Improving Mothers’ Own Milk Provision at NICU Discharge: Optimizing Achievement of Secretory Activation and Coming to Volume as Key Strategies

Wednesday, 15 February 2023

 Embedded in this approach is evidence that the mammary gland undergoes essential programming during the first two weeks postpartum, which can be measured with biomarkers, and is essential to long-term mothers’ own milk (MOM) provision.  Clinical strategies that target the early postpartum period will be highlighted, including species-specific mammary gland stimulation, monitoring of MOM biomarkers of secretory activation and assessment of coming to volume.  Additionally, the distinction between impaired secretory differentiation and delayed/impaired secretory activation in this population will be discussed, with application to NICU mothers who have multiple inflammation-based morbidities that increase the risk for lactation problems.

Learning objectives

  • Cite evidence about differences in outcomes for MOM-fed versus pasteurized donor human milk (PDHM)-fed premature infants, underscoring the importance of prioritization of MOM availability.
  • Define terminology, including:  achievement of secretory activation; achievement of coming to volume; biomarkers (MOM biomarkers and pumped MOM volume), secretory differentiation, and maternal inflammation-based morbidities.
  • Compare the effectiveness and efficiency of MOM removal via electric breast pump versus hand-expression only techniques during this critical window.
  • Delineate best clinical practices to optimize achievement of secretory activation and coming to volume, including the use of point-of-care MOM biomarkers of secretory activation (sodium, lactose, citrate, total protein and sodium: potassium ratio).

Event details

Date           15 February 2023

Duration    1 hour

Time           20:00 – 21:00 Central European Time (13:00 – 14:00 Central Standard Time)


Paula Meier PhD, RN

Paula MeierPhD, RN

Paula Meier, PhD, RN, is a Professor of Pediatrics and Nursing at Rush University Medical Center in Chicago. Dr. Meier has worked as a practitioner, researcher, and educator in the area of human milk, lactation and breastfeeding for premature infants and their mothers since 1975. She spearheaded the multidisciplinary Rush University NICU Human Milk Research Team that has conducted numerous externally-funded translational research and demonstration projects focused on the removal of barriers to high-dose, long-exposure mothers' own milk feedings for NICU infants. Dr. Meier's lifetime research focus has been focused on the improvement of initiation and maintenance of lactation in breast pump-dependent mothers of NICU infants, and in the development and testing of clinical techniques to optimize the impact of human milk on health and cost outcomes in NICU infants.

Dr. Meier has published over 250 peer-reviewed manuscripts and parent educational materials and has mentored graduate students from a multitude of disciplines.  She is a former president of the International Society for Research in Human Milk and Lactation (ISRHML; 2012-2014) and has served for over 20 years as a member of the Health Advisory Council for La Leche League.  She has received Distinguished Alumna Awards from the University of Illinois and Rush University, and in 2013 received the Audrey Hepburn Award for Contributions to the Health and Welfare of Children from Sigma Theta Tau, International.  She was an invited member of the WHO task force on donor human milk, 2019, and the NICHD BEGIN (Breastmilk Ecology:  Genesis of Infant Nutrition) task force in 2020-2021. She has served as a reviewer for human milk-related research on multiple NIH review panels. Most recently, she is the recipient of the 2022 Macy-Gyorgy Award from ISRHML, a biennial award that recognizes outstanding lifetime research contributions to human milk, lactation and breastfeeding.