College of Nursing, Rush University, Chicago, Illinois.
Department of Women and Children's Nursing, College of Nursing, Rush University, Chicago, Illinois.
Breastfeed Med. 2020 Apr;15(4):191-212. doi: 10.1089/bfm.2019.0247. Epub 2020 Mar 9.
Maternal concern about inadequate milk volume commonly emerges in the first 2 weeks postpartum, a critical lactation period that includes secretory activation. This review summarizes the biology of secretory activation and evaluates the accuracy and feasibility of published measures of secretory activation. A systematic search of measures of secretory activation for mothers of healthy term and preterm infants yielded 62 abstracts. Following additional screening, 15 publications qualified for quantitative synthesis review and were evaluated with respect to accuracy (validated with another measure of secretory activation in the same mother) and feasibility (accessibility, cost, and ease of use). (MP) is the most feasible measure, but its accuracy has not been established. have been validated with maternal milk-borne biomarkers in breastfeeding, and breast pump-dependent mothers and normal values have been published. Accuracy of concentrations has not been established for secretory activation and lacks feasibility. are the accurate standard to which other measures are compared but currently lack feasibility for routine use. Use of secretory activation measures can personalize lactation care by matching maternal risk with appropriate diagnostics. Priorities for research and practice include validation of MP as a population-based screening tool, implementation of techniques that measure patterns of increase in milk volume for moderate risk populations, and the development of milk biomarker science for point-of-care use in the most complicated lactation scenarios.
产妇对乳汁量不足的担忧通常出现在产后的头 2 周，这是一个关键的泌乳期，包括分泌激活。本综述总结了分泌激活的生物学特性，并评估了已发表的分泌激活测量方法的准确性和可行性。系统检索了健康足月和早产儿母亲的分泌激活测量方法，得到了 62 篇摘要。经过进一步筛选，有 15 篇出版物符合定量综合评价的条件，并就准确性（与同一母亲的另一种分泌激活测量方法进行验证）和可行性（可及性、成本和易用性）进行了评估。测量单次挤奶量（Milk Output Per Pump，MP）是最可行的方法，但尚未确定其准确性。通过母乳喂养中乳汁携带的生物标志物以及依赖吸乳器的母亲和正常值已经对 2 小时排空量（2-Hour Pumped Volume，2HV）和 4 小时排空量（4-Hour Pumped Volume，4HV）进行了验证。单次挤奶量浓度的准确性尚未确定，且缺乏可行性。4 小时排空量（4HV）是其他方法比较的准确标准，但目前缺乏常规使用的可行性。分泌激活测量方法的使用可以通过将母亲的风险与适当的诊断相匹配来个性化哺乳护理。研究和实践的优先事项包括将 MP 验证为基于人群的筛查工具，实施用于中度风险人群测量乳汁量增加模式的技术，以及为最复杂的哺乳情况开发用于即时护理的乳汁生物标志物科学。
