Milk Removed Research Articles

The interplay of continuous milk ejection and milking system with and without prestimulation at different vacuum settings

Efficient machine milking requires an optimal interaction of alveolar milk ejection in the udder and milk removal by the milking machine. The aim of the present study was to test whether the equilibrium between continuous milk ejection and milk removal can also be maintained at very fast milking through a particularly high vacuum. Eight Holstein dairy cows were milked at 42, 52, or 60 kPa, with (PS) or without (nPS) prestimulation. Each of the 6 treatments was conducted at 2 afternoon milkings in each animal. The prestimulation lasted 40 s and consisted of forestripping and teat cleaning. The cluster attachment followed after a 20-s latency period. Throughout each milking, B-mode ultrasound videos of the gland cistern of 1 front quarter as well as milk flow and claw vacuum curves were recorded. Total milk yield was neither affected by nPS or PS nor by the vacuum level. Milk removed within the first minute and the first 2 min of milking and average milk flow were higher, and the duration of incline and time until peak milk flow were shorter at PS than at nPS milkings at all vacuum levels. Machine-on time was shorter at PS than at nPS milkings, although only at 42 and 52 kPa vacuum, obviously caused by the high percentage of bimodalities occurring in nPS milkings (17% bimodalities in PS vs. 92% bimodalities in nPS milkings). The frequency of bimodalities was higher at high than at low vacuum both in PS and nPS milkings. Peak flow rate and average milk flow were both higher at higher vacuum levels. The duration of milk flow plateau was shorter at 60 kPa than at 42 kPa milkings. At the highest vacuum (60 kPa), the shorter plateau phase indicated a declining milk ejection rate toward the end of the plateau phase, and milk ejection could no longer keep up with the fast milk removal; hence, a higher milking efficiency at a higher vacuum level could only be achieved as long as the gland cistern remained sufficiently filled by the continuous milk ejection. The ultrasound imaging confirmed this finding as the duration of cisternal area plateau in the recorded front quarter was shorter at high than at low vacuum. Thus, the highest vacuum of 60 kPa did not cause a shorter machine-on time than 52 kPa. In conclusion, milking at a very high vacuum can increase milking efficiency compared with a low vacuum. However, a vacuum reduction at the start and toward the end of milking is required to prevent overmilking if milking is performed at a very high vacuum.

Breast Milk Production in Women Who Use Nipple Shields for Persistent Nipple Pain

ObjectiveTo examine relationships between nipple pain scores and 24-hour milk production volumes, breastfeeding and pumping frequencies, and breastfeeding duration in women using nipple shields for persistent nipple pain. DesignSecondary outcome analysis of a prospective cohort study. SettingResearch laboratory and participants’ homes. ParticipantsTwenty-five breastfeeding women (6 ± 4 weeks after birth) who used nipple shields for persistent nipple pain. MethodsWe conducted a randomized trial to investigate the primary outcome of milk transfer with and without nipple shields among participants with and without nipple pain. Here, we report secondary outcomes of associations between 24-hour milk production, breastfeeding and pumping frequencies, breastfeeding durations, and intake in participants using a nipple shield for nipple pain. Participants completed demographic, health and breastfeeding questionnaires and, at two monitored breastfeeding sessions, completed a pain visual analogue scale and Brief Pain Inventory–Short Form (BPI-SF; total and subscale scores for pain interference with General Activity, Mood, Sleep, and Breastfeeding). Milk production (milliliters per 24 hours), feed volumes, and percentage of available milk removed were calculated from data and milk samples obtained by participants over one 24-hour period and at study visits. Participants logged 24-hour data on a customized research website. We used descriptive statistics as well as simple and multiple linear regression for analyses. ResultsMilk production and feeding duration were not associated with nipple pain scores (visual analogue scale: p = .80, BPI-SF: p = .44). An increase in BPI-SF Breastfeeding subscale score of 1 unit, indicating pain interference with breastfeeding, was associated with a 0.28 decrease in 24-hour breastfeeding frequency (p = .02) and an 18.8-ml decrease in 24-hour breastfeeding intake (p = .04). ConclusionPersistent nipple pain was associated with reduced breastfeeding frequency; therefore, continuing professional support is required to ensure adequate milk removal and pain management.

