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Breastfeed Med. 2018 Jun;13(5):352-360. doi: 10.1089/bfm.2017.0183. Epub 2018 Apr 30.

Human Milk Biomarkers of Secretory Activation in Breast Pump-Dependent Mothers of Premature Infants.

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1 Department of Pediatrics, Section of Neonatology, Rush University Medical Center , Chicago, Illinois.
2 Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children , Toronto, Canada .
3 College of Nursing, Rush University Medical Center , Chicago, Illinois.
4 School of Molecular Sciences, University of Western Australia , Perth, Australia .
5 Department of Women and Children's Nursing, Rush University Medical Center , Chicago, Illinois.



Mothers of premature infants confront barriers to coming to volume (CTV; ≥500 mL/day mother's own milk [MOM] by postpartum day 14), a strong predictor of continued MOM provision at neonatal intensive care unit (NICU) discharge. We sought to determine concentrations of secretory activation biomarkers (MOM sodium, total protein, lactose, and citrate) during the first 14 postpartum days and to describe relationships among these biomarkers, pumped MOM volume, CTV, and pumping frequency.


This descriptive observational study collected serial MOM samples, pumped MOM volume, and pumping frequency during the first 14 postpartum days in 16 breast pump-dependent mothers who delivered <33 weeks gestation. Daily biomarker concentrations were compared to published normal values for mothers of term infants. Relationships among biomarkers, pumped MOM volume, and pumping frequency were determined.


On postpartum day 5, only 40% of MOM samples revealed normal concentrations of all four biomarkers, and normalcy was not maintained throughout the first 14 days. All eight mothers (50%) who achieved CTV had normal concentrations for four biomarkers at 5.4 ± 3.5 days postpartum and had more cumulative pumping sessions by day 5 (p = 0.03). A dose-response relationship between number of normal biomarkers and pumped MOM volume was demonstrated for postpartum days 3 (p = 0.01) and 5 (p = 0.04).


Secretory activation is delayed in mothers who deliver prematurely and is closely tied to CTV, MOM volume, and pumping frequency. MOM biomarkers hold promise as objective research outcome measures and for point-of-care testing to identify and proactively manage mothers at risk for compromised lactation.


breastfeeding; coming to volume; human milk; maternal; neonatal; secretory activation


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