ArticlePediatric research2026
Mothers' milk Na without Na:K ratio detects secretory activation in mothers of preterm infants.
Article in Pediatric research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSecretory activation is a critical lactation milestone that can be measured objectively using point-of-care (POC) techniques, improving research rigor and informing interventions for insufficient mothers' own milk (MOM) volume in mothers of preterm infants. MOM sodium (Na) and sodium:potassium (Na:K) ratio are commonly used biomarkers, but whether Na:K adds value beyond Na alone remains unclear. Because POC K measurement requires additional time, cost, MOM volume and calculations, we evaluated whether Na alone can serve as a stand-alone secretory activation measure during the first 14 days postpartum.
methodsWe conducted a secondary pooled analysis of five prospective studies from two sites (n = 176; 2458 MOM samples). Paired Na and Na:K measures were compared using prespecified thresholds for secretory activation achievement (Na ≤ 16 mM; Na:K ≤ 0.8) across domains: daily agreement, first day of achievement, variation across key clinical factors, and continuous-value agreement.
resultsNa and Na:K showed strong agreement across all analytic domains during days 1-14 postpartum, with no evidence that Na:K added diagnostic value beyond Na alone.
conclusionIn breast pump-dependent mothers of preterm infants, Na alone is a robust biomarker of secretory activation and can be used without Na:K ratio to detect delayed and/or impaired secretory activation. IMPACT: This study provides evidence that point-of-care (POC) mothers' own milk (MOM) sodium (Na) concentration alone is a sufficient and reliable biomarker of secretory activation in breast pump-dependent mothers of preterm infants. While the sodium-to-potassium (Na:K) ratio has also been used, POC K involves increased time, cost, MOM volume and hand-calculation. Our analysis of 2458 paired measures of Na and K shows the Na:K ratio offers no additional diagnostic value beyond Na alone for detection of secretory activation in this population, informing biomarker-based lactation measures in research and neonatal intensive care unit settings.
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