Measurement of Mammary Blood Flow in Lactating Camels (Camelus dromedarius) Using Antipyrine Absorption Method

Mammary blood flow has been measured in human breast as well as cow, sheep and goat udders. According to the available literature, mammary blood flow has not been measured in lactating camels. So, the objective of this research was to measure mammary blood flow (MBF) in lactating camel. Data from two lactating camels were used to measure MBF using the antipyrine absorption method. Following complete manual removal of the milk from the udder, 3g of antipyrine dissolved in 30mL of distilled water was injected into each udder gland by the teat orifice. Blood samples were collected simultaneously from the left and right milk veins and pulmonary artery at 15, 20, 25, 30, 35, and 40 minutes following the infusion of antipyrine. Oxytocin (20IU) was injected intravenously 45 min following the infusion of antipyrine, and the volume of the milk removed by manual milking from each udder quarter was measured. Concentrations of antipyrine in the milk and blood were calculated, and MBF per udder gram per minute was measured. Results showed MBF of 6250ml/min (9000L/24h) for camel number 1 and 7800ml/min (11232L/24h) for camel number 2. Blood to milk ratios were 1200:1 and 1021:1 for camel number 1 and 2, respectively. MBF per gram of udder weight was 735.29ml/min/g and 829.78ml/min/g for camel number 1 and 2, respectively.

Nipple shield use does not impact sucking dynamics in breastfeeding infants of mothers with nipple pain.

Nipple shields (shield) may reduce pain during breastfeeding, but the impact on infant sucking dynamics is not known. We examined the effects of shield use on sucking dynamics, milk removal and nipple pain in two groups of breastfeeding dyads: pain group (PG): shield used for nipple pain; comparison group (CG): no breastfeeding difficulties. Twenty PG (6 ± 4 weeks postnatal) and 28 CG dyads (8 ± 6 weeks postnatal) attended 2 monitored breastfeeding sessions with shield use randomised. Within-subject outcomes were compared. PG: shield use did not affect intra-oral vacuum (peak p = 0.17, baseline p = 0.59), sucking frequency (p = 0.20) or milk transfer (40 mL vs 48 mL, p = 0.80; percentage of available milk removed (PAMR) 55% vs 57%, p = 0.88), and reduced McGill pain scores (p = 0.012). CG: shield use increased non-nutritive sucking (10% more, p = 0.049), and reduced nutritive sucking (18% less, p = 0.017) and milk transfer (63 mL vs 31 mL p < 0.001, PAMR 65% vs 36% p < 0.001). For both groups, feeding duration increased by 2 min (p < 0.0001) and non-nutritive portions of the feed increased with shield use.Conclusion: Nipple shield use improved maternal comfort and did not impact milk removal or sucking strength in PG, but significantly reduced milk transfer and nutritive sucking in CG. What is Known: • Mothers report that nipple shields reduce nipple pain and enable continued breastfeeding. • Concerns that nipple shield use may reduce milk transfer and alter infant sucking patterns are based on limited published evidence. What is New: • Nipple shield use is associated with a 25% reduction in pain scores in breastfeeding mothers with chronic nipple pain. • Milk transfer is not reduced in dyads that regularly use a shield for chronic nipple pain. • Intra-oral vacuums are not impacted by nipple shield use in mothers experiencing pain.

