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Breast Development in the Newborn

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Breast Development in the Newborn Arch Dis Child: first published as 10.1136/adc.56.7.525 on 1 July 1981. Downloaded from Archives of Disease in Childhood, 1981, 56, 525-529 Breast development in the newborn JOHN F McKIERNAN AND D HULL Department ofChildHealth, Medical School, University ofNottingham SUMMARY Breast size and milk secretion was studied in term and preterm infants. Breast nodules were palpable in most of the mature infants, both boys and girls. In 6 term infants without palpable breast tissue there was a high incidence of complications during late pregnancy or delivery. In light-for-gestational age infants the breast diameter was generally appropriate for gestation. None of the infants under 31 weeks' gestation had palpable breast tissue at birth, but some in the first weeks of life developed breast tissue and secreted milk. Milk had been secreted by most of the mature infants by age 7 days, and the onset was earlier in light-for-dates infants. The breast does not regress rapidly after birth. The nodules persist into the second half ofthe first year by which time sex differences have emerged. Clearly the growth and activity of the neonatal breast cannot be explained solely in terms of the influence of maternal hormones towards the end of gestation. Further studies on early breast tissue development may indicate the other endocrine factors concerned. Breast nodules are present in most newborn infants, release in the first year of life was examined in boys and girls alike, and towards the end of the normal, healthy, and mature infants and compared first week of life, gentle palpation of the nodules with that of the small, preterm infant. The clinical generally results in the release of milk. Histological features of infants who did not have breast tissue at studies have demonstrated that the nodules are birth are also reported. formed of well developed breast tissue with lacteals, acini, and actively secreting alveolar cells.1 2 Bio- Methods chemical analyses of the secretion have shown that it http://adc.bmj.com/ contains carbohydrate, proteins, and fats, and it has The diameter of the breast nodule was measured by been suggested that it is similar to first milk in comparing the diameter of the palpable breast tissue mothers.2 3 Detailed analyses have not been made. with discs of standard size. Both breasts were There is evidence that oestrogens, progesterone and measured and the results reported as the average of mammotropic peptides, including prolactin and the two. All the measurements were made by one human placental lactogen, take part in the growth and development of breast tissue during pregnancy.4 on September 29, 2021 by guest. Protected copyright. - zeros However there is uncertainty about the extent that Excluding 30 n=137 Girls hormones, which act on the maternal tissues and are Mean breast diameter 1 I ---All values present in the maternal circulation, are responsible 042. ll- for the breast development in the newborn infant. 11 The failure of many preterm infants to develop I10 n . [ 0 2 4 6 8 10 12 14 breast nodules or secrete milk after birth, indicates 30- Diameter (mm) the importance of the intrauterine environment. On the other hand, the fetus itself produces a variety of 20 Boys hormones which may influence breast development- n = 145 for example prolactin levels in the infant's blood are 0I. 30 high at birth and in the succeeding days.5 10 -- e/20 11 If the fetal breast tissue is the end organ of 10- oestrogen, progesterone, and prolactin activity, its 0A size and behaviour after birth may provide interest- 0 2 4 6 8 10 12 14 0 2 4 6 8 10 12 14 ing information on the differences in endocrine Diameter (mm) Diameter (mm ) environment experienced by the infants before birth. Fig. 1 Distribution of breast nodule diameter in The natural history of breast tissue growth and milk 282 unselected newborn infants. 525 Arch Dis Child: first published as 10.1136/adc.56.7.525 on 1 July 1981. Downloaded from 526 McKiernan and Hull 10-r n=7 n=9 n=16 n=13 n=33 n=16 n=61^4 n=134 1% 8 E E 6 L- a, E 0 21. Fig. 2 Comparison of mean (+ SE) breast diameter between AGA and LGA OL- infants 37 to 40 weeks' gestation. 