Levene Ilana, O'Brien Frances, Fewtrell Mary, Quigley Maria A
National Perinatal Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford, UK.
Newborn Care, John Radcliffe Hospital, Oxford, UK.
Matern Child Nutr. 2025 Jan;21(1):e13719. doi: 10.1111/mcn.13719. Epub 2024 Sep 6.
When infants cannot directly breastfeed after birth, mothers are advised to initiate lactation through mechanical expression. Families are recommended to target an expression volume of at least 500-750 mL by Day 14 after birth, as this is considered a 'critical window' to establish milk supply. This is challenging for many mothers after a very preterm birth. This article explores the relationship of early milk quantity and later full breastmilk feeding as a 'gold standard' outcome, using statistical techniques designed for diagnostic tests. A cohort of 132 mothers of infants born at 23 + 0 to 31 + 6 weeks' gestational age submitted expressing logs on Day 4, 14 and 21 after birth and provided later feeding outcome. Using receiver operating characteristic (ROC) analysis, the following 24-h milk quantities were identified as associated with high probability of full breastmilk at 36 weeks' post-menstrual age (PMA): on Day 4, ≥250 g (specificity 88%; positive predictive value 88%) and on Day 21 ≥650 g (specificity 88%; positive predictive value 91%). The following values were identified as associated with low probability of full breastmilk at 36 weeks' PMA: on Day 4 <50 g (sensitivity 92%; negative predictive value 72%) and on Day 21 <250 g (sensitivity 90%; negative predictive value 70%). Participants exceeding the high thresholds had 3-4 times increased likelihood of full breastmilk, whereas those below the low thresholds had 3-5 times lower likelihood. These thresholds have potential as targets for families, to provide individualised prognostic information and to help clinicians target more intensive lactation support.
当婴儿出生后无法直接进行母乳喂养时，建议母亲通过机械挤奶来启动泌乳。建议家庭在出生后第14天达到至少500 - 750毫升的挤奶量，因为这被认为是建立乳汁供应的“关键窗口期”。对于许多极早产的母亲来说，这具有挑战性。本文使用专为诊断测试设计的统计技术，探讨了早期乳汁量与后期纯母乳喂养这一“金标准”结果之间的关系。一组132名孕龄在23 + 0至31 + 6周出生婴儿的母亲，在出生后第4天、第14天和第21天提交了挤奶记录，并提供了后期喂养结果。通过受试者操作特征（ROC）分析，确定以下24小时乳汁量与月经龄36周时纯母乳喂养的高概率相关：在第4天，≥250克（特异性88%；阳性预测值88%），在第21天≥650克（特异性88%；阳性预测值91%）。确定以下数值与月经龄36周时纯母乳喂养的低概率相关：在第4天<50克（敏感性92%；阴性预测值72%），在第21天<250克（敏感性90%；阴性预测值70%）。超过高阈值的参与者纯母乳喂养的可能性增加3 - 4倍，而低于低阈值的参与者可能性降低3 - 5倍。这些阈值有可能作为家庭的目标，提供个性化的预后信息，并帮助临床医生针对更强化的泌乳支持。