Effect of nipple shield use on milk removal: a mechanistic study

BackgroundConcerns about reduced milk transfer with nipple shield (NS) use are based on evidence from studies with methodological flaws. Milk removal during breastfeeding can be impacted by infant and maternal factors other than NS use. The aim of this study was to control electric breast pump vacuum strength, pattern and duration across multiple study sessions to determine if NS use reduces milk removal from the breast.MethodsA within-subject study with two groups of breastfeeding mothers (infants < 6 months) were recruited; Control Group (CG): no breastfeeding difficulties; Pain Group (PG) used NS for persistent nipple pain. Mothers completed three randomised 15 min pumping sessions using the Symphony vacuum curve (Medela AG); no NS, fitted NS, and a small NS. Sessions were considered valid where the applied vacuum was within 20 mmHg of the set vacuum. Milk removal was considered as pumped milk volume, and also percentage of available milk removed (PAMR), which is calculated as the pumped volume divided by the estimated milk volume stored in the breast immediately prior to pumping.ResultsOf 62 sessions (all: n = 31 paired sessions) a total of 11 paired sessions from both PG (n = 03) and CG (n = 08) were valid (subset) with and without a fitted NS. Only 2 small shield sessions were valid and so all small shield measurements were excluded. Both pumped volumes and PAMR were significantly lower with NS use for all data but not for subset data. (All: Volume and PAMR median: no NS: 76.5 mL, 69%, Fitted NS: 32.1 mL, 41% respectively (volume p = 0.002, PAMR p = 0.002); Subset: Volume and PAMR median: no NS: 83.8 mL, 72%; Fitted NS: 35.2 mL, 40% (volume p = 0.111 and PAMR p = 0.045). The difference in PAMR, but not volume, was statistically significant when analysed by linear mixed modelling. A decrease of 10 mmHg was associated with a 4.4% increase in PAMR (p = 0.017).ConclusionsThis experimental data suggests that nipple shield use may reduce milk removal. Close clinical monitoring of breastfeeding mothers using nipple shields is warranted.

Comparison of maternal milk ejection characteristics during pumping using infant-derived and 2-phase vacuum patterns

BackgroundMilk ejection characteristics remain consistent throughout 12 months of lactation in women who expressed breastmilk with an electric breast pump. In addition these characteristics appear to remain constant when women are breastfeeding or pumping suggesting that milk ejection is a robust physiological response. It is not known whether the stimulation of an infant at the breast in the early post partum period influences milk ejection patterns or whether this is a programmed event. However, as more data become available on the mechanisms involved in infant feeding, pumping patterns mimicking the infant more closely may provide enhanced results. The objective of this study was to compare milk ejection characteristics obtained when using a novel infant-derived pumping pattern with an established 2-phase pattern.MethodsA convenience sample of ten lactating mothers, 1 to 40 weeks of lactation with normal milk production were recruited in 2015. Each participated in two pumping sessions in which either a 2-phase pattern or infant-derived pattern were randomly assigned. Milk volume and milk ejection characteristics were recorded and the percentage of available milk removed (PAMR) was calculated. Statistical analysis used linear mixed effects modeling to determine any differences between breasts and pump patterns with the consideration of individual variability as a random effect.ResultsThe number of milk ejections and milk ejection characteristics did not differ between patterns. Milk volumes removed were 53.6 ± 28.5 ml (PAMR 58.2 ± 28.4) for the 2-phase pattern and and 54.2 ± 26.3 ml (PAMR 52.2 ± 22.3) for the infant derived pattern. Peak milk flow rates were positively associated with the available milk (p = 0.0003) and PAMR (p = 0.0001), as was the volume of milk removed during each milk ejection (p = 0.001 and p = 0.0001).ConclusionAn experimental pumping pattern designed to resemble infant sucking characteristics did not alter milk ejection characteristics or milk removal parameters compared with an established 2-phase pattern. Theses findings provide further evidence that milk ejection is a robust physiological response.

Changes in R0/R∞ ratio and membrane capacitance are associated with milk removal from the breast.

Perceived low milk supply is a common reason for introducing supplementary feeds, which in turn serves to further diminish the milk supply. Current methods of measuring milk production and milk transfer from the breast to the infant are inaccessible to the mothers. There is a need for an inexpensive, portable device to enable mothers to measure milk transfer to either confirm their milk production is adequate or identify breastfeeding issues early. The aim of this study was to examine changes in bioimpedance spectroscopy associated with milk removal from the human lactating breast using an electric breast pump. Thirty lactating women participated in 2 research sessions performed in random order over 2 weeks. Milk flow rate and volume were measured during pumping. All mothers completed 24-hour milk profiles. Breasts were monitored using bioimpedance spectroscopy. Analysis was performed using linear mixed effects models to investigate the relationship between both proportional change in membrane capacitance (Cm) and R0/R∞ with milk removal. There was an inverse relationship between R0/R∞ and milk removed (p<0.001). A positive relationship was also observed between Cm and both volume of milk removed (P<0.001) and percentage of available milk removed (p<0.001). This study has shown that changes in bioimpedance are related to the volume of milk removed from the breast during pumping. This modality may hold promise for the measurement of the effectiveness of the breastfeeding infant in removing milk from the breast.

