EFFECT OF TIME OF STARTING ASSEMBLY POST-BIRTH ON THE

VOLUME OF BREASTFEEDING IN MOMS WITH LBW BABIES

Ratna Kusumawati, Melina Defita Sari, Reny Noorharyanti, Novia Pratiwi
Email: akbarrojakrouf@gmail.com
Abstract
Background :Breastfeeding for premature babies reduces morbidity. Unfortunately, mothers

with LBW often have difficulty providing breast milk. Early initiation of expressing

breastmilk after delivery is thought to increase the volume of milk. Although there are

recommendations for expressing breastmilk from an early age, there is still little research that

supports this recommendation. This study compared the volume of breastmilk produced by

mothers with LBW babies who expressed milk before 6 hours after delivery with mothers

who started expressing breastmilk after 6 hours after delivery.

Subjects and methods: Fourteen mothers who gave birth to LBW babies were classified

according to when they started expressing breastmilk after delivery. Group I expressed

the milk before 6 hours, while Group II expressed the milk after 6 hours. Measuring the

total volume of breast milk was taken on day 1, day three and day five.
Results: group I produced more breast milk than the second group on days 3 and 5,

although it was not statistically significant.

Conclusion: Early initiation of expressing breastmilk in less than 6 hours allows the

mother to get more expressed breast milk and helps improve lactation success in

mothers with LBW infants.

PRELIMINARY
Breast milk in premature babies is needed because the baby's digestive
conditions and immunity are still not mature enough. This is because breast milk
contains vast protection, which is needed by infants, especially LBW. The
advantages of breastfeeding are the reduced incidence of feeding intolerance, late
onset sepsis and NEC. And breastfeeding also reduces the length of stay in the
hospital and affects the neurological development of the baby (Leslie, 2015).
Unfortunately mothers with LBW often have difficulty providing breast milk
compared to term babies. One of the factors causing this insufficient breast milk is the

delay in the occurrence of stage II lactogenesis. Delayed stage II lactogenesis is common

in term infants who delayed initiation of breastfeeding after delivery and is associated

with reduced breastfeeding success (Ryan A, 2002).

The delivery of premature babies is associated with delayed achievement of stage II

lactogenesis and this results in inadequate amounts of breast milk. This is due to the

separation of the baby from the mother and the inability of the baby to breastfeed directly

with the mother so that stage II lactogenesis will be delayed. And the mother cannot

produce the milk that the baby really needs (Henderson, 2008).
A possible solution to this problem is to express breast milk from the very

beginning of birth (Furman, 2002). Amanda K Debes (2013), conducted a systematic

review of 18 studies examining the relationship between early breastfeeding initiation and

neonatal morbidity and mortality, concluding that early breastfeeding is a simple measure

that significantly improves infant care outcomes and should be universally recommended.

Likewise, the mother of the LBW baby, the earlier the milking is related to an increase in

breast milk volume (Leslie, 2015)

This study aims to compare the volume of milk in LBW mothers who express
breast milk for less than 6 hours and more than 6 hours.

SUBJECTS AND METHODS

This study was an observational study with a prospective cohort approach,
namely expressing breast milk to mothers with LBW babies within 6 hours of
delivery and more than 6 hours. This milking will be followed for a certain period
of time, namely on the first 24 hours, the second day, the third day, and the fifth
day, then the effect will be seen on the volume of breast milk.
The sample in this study were all postpartum mothers with the criteria of
baby weight 1000-1500 grams. . The inclusion criteria in sampling were
postpartum mothers with babies weighing 1000-1500 grams, mothers willing to
be respondents, mothers intending to breastfeed, mothers babies having
husbands and they expected the baby's presence. While the exclusion criteria for
 this study included: Postpartum mothers with babies with major congenital
abnormalities, mothers with HIV disease, mothers who were admitted to the
ICU (Intensive Care Unit).
The following table shows the characteristics of the sample homogeneity.
<6 hours > 6 hours p
BBL (Birth Weight) 1186.1 ± 53.5 1362.6 ± 293.1 0.085 #
Gender of the baby Male 3 42.9% 3 42.9% 1,000 $
Women 4 57.1% 4 57.1%
Age 32.9 ± 3.9 29.6 ± 5.7 0.235
Pend. Last one Junior High 3 42.9% 1 14.3% 0.543
High school 0 0.0% 1 14.3%
D3 1 14.3% 1 14.3%
S1 3 42.9% 4 57.1%
Profession IRT 4 57.1% 2 28.6% 0.013
Civil
3 42.9% 0 0.0%
servants
Employees 0 0.0% 5 71.4%
Gestational Age 28.3 ± 1.1 30.9 ± 2.5 0.038 #
Number of children 2.0 ± 0.8 2.0 ± 0.8 1,000
Concomitant Diseases There is 0 0.0% 1 14.3% 1,000 $
Not 7 100.0% 6 85.7%
Pain Score 0 0.3 ± 0.8
Does the mother have the Yes 7 100.0% 7 100.0% -
Not 0 0.0% 0 0.0%
desire to breastfeed
Way of Birth Spontaneous 7 100.0% 0 0.0% 0.001 $
SC 0 0.0% 7 100.0%
#) Mann Whitney, Independent T test, $) Fisher exact test, Chi-Square
RESULTS AND DISCUSSION
After analyzing, the results showed that mothers who were breastfed earlier
showed more products in the first 5 days. The total average volume of breastmilk on
the fifth day for mothers who were expressed for less than 6 hours was 0.65, which is
many times more than for mothers who were expressed for more than 6 hours 390.04
cc and 592.00 cc, (P = 0.05. ). The mean volume of breastmilk in the two groups is
shown in Table 2.3.
Table 3.4 Total volume of breast milk for 5 days
H1 volume H2 volume Volume H3 Volume H4 Volume H5 p1
Starting <6 0,000 *
21.86 ± 85.94 ± 210.50 ± 269.86 ±
to blush hour 3.84 ± 7.20
39.62 * 119.26 * 161.14 * 219.87 *
s
> 6 0,000 *
20.39 ± 43.26 ± 149.43 ± 175.71 ±
hour 1.24 ± 2.33
32.62 48.66 * 121.33 * 95.37 *
s
p2 0.647 # 0.898 # 0.338 # 0.439 0.319
p1) Friedman continued Wilcoxon, p2) Independent T test, #) Mann Whitney

