• Masahiko Murase, Laurie Nommsen-Rivers, Ardythe L Morrow, Misato Hatsuno, Katsumi Mizuno, Motohiro Taki, Tokuo Miyazawa, Yuya Nakano, Madoka Aizawa, and Kazuo Itabashi.
• Showa University School of Medicine, Department of Pediatrics, Tokyo, Japan Cincinnati Children's Hospital Medical Center, Division of Neonatology, Center for Interdisciplinary Research in Human Milk and Lactation, Cincinnati, OH, USA masahiko.murase@cchmc.org.
• J Hum Lact. 2014 Nov 1; 30 (4): 425-35.

BackgroundFactors associated with successful provision of mother's own milk (MOM) for premature infants in a Japanese neonatal intensive care unit (NICU) context are not well known.ObjectiveWe determined the independent risk factors for low milk volume at day 4 postpartum and formula feeding at the time of NICU discharge.MethodsWe reviewed the medical records of mothers who delivered at < 32 weeks' gestation. We determined maternal, premature infant, and milk expression variables predictive of (1) day 4 postpartum milk volume being less than the cohort median and (2) formula feeding at the time of NICU discharge, reported as adjusted odds ratios (95% confidence interval).ResultsAmong 85 dyads, median (quartile range) milk volume on day 4 postpartum was 153 (34-255) mL. The rate of formula feeding at discharge was 42%. Mothers delivering by cesarean (vs vaginal) delivery had 4.3-fold (1.5-12.4) greater odds of day 4 milk volume < median (P < .01). Pregnancy-induced hypertension, delayed milk expression initiation, and low pumping frequency were strongly associated with cesarean delivery. Subsequently, mothers with day 4 milk volume < median (vs ≥ median) had 7.1-fold (2.6-19.5) greater odds of formula feeding at discharge (P < .01).ConclusionCesarean delivery is associated with lower milk volume on day 4 but may represent a composite of underlying risk factors for low milk volume in the early postpartum period. Further, low milk volume on day 4 is a strong correlate of lack of exclusive breast milk feeding at NICU discharge.© The Author(s) 2014.

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