Vacuum characteristics of the sucking cycle and relationships with milk removal from the breast in term infants

BackgroundThe importance of an infant's intra-oral vacuum in milk removal from the breast has been established. However, the relationship between the vacuum curve and milk transfer is not well understood. AimsTo investigate the parameters of the infant suck cycle in relation to the volume of milk removed from the breast. Study designCross-sectional study to elucidate the role of infant intra-oral vacuum in efficient milk removal from the breast. SubjectsNineteen fully breastfed term infants. MethodsIntra-oral vacuum was recorded during monitored breastfeeds using a pressure transducer. Ultrasound imaging (milk flow) and respiratory inductive plethysmography (swallowing) were used to determine the nutritive sucking (NS) portion of the feed. Milk intake was determined by weighing infants before and after feeds. Vacuum traces of the first and next 2min of NS from the first breast were analysed. ResultsThe volumes of milk removed during both NS periods were negatively associated with peak vacuum (p<0.001) and rate of vacuum application (p<0.001), and positively related to area under first half of the suck cycle (p<0.001). Most parameters changed significantly from the first 2min of NS to the next 2min including significant reduction in peak vacuum and area under first half of the suck cycle. ConclusionThese results further support the role of intra-oral vacuum, specifically optimal peak vacuum, in effective and efficient milk removal during breastfeeding. It also appears that infants modify their sucking dynamics to adapt to changes in milk flow during milk ejection as the breast empties.

Effect of microbiological testing on subsequent mid-infrared milk component analysis of the same milk sample

Our objectives were to determine if mixing and sampling of a raw milk sample at 4°C for determination of total bacteria count (TBC) and if incubation at 14°C for 18h and sampling for a preliminary incubation (PI) count influenced the accuracy of subsequent fat, protein, or lactose measurement by mid-infrared (IR) analysis of milk from the same sample container due to either nonrepresentative sampling or the presence of microbial metabolites produced by microbial growth in the milk from the incubation. Milks of 4 fat levels (2.2, 3, 4, and 5%) reflected the range of fat levels encountered in producer milks. If the portion of milk removed from a cold sample was not representative, then the effect on a milk component test would likely be larger as fat content increases. Within the milks at each fat level, 3 treatments were used: (1) 20 vials of the same milk sampled for testing TBC using a BactoScan FC and then used for a milk component test; (2) 20 vials for testing TBC plus PI count followed by component test; and (3) 20 vials to run for IR component test without a prior micro sampling and testing. This was repeated in 3 different weeks using a different batch of milk each week. No large effect on the accuracy of component milk testing [IR fat B (carbon hydrogen stretch) and fat A (carbonyl stretch)] due to the cold milk sample handling and mixing procedures used for TBC was detected, confirming the fact that the physical removal of milk from the vial by the BactoScan FC (Foss Electric, Hillerød, Denmark) was a representative portion of the milk. However, the representativeness of any other sampling procedure (manual or automated) of a cold milk sample before running milk component testing on the same container of milk should be demonstrated and verified periodically as a matter of routine laboratory quality assurance. Running TBC with a BactoScan FC first and then IR milk analysis after had a minimal effect on milk component tests by IR when milk bacteria counts were within pasteurized milk ordinance limits of <100,000 cfu/mL. Running raw milk PI counts (18h of incubation at 13–14°C) with the BactoScan FC before milk component testing by IR milk analysis had an effect on component tests. The effect was largest on fat test results and would decrease the accuracy of milk payment testing on individual producer milks. The effect was most likely due to the absorption of light by bacterial metabolites resulting from microbial growth or other chemical degradation processes occurring in the milk during the PI count incubation, not by the sampling procedure of the BactoScan. The direction of the effect on component test results will vary depending on the bacteria count and the type of bacteria that grew in the milk, and this could be different in every individual producer milk sample.

Effect of Warm Breastshields on Breast Milk Pumping

The effect of using a warm breastshield on the efficiency, effectiveness, and comfort of expressing milk with an electric breast pump was assessed. The authors tested a standard breastshield at 25°C and a breastshield warmed to 39°C on 25 mothers using their maximum comfortable vacuum or -125 mm Hg. Using a warm breastshield effectively warmed the nipple and areola and, combined with maximum comfortable vacuum, decreased the time to remove 80% of the total milk yield and increased the percentage of available milk removed after 5 minutes of expression, with no change in the percentage of available milk removed after 15 minutes of expression compared with an ambient-temperature breastshield. The data confirmed that use of the mother's maximum comfortable vacuum was more efficient than a vacuum of -125 mm Hg. Using a warm breastshield with an electric breast pump was comfortable and improved the efficiency of milk removal.

