, Department of Pediatrics, Tokyo, Japan.
authors: Motohiro
authors: M
authors: Taki
authors: Showa University School of Medicine, Department of Pediatrics, Tokyo, Japan.
authors: Tokuo
authors: T
authors: Miyazawa
authors: Showa University School of Medicine, Department of Pediatrics, Tokyo, Japan.
authors: Yuya
authors: Y
authors: Nakano
authors: Showa University School of Medicine, Department of Pediatrics, Tokyo, Japan.
authors: Madoka
authors: M
authors: Aizawa
authors: Showa University School of Medicine, Department of Pediatrics, Tokyo, Japan.
authors: Kazuo
authors: K
authors: Itabashi
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D007564:Japan; D007774:Lactation; D008297:Male; D008425:Maternal Behavior; D008895:Milk, Human / Q000378:metabolism*; D009034:Mother-Child Relations; D007752:Obstetric Labor, Premature; D011247:Pregnancy; D012189:Retrospective Studies
keywords: breast milk; breastfeeding; cesarean delivery; lactation; preterm delivery