Anemia of Prematurity - Portal Neonatal

Human Milk and Lactation
Last Updated: August 7, 2004
Synonyms and related keywords: human lactation, human milk, breast milk, breastfeeding, breastfeeding,
milk production, nursing, lactating, mother's milk, mammary gland, mammogenesis
AUTHOR INFORMATION Section 1 of 11
Author: Carol L Wagner, MD, Associate Professor, Department of Pediatrics, Division of
Neonatology, Medical University of South Carolina
Coauthor(s): Eric M Graham, MD, Staff Physician, Department of Pediatrics, Medical University of
South Carolina; William W Hope, MD, Staff Physician, Department of Surgery, Greenville Memorial
Hospital
Carol L Wagner, MD, is a member of the following medical societies: American Academy of
Pediatrics, and Society for Pediatric Research
Editor(s): George Cassady, MD, Clinical Professor, Department of Pediatrics, Stanford University
School of Medicine; Robert Konop, PharmD, Director, Clinical Account Management, Ancillary Care
Management; Brian S Carter, MD, Associate Director, Associate Professor, Department of
Pediatrics, Division of Neonatology, Vanderbilt University Medical Center and Gateway Medical
Center; Paul D Petry, DO, FACOP, Assistant Professor, Department of Pediatrics, Division of
Maternal Child Health, Northeast Regional Medical Center; and Neil N Finer, MD, Director, Division
of Neonatology, Professor, Department of Pediatrics, University of California at San Diego
INTRODUCTION Section 2 of 11
Breast milk is commonly known as the best form of nutrition for neonates and infants. Human milk has
bioactive properties that facilitate the transition of life from in utero to ex utero. This dynamic fluid
provides a diverse array of bioactive substances to the developing infant during critical periods of
brain, immune, and gut development. The clinician must be familiar with how human milk is
manufactured by the mammary gland and with the properties of human milk that render it nourishing
and protective of the breastfeeding infant.
Clinicians play a crucial role in a mother's decision to breastfeed and can facilitate her success in
lactation. Although a mother may not be aware of the evidence indicating that breast milk contributes
to her baby's short- and long-term well-being, she has certain attitudes and cultural beliefs about
breastfeeding. The issue of bonding between mother and newborn may be a strong factor; however,
stronger cultural or societal barriers may be present that result in formula feeding. Such issues must
be understood for successful counseling. The mother makes her decision regarding breastfeeding
prior to delivery in more than 90% of cases; therefore, a discussion regarding her choice of infant
nutrition after delivery should take place beginning in the second trimester and as part of an ongoing
dialogue during each obstetric visit.
This article reviews the development of the mammary gland (mammogenesis), the process by which
the mammary gland develops the capacity to secrete milk (lactogenesis), the process of milk
production (lactation), and the specific properties of human milk that make it unique and appropriate
for human infants. In a related article entitled Counseling the Breastfeeding Mother, the mechanics of
breastfeeding and how to evaluate the breastfeeding mother-infant dyad are discussed. These articles
are intended to be overviews. For a more in depth treatise, please refer to textbooks by Lawrence and
Lawrence (1999) and Riordan and Auerbach (1998).