Research

Pamela D. Hill, PhD, RN, CBE, FAAN, Funded Projects

Initiation of Lactation in Pump-Dependent Mothers of a Preterm or Ill Term Infant

Funding Source: UIC College of Nursing

Dates: 9/1/06 – 6/30/08

Abstract: The long-term goal of our research program is to develop interventions to be used with mothers who provide own mother's milk (OMM) for their infants who are hospitalized based on either prematurity or illness. This population of mothers is pump-dependent for the initiation and maintenance of lactation. Based on 21st century birth rates in the United States and our recent findings of lactation failure, annually 240,406 preterm infants and 455,000 term infants are deprived of OMM because of milk deficiency. These infants are deprived of the important nutritional, immunological, and developmental benefits of being nourished by OMM. These benefits are particularly important to preterm infants, whose survival can be enhanced by nourishment from their mother's mechanically expressed milk. Lacking is characterization of selected breast milk components or biomarkers that may influence the initiation of lactation (lactogenesis) during the first week postpartum and subsequently lactation.

In this 1-week pilot study proposal with telephone follow-up at day 28-30 after birth, we will characterize normative values for BMB of lactogenesis and procedural issues (pumping duration, subject burden) in 40 mothers of preterm and term infants who provide milk for their infants by pumping their breasts because the infants are too ill to feed at breast. Mothers will provide milk samples daily from postpartum day 3 to 7 for measurement of BMB, daily milk volume, and report on behavioral factors (parity, obesity, length of labor, delivery mode, exhaustion rating, hours to initiation of breast stimulation, frequency of breast stimulation) obtained from the medical record or the daily log kept by the mother). The specific aims are to:

1. Estimate the parameters (mean, standard deviation) of selected BMB of lactogenesis (sodium, lactose, beta casein, citrate, maternal perceived onset of lactation) and milk volume (measured as a liquid in milliliters as a function of a standardized simultaneous double pumping routine) on postpartum days 3, 4, 5, 6, 7 in mothers who are pump-dependent and deliver either a preterm or term infant who is too ill to feed at breast.

2. Determine the procedural issues (average length of days that mothers of a term ill infant must use mechanical expression prior to the infant feeding at breast) and subject burden (amount of missing data as an indicator of subject burden) for mothers of a preterm or term infant.

We expect the mean, standard deviation, and intra-class correlation values will help us determine power calculations for a larger study as the current published research lacks the needed information concerning BMB in pump-dependent mothers. We also expect to learn the number by which we will need to over-sample mothers of term infants who are too ill to suckle at breast and the instrumentation burden of study procedures. All of this information will help us plan the R01 application focused on predicting lactogenesis from BMB and behavioral factors.