Project Details

Improving methods to measure milk volume intake among breastfeeding, small and vulnerable newborns

Unmesha Roy Paladhi, PhD, MPH

Summary

BACKGROUND: The National Academy of Sciences recently identified the accurate measurement of breast milk intake volumes as a major priority for breast milk research as although 24-hour test-weighing (weighing infant before and after a feed) is the gold standard to measure intake volume, single-timepoint test-weighing is more frequently used due to ease of implementation but prone to inaccuracies due to the diurnal variation in maternal milk production. GAP: There are limited methods to accurately assess breast milk intake volume in directly breastfeeding infants. Furthermore, there are no studies evaluating the volumetric adequacy of breast milk volume intake among preterm and SGA infants (ie. small and vulnerable newborns) in a low-middle income country, where small and vulnerable newborns predominantly breastfeed. HYPOTHESIS: Single-timepoint test-weighing will estimate 24-hour breast milk volume intake to within +/-30 mL of 24-hour test-weighing. The PIBBS scale will identify infants consuming <100ml/kg/day of breast milk with high discrimination (AUC >0.80). SGA infants will consume a similar milk volume to full-term infants over 24 hours, however late-moderate preterm infants will consume a lower 24-hour volume than full-term infants. METHODS: Nested within an RCT examining the effects of maternal multiple micronutrient (MMS) supplementation during lactation on child development in Ethiopia, we will conduct 24-hour test-weighing and the PIBBS assessment on 90 infants (n=30 full-term, appropriate size for gestational age infants; n=30 preterm; n=30 full-term, SGA) at 1 month after delivery. I will compare 24-hour milk intake volume measured by single-timepoint test-weighing vs. 24-hour test-weighing, determine breastfeeding adequacy measured by PIBBS vs. 24-hour test-weighing, and measure the association between being born SVN and 24-hour milk intake volume. RESULTS: Pending. IMPACT: This study will determine if single-timepoint test-weighing is an accurate method to measuring infant breast milk intake, compared to the gold standard of 24-hour test-weighing in small and vulnerable newborns in Ethiopia and quantify the volume and adequacy of breast milk consumption by SVNs. Website Link: https://globalaim.bwh.harvard.edu/staff-member/unmesha-roy-paladhi/