Nuffield Department of Public Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom.
Institute of Child Health, University College London, London, United Kingdom.
PLoS One. 2024 Jul 29;19(7):e0307522. doi: 10.1371/journal.pone.0307522. eCollection 2024.
Mothers of very premature infants often have difficulties expressing breastmilk, which can cause distress and potential negative impact on infant health. Clinical recommendations on breastmilk expression are extrapolated from term infants' breastfeeding patterns. This study's objective was to analyse the association of expressing pattern with lactation outcomes after very premature birth.
132 participants were recruited after birth between 23+0 and 31+6 weeks' gestation. Participants recorded the milk expressed in several 24-hour periods in the three weeks after birth.
Expressing frequency was positively associated with 24-hour milk yield, with an adjusted 30.5g increase per expressing session on day four (95% CI 15.7 to 45.3) and 94.4g on day 21 (95% CI 62.7 to 126.2). Expressing ≥8 times per day was associated with higher adjusted milk yield than expressing <6 times (on day four, 146.8g, 95% CI 47.4 to 246.1), but not in comparison to expressing 6-7 times (on day four, 82.1g, 95% CI -25.9 to 190.1). Participants with six months or more prior breastmilk feeding experience had a higher adjusted milk yield than others (on day four, 204.3g, 95% CI 125.2 to 283.3). Night-time (2300-0700 hours) expressing sessions were not associated with increased milk yield after adjustment for time since the prior session. On average, participants who had a longest gap between expressions of less than six hours achieved the UK target of 750g breastmilk, whereas those with a longer gap did not.
Expressing frequency was an important determinant of milk yield. Clinical recommendations to express ≥8 times per day were supported but for some, 6-7 times was sufficient. This was particularly likely for those with six months or more of prior breastmilk feeding experience. A need to express during the night-time hours appeared to be related to minimising the gap between expressions rather than an inherent value of night-time expression.
早产儿的母亲在母乳喂养方面往往存在困难，这可能会导致婴儿的不适和潜在的健康问题。关于母乳喂养的临床推荐是从足月婴儿的母乳喂养模式中推断出来的。本研究的目的是分析母乳喂养模式与极早产儿出生后泌乳量的关系。
在妊娠 23+0 至 31+6 周之间分娩后，招募了 132 名参与者。参与者在出生后三周内记录了几次 24 小时的乳汁分泌量。
母乳喂养的频率与 24 小时奶量呈正相关，在第四天每增加一次挤奶量，可增加 30.5g（95%CI 15.7 至 45.3），在第 21 天增加 94.4g（95%CI 62.7 至 126.2）。每天挤奶 8 次以上与更高的调整后产奶量相关，而每天挤奶 6-7 次并不相关（第四天 82.1g，95%CI -25.9 至 190.1）。与没有 6 个月以上母乳喂养经验的参与者相比，有 6 个月或以上母乳喂养经验的参与者的调整后产奶量更高（第四天 204.3g，95%CI 125.2 至 283.3）。在调整了上次挤奶时间后，夜间（2300-0700 小时）挤奶时间与产奶量的增加无关。平均而言，那些两次挤奶间隔不到 6 小时的参与者达到了英国 750g 母乳的目标，而那些两次挤奶间隔较长的参与者则没有达到。
母乳喂养的频率是乳汁产量的一个重要决定因素。临床推荐每天挤奶 8 次以上得到了支持，但对于一些人来说，每天挤奶 6-7 次就足够了。这对于那些有 6 个月或更长时间母乳喂养经验的人来说尤其可能。夜间挤奶的需求似乎与减少挤奶间隔有关，而不是夜间挤奶的内在价值。