Table 3.5
Breastmilk volume over time

The mean volume of breastmilk increased significantly from day to day, both
in samples that started to express <6 hours or> 6 hours (p <0.05). Breastmilk volume
increased significantly from day 2 for samples who were blushing <6 hours, while
samples who were flushed> 6 hours experienced an increase in milk volume on day 3.
The mean volume of breastmilk at each observation who blushed <6 hours
was higher than those that started to express> 6 hours but did not show a significant
difference (p> 0.05)
As we know, this study is intended to determine the effect of
expressing breastmilk less than 6 hours after giving birth compared to mothers
who express breastmilk for more than 6 hours. The mean volume of milk in the
group that started expressing less than 6 hours was higher than the group that
started expressing more than 6 hours. But statistically it does not show any
significant differences. This is possible because of the small number of samples
studied.
The mean volume of breastfeeding increased significantly from day to
day in both groups (p <0.05). The volume of breastmilk increased significantly
starting from day 2 for samples who were blushing <6 hours, while samples
who were flushed> 6 hours experienced an increase in the volume of milk at
day 3. This shows that expressing breastmilk early on the first day after delivery
will help the mother to provide breast milk in the early life of the baby.
The results of this study are congruent with other studies where there
was an association between early milking and an increase in the volume of milk
expressed, Parker et al found that breast milk expressed before the first 6 hours
of birth on the seventh day showed more volume than mothers who expressed
breastmilk more than six. hour. Hill et all found an association between
expressing milk 27.3 ± 14.9 hours after delivery and the volume of breastmilk in
the first 7 days. Furman et al found a positive relationship between expressing
breast milk in the first 6 hours with prolonged lactation. Hopkins et all also
reported a positive association between expressing milk and volume at the
second week.
One of the 7 mothers in the group who were expressed breast milk for
more than 6 hours produced 0 cc of expressed breast milk on the second day.
Some NICU chambers will initiate enteral nutrition within 24 hours. If the
mother fails to express breastmilk when the baby has to drink, it will certainly
delay enteral nutrition and prolong parenteral nutrition.

On the fifth day, the volume of milk produced by mothers in both

groups in a day was 243.40 cc-592 cc. Few studies have examined the amount
of breast milk produced by mothers who deliver LBW in the first week. Parker
et all found the mother would produce 148cc- 4021cc. Henderson ett all found
 that the breast milk produced by mothers was 264 cc-4137.9 cc in the first 7
days.

The average length of stay for infants in this study was 36 days. In the
first group the average length of stay was 43 days while in the second group it
was 26 days. Meanwhile, the average LBW hospitalization based on the 2019
Perinatal Regester was 21 days. inpatient. However, several existing studies
show that breast milk affects length off stay and infant patient morbidity. l,
Tricia Jhonson et all found that giving breastmilk at the time of treatment
reduced the cost of care and LOS. Corpeleijin et all. found that breast milk
intake in the first 24 hours was associated with a reduction in mortality and
morbidity of LBW.

CONCLUSION

This study aims to determine the effect of the time to express breastmilk on the
volume of milk produced by mothers with LBW. It was found that expressing
breastmilk for less than 6 hours can help mothers produce more milk. The
relationship between initiation of breastfeeding within 6 hours and the success of
lactation was not known in this study. More research is needed to determine the
optimal time to start expressing breastmilk and in larger samples.

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