3463 College of Nursing, University of Florida, Gainesville, FL, USA.
213850 Patient Revenue Management Organization, Duke University Health System, Durham, NC, USA.
J Hum Lact. 2021 Aug;37(3):581-592. doi: 10.1177/0890334420980424. Epub 2020 Dec 22.
Inconsistent information exists regarding indicators of secretory activation in mothers delivering very low birth weight infants.
To compare time to the onset of secretory activation using three separate indicators. A secondary aim examined the association between indicators of secretory activation and milk production.
Indicators of secretory activation included maternal perception, volume attainment (production of 20 mL in two consecutive expression sessions) and biomarkers (sodium and lactose) obtained at volume attainment. Milk production was measured on Days 1-7 and then weekly for 6 weeks.
In 69 mothers of infants born ≤ 32 weeks' gestation and 1500 g, we found no correlation in time to secretory activation between indicators. Earlier volume attainment was associated with increased milk production on Days 1-7, 14, 21, and 28 (all < .007). Participants who exhibited both normal lactose and sodium levels produced more milk on Days 28 and 42 ( = .028 and .011), those with only normal lactose levels produced more on Day 42 ( = .026) and those with only normal sodium levels on Day 28 ( = .036). Earlier secretory activation by volume attainment was associated with increased expression frequency during Days 2-5 (all < .014) and participants with normal biomarkers expressed more frequently during Days 2-5 (all < .020).
Mothers of very low birth weight infants are at risk for delayed secretory activation, which may decrease their milk production. Frequent expression during the first 5 days postpartum may promote earlier secretory activation. Valid methods of determining secretory activation are necessary to develop interventions promoting earlier secretory activation.
在分娩极低出生体重儿的母亲中，关于分泌激活的指标存在不一致的信息。
使用三种不同的指标比较分泌激活的起始时间。次要目的是研究分泌激活指标与乳汁分泌之间的关系。
分泌激活的指标包括母亲的感知、容量达到（连续两次表达中产生 20 毫升）和在容量达到时获得的生物标志物（钠和乳糖）。在第 1-7 天和第 6 周的每周测量乳汁产量。
在 69 名分娩胎龄≤32 周且体重≤1500 克的婴儿的母亲中，我们发现三种指标之间在分泌激活的时间上没有相关性。较早的容量达到与第 1-7 天、第 14 天、第 21 天和第 28 天的乳汁产量增加相关（均<.007）。同时表现出正常乳糖和钠水平的参与者在第 28 天和第 42 天的乳汁产量更高（=.028 和.011），仅表现出正常乳糖水平的参与者在第 42 天的乳汁产量更高（=.026），仅表现出正常钠水平的参与者在第 28 天的乳汁产量更高（=.036）。通过容量达到较早的分泌激活与第 2-5 天的表达频率增加相关（均<.014），且生物标志物正常的参与者在第 2-5 天的表达频率更高（均<.020）。
极低出生体重儿的母亲存在分泌激活延迟的风险，这可能会降低她们的乳汁产量。产后第 1-5 天频繁表达可能会促进更早的分泌激活。需要有效的确定分泌激活的方法来制定促进更早分泌激活的干预措施。
