Journal Article

The relationship of early expressed milk quantity and later full breastmilk feeding after very preterm birth: A cohort study

Fewtrell, Mary, Quigley, Maria A., Levene, Ilana, O'Brien, Frances

2025

Overview

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. In this observational study, we identified a series of thresholds for early expressed milk quantity that risk stratified long‐term full breastmilk feeding after very preterm birth. These thresholds have potential as targets for families, to provide individualised prognostic information and to help clinicians direct more intensive lactation support. Key messages Mothers of very preterm infants who expressed at least 250 g at day four after birth had a high probability of providing later full breastmilk: 88% (95% CI: 72%–97%). This was similar for those who expressed at least 650 g at Day 21: 91% (95% CI: 77%–98%). Mothers of very preterm infants who expressed less than 50 g at day four after birth had a low probability of providing later full breastmilk: 28% (95% CI: 10%–53%). This was similar for those who expressed less than 250 g at Day 21: 30% (95% CI: 12%–54%). These thresholds may be useful for families to understand their lactation trajectories and for clinicians to target support.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc,Wiley
• Subject: Adult / Age Factors / breast feeding / Breast Milk Expression - methods / Breast Milk Expression - statistics & numerical data / Breastfeeding & lactation / Cohort analysis / Diagnostic tests / Families & family life / Female / Gestational Age / human / Humans / infant / Infant, Extremely Premature / Infants / intensive care units / lactation / Lactation - physiology / Male / Menstruation / Milk / Milk, Human - physiology / Mothers / Mothers - statistics & numerical data / neonatal / newborn / Original / Predictions / Predictive Value of Tests / Pregnancy / Premature birth / Probability / ROC Curve / Thresholds / Time Factors / Young Adult