PEDIATRICS Vol. 93 No. 5 May 1994, pp. 802-806
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The Clinical Usefulness of Breast Milk Sodium in the Assessment of Lactogenesis

Jane A. Morton MD1

1 Palo Alto Medical Foundation, Palo Alto, CA

Objective. A study was undertaken to assess the value of breast milk sodium concentration (BM [Na+) during early lactogenesis in predicting nursing outcome.

Methods. Samples of breast milk from 130 nursing mothers were obtained between the 3rd and 8th postpartum day for analysis of BM [Na+]. Approximately half the mothers were referred for nursing problems, although no problems were anticipated in the other primiparous mothers. A BM [Na+] of le16 mmol/L was considered normal. For women with normal BM [Na+], follow-up was scheduled at 1 month, whereas those with high [Na+] were evaluated more frequently with repeated [Na+] determinations.

Results. Of the 65 women with normal BM [Na+] (excluding five mothers who had experienced breast surgery), 95.4% were exclusively and successfully breast-feeding at 1 month without intervention. Of 60 women with high BM [Na+], all of whom received intervention, 55% were ultimately successful. In general, those who failed tended to have higher initial [Na+] determinations; additionally, the longer the [Na+] remained elevated, the lower the success rate. Infant weight gain was greater if the initial BM [Na+] was normal. Infants of mothers with normal BM [Na+] gained an average of 994 g above birth weight by 1 month in contrast to the average weight gain of 818 g in infants of mothers with initially elevated [Na+].

Conclusion. This study suggests that a normal drop in [Na+] is highly predictive of successful lactation, although a prolonged elevation of [Na+] signifies impaired lactogenesis with a high risk of failure. The clinical usefulness and limitations of this determination are discussed.

Submitted on June 30, 1993
Accepted on September 7, 1993




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