Dynamics of Milk Removal During Simultaneous Breast Expression in Women

To investigate the dynamics of milk removal during breast expression. This study used a continuous weighing balance to determine changes in milk flow rate and their relationship to the proportion of milk removed over time and the percentage of the available milk removed during simultaneous expression (15 minutes) of the left and right breasts in 34 mothers of healthy, term, breastfeeding infants. Multiple milk ejections (5.1±2.0; range, two to 14) were detected as increases in milk flow rate. A larger total expression volume was associated with a higher maximum milk flow rate (p<0.001). However, 14% less of the available milk was removed for a 100 g increase in available milk (p<0.001). After 2.9±1.4 and 6.0±2.5 minutes, 50% and 80%, respectively, of the total expression volume was removed. Milk flow was more active in the first 7 minutes than the last 7 minutes. At the eighth minute (midpoint), 54±25% of the available milk and 86±9% of the total expression volume were removed. The maximum milk flow rate was predictive of the total volume expressed. After the eighth minute of expression the milk flow rate was reduced. Increasing volumes of milk in the breast were associated with less complete breast emptying. These data suggest that long expression sessions are not required for mothers who are not pump dependent and that extending intervals between expressions results in less effective milk removal.

Measuring Milk Synthesis in Breastfeeding Mothers

Breastfeeding mothers expressed their breasts hourly for periods up to 7 hours, without exogenous oxytocin, to determine the consistency of milk removal and the relationship between the volume of milk removed and the mother's 24-hour milk production. Mothers (n = 20) measured their 24-hour milk production from each breast by test-weighing their babies at home. Mothers came to the research laboratory for a day visit and expressed milk from either both or one breast (left or right) for 10-15 minutes, every hour for 2-7 hours. Mothers were not instructed to restrict breastfeeding prior to the first (0-hour) expression. It was found that the milk volume at 1 hour (59.7 +/- 36.5 and 46.5 +/- 25.6 mL/hour for the right and left breast, respectively) was significantly (p < 0.05) higher than the milk volume from subsequent hourly intervals. The average hourly volumes obtained from the 2nd to 7th hour (18.0 +/- 3.1 and 14.0 +/- 4.8 mL/hour for the right and left breast, respectively) were not significantly different from the average hourly rates calculated for the 24-hour milk production (18.4 +/- 6.3 and 15.5 +/- 5.1 mL/hour for the right and left breast, respectively). Furthermore, local inhibition was not observed during hourly expressions of up to 7 hours. The average hourly volumes of milk from the 2nd to 7th hour expressions could provide an estimate of the rate of milk secretion. Further study is required to fully validate these findings.

Suitability of low-dosage oxytocin treatment to induce milk ejection in dairy cows

Chronic use of high oxytocin (OT) dosages can cause a reduced response to endogenous OT. In this study the OT dosages used in the milking practice of 82 dairy cow farms were recorded. The OT dosages per cow used were high, especially when injected i.m. (23±2 IU) compared with i.v. (7±1 IU). In addition, the minimum OT dosages needed to obtain normal milk removal in cows with disturbed milk ejection were investigated. Seventeen cows routinely treated with OT during milking (group T) and 17 cows without previous OT treatment were used (group C). After cessation of spontaneous milk flow, both T and C groups were injected i.v. with a low dosage of OT (0.2 or 0.5 IU/cow). The time from injection until cessation of the OT-induced milk flow was recorded (response phase). The response phase and the amounts of removed milk by effect of the OT injection increased with increasing OT dosage. Values for 0.2 and 0.5 IU/cow of OT injected i.v. were (response phase and amount of milk removed) 198±27 and 302±18s and 3.4±0.7kg and 6.5±1.3kg, respectively, for the C group, and 157±15 and 221±16s and 3.2±0.5 and 5.5±1.0kg, respectively, for the T group. Within 20min of the OT injection, plasma concentrations returned to basal levels. The threshold OT concentration at cessation of milk flow after injection of 0.2 or 0.5 IU/cow of OT was calculated based on the OT plasma half-life. The threshold increased with increasing dosages of OT and was higher in group T (8±1 and 14±1 pg/mL for 0.2 and 0.5 IU/cow, respectively) than in group C (7±1 and 11±1 pg/mL for 0.2 and 0.5 IU/cow, respectively). In conclusion, desensitization of the udder toward OT occurs when the udder is exposed to elevated OT plasma concentrations, both short-term during the actual milking and long-term due to chronic high-dosage OT treatment. However, low-dosage OT treatments to induce normal milk removal can minimize the observed side effects.

