Preer and Philipp have drawn attention to inadequate breastfeeding
and neonatal jaundice but omitted to mention the most important factor in
breastfeeding success: the let-down reflex.1
In addition to prolactin, oxytocin (the hormone associated with the
reflex) stimulates milk production: numerous oxytocin receptors on the
milk secreting cells of the breast alveoli mediate a massive release of
casein (milk protein) into the lumen of the alveoli.2 The let-down reflex
(via oxytocin) then transfers milk to the infant: in between the positive
pressure waves of the reflex milk flows back towards the breast alveoli,
away from the infant.3
Frequent feeding in the early postpartum period is associated with lower
bilirubin levels whilst jaundiced infants may be lethargic and feed
poorly.4 Good positioning and latching and relying on infant demand may,
of themselves, not be sufficient to ensure frequent feeding, good milk
production and transfer.
Mothers need to know how to institute a beneficial feeding pattern to
optimise the milk intake of their infant and avoid 'not enough breast
milk' jaundice.
References
1 Prier GL, Philipp BL. Understanding and managing breast milk jaundice.
Arch Dis Child Fetal Neonatal Ed August 5 2010 doi:10.1136/adc2010.184416
2 Lollivier V, Marnet PG, Delpal S, Rainteau D, Achard C, Rabot A et al.
Oxytocin stimulates secretory processes in lactating rabbit mammary
epithelial cells. J Physiol. 2006;570 (Pt 1):125-40.
3 Ramsay DT, Kent JC, Owens RA, Hartman PE. Ultrasound imaging of milk
ejection in the breast of lactating women. Pediatrics 2004; 113; 361-367
4 de Carvalho M, Klaus MH, Merkatz RB. Frequency of breast-feeding and
serum bilirubin concentration. Am J Dis Child 1982 Aug 136(8):737-8
Conflict of Interest:
None declared
Preer and Philipp have drawn attention to inadequate breastfeeding and neonatal jaundice but omitted to mention the most important factor in breastfeeding success: the let-down reflex.1 In addition to prolactin, oxytocin (the hormone associated with the reflex) stimulates milk production: numerous oxytocin receptors on the milk secreting cells of the breast alveoli mediate a massive release of casein (milk protein) into the lumen of the alveoli.2 The let-down reflex (via oxytocin) then transfers milk to the infant: in between the positive pressure waves of the reflex milk flows back towards the breast alveoli, away from the infant.3 Frequent feeding in the early postpartum period is associated with lower bilirubin levels whilst jaundiced infants may be lethargic and feed poorly.4 Good positioning and latching and relying on infant demand may, of themselves, not be sufficient to ensure frequent feeding, good milk production and transfer. Mothers need to know how to institute a beneficial feeding pattern to optimise the milk intake of their infant and avoid 'not enough breast milk' jaundice.
References
1 Prier GL, Philipp BL. Understanding and managing breast milk jaundice. Arch Dis Child Fetal Neonatal Ed August 5 2010 doi:10.1136/adc2010.184416
2 Lollivier V, Marnet PG, Delpal S, Rainteau D, Achard C, Rabot A et al. Oxytocin stimulates secretory processes in lactating rabbit mammary epithelial cells. J Physiol. 2006;570 (Pt 1):125-40.
3 Ramsay DT, Kent JC, Owens RA, Hartman PE. Ultrasound imaging of milk ejection in the breast of lactating women. Pediatrics 2004; 113; 361-367
4 de Carvalho M, Klaus MH, Merkatz RB. Frequency of breast-feeding and serum bilirubin concentration. Am J Dis Child 1982 Aug 136(8):737-8
Conflict of Interest:
None declared