Effect of vacuum profile on breast milk expression using an electric breast pump.

The authors compared milk expression using 5 experimental vacuum patterns and a commercially available vacuum pattern ranging in cycle times (20 to 78 cycles/min) and vacuum curve dynamics in 30 mothers using an experimental, software-controlled electric breast pump. The volume of milk removed over 5 minutes differed (P = .0072) between patterns (range = 62.8 +/- 6.6 mL to 47.2 +/- 5.1 mL). However, there was no difference in the percentage of available milk removed (range = 99.4% +/- 15.1% to 70.6% +/- 8.6%). The rate of milk removal differed between patterns at both the beginning (1 minute) and end (1.5 minutes) of the expression period (P < .05). Peak vacuum chosen differed between patterns (P = .0085) but was not related to either the volume or percentage of available milk expressed. Breastfeeding characteristics did not differ between poor and successful expressers. These results show that breast milk expression by an electric breast pump can be influenced by the vacuum pattern.

The determination of short-term breast volume changes and the rate of synthesis of human milk using computerized breast measurement.

The feasibility of using sequential breast volume measurements as a method of studying short-term rates of milk synthesis in women has been established. We have developed a rapid Computerized Breast Measurement system for the determination of breast volume, based upon the Shape Measurement System. A circle encompassing all the breast tissue is drawn in black face paint on the subject's skin. Six patterns of sixty-four horizontal light stripes are projected onto the breast and chest wall surface. A CCD camera relays video images to a computer, which produces a model of the chest by active triangulation. The volume of the breast and the chest wall segment enclosed by the circle is then calculated. The precision of the method was dependent upon the subject repositioning carefully. The coefficient of variation of replicate measurements was 1.6%. The accuracy of the method was established by comparing the change in breast volume before and after a breast-feed with the amount of milk removed by the infant as determined by test weighing. There was a close relationship between the removal of milk by the infant (x) and the change in breast volume (y), (r = 0.93, n = 73, y = 1.10x - 3.25). The rates of milk synthesis between breast-feeds, for six women determined on one to eight occasions, varied from 11 to 58 ml/h. The results show that the amount of milk available in the breast is not necessarily an important determinant of the amount of milk removed by the infant at a breast-feed.

Neurohormonal mechanisms in emotional inhibition of milk ejection.

SUMMARY 1. Fifteen lactating rabbits were maintained on a regime of one daily nursing in which litter weights, milk yields and duration of nursing were recorded. 2. Sodium pentobarbitone anaesthesia blocked the milk-ejection reflex and prevented the removal of more than 15% of the full milk yield by the young. Intravenous injection of 50 mU oxytocin regularly restored normal milk removal; 10 and 20 mU did not. 3. In thirty-five out of forty-two experiments in which the does were suckled while under forcible restraint the amount of milk removed was reduced by 20–100%. In twenty-nine cases injection of 50 mU oxytocin restored normal milk removal. In the remaining six experiments this replacement therapy was fully effective only after the does had been anaesthetized. 4. Kymograph records of milk-ejection responses showed that normal milk removal was associated with a reflex milk-ejection response similar to that produced by 50 mU oxytocin, and incomplete milk removal with a reduced (=5 mU oxytocin) or absent milk-ejection response. Where injection of 50 mU oxytocin failed to restore normal milk removal in the conscious animal, the resulting milk-ejection response was reduced by an amount similar to that produced by injection of 1μg adrenaline. 5. The results indicate that, while activation of the sympathetico-adrenal system does occur, the main factor in emotional disturbance of the milk-ejection reflex is a partial or complete inhibition of oxytocin release from the posterior pituitary gland.