37 38 39 40 Gestational age (weeks) E Light for gestational C Appropriate for age gestational age observer. If after firm palpation, secretion could be There was no difference between the sexes. observed from the nipple, milk 'release' was judged Fifteen infants without palpable nodules had been to have taken place. The gestational age of each born preterm but 6 had not, and these 6 had had a infant was calculated in completed weeks of preg- surprising incidence of problems during late preg- nancy from the first day of the mother's last men- nancy and delivery (Table). Sometimes mothers strual period. If this date was unknown gestation after their first pregnancy have difficulty establishing was estimated from ultrasound data. Infants were breast feeding, and milk comes more easily with classified as either light-for-gestational age (LGA), second and subsequent pregnancies; however there or appropriate-for-gestational age (AGA), using the was no significant difference between breast dia- http://adc.bmj.com/ standards of Thomson et al.6 and allowing for sex of meter in infants of first or subsequent pregnancies. the infant and parity of the mother. It might have been expected that breast tissue being Measurements were made on (1) 282 unselected inessential, would be undersized in the under- infants of varying weights and gestations within the nourished newborn infant. That is certainly not first 2 days of life. (2) 98 infants of birthweights so. Indeed the breast appears to grow according to <3 0 kg. (3) 19 healthy infants, aged 5 to 8 months, gestation rather than according to body size (Fig. 2). attending child health clinics. Serial measurements were made on (a) 21 term, on September 29, 2021 by guest. Protected copyright. healthy infants over the first 10 months of life, and Table Details of the 6 term infants who did not have (b) 23 preterm AGA infants who did not have palp- breast nodules at birth able breast tissue at birth for the first 10 weeks of Case Birthweight Gestation Delivery Complication life. The time of onset of milk secretion was studied (kg) (weeks) groups by serial observations in 4 of infants: 13 1 2.95 41 Forceps Static maternal weight mature AGA infants, 21 LGA infants, 13 AGA in late pregnancy. infants of 34 to 37 weeks' gestation, and 19 AGA Failure to progress in labour infants of 26 to 33 weeks' gestation. 2 3.2 39 Emergency Falling maternal caesarean weight in late section pregnancy. Results Failure to progress in labour 3 2.78 38 Forceps Failure to progress Breast nodule size. Breast tissue was palpable in in labour most newborn infants and the measurement came 4 3-3 41 Forceps Fetal distress. Birth asphyxia within a normal distribution with the exception of 5 2.82 44 Caesarean Maternal hypertension. the 21 infants in whom no breast tissue could be section birth asphyxia palpated (Fig. 1). 6 4.08 40 Normal - Arch Dis Child: first published as 10.1136/adc.56.7.525 on 1 July 1981. Downloaded from Bteast development in the newborn 527 The time in gestation when breast tissue becomes 20.r palpable varies greatly. It was found in some infants under 32 weeks' gestation, but was not palpable in one-third of infants of 36 weeks' gestation (Fig. 3). 16 0 o o E12 0 E 12r * Appropriate for gestational age 0 L- o Light for gestational age 0* * 0 do 8 @0 E 4a- 101 n=78 Mean - 4 1-8 0 so E 0 * o:0 O0 . -E * 0 6 * 0 0 Boys Girls , ( n=8 ) ( n=11) Age 5-8 months E * 0 0 - O 5 0 0 Fig. Breast diameter in 19 infants. * 0 - 0 2 In 23 preterm infants who did not have breast 0 . " _ MM .0 COO nodules at birth, breast tissue became palpable in 25 26 28 30 32 34 36 38 over 40% of them during the first 9 weeks of life, Gestational age (weeks) although none developed large nodules of the size Fig. 3 Breast diameter in 78 preterm infants. that are found in term newborn infants. In healthy mature infants, the diameter of the breast increased during the first 2 weeks of life after which it de- 24 creased to an average of about 10 mm (Fig. 4) where it remained until about 4-6 months of age. By this time there was a difference between boys and girls n= 21 which was even more apparent by age 10 months http://adc.bmj.com/ 20 - (Fig. 5). 40- Mean Milk secretion. In most mature term infants milk 16. secretion first appeared between the 5th and 7th days of life. The onset of secretion was earlier in the infants who were LGA (Fig. 6). Of the mature infants, 17 of 19 were still secreting in the second on September 29, 2021 by guest. Protected copyright. o12 week, 8 of 17 in the fourth, but none by the eighth week. Milk was released within the first 9 days of life in 7 of 13 preterm infants of 34 to 37 weeks' gestation. None of the more immature infants was secreting milk in the first week of life and later onset was noted in 4. 4- Discussion Although the observation that breast tissue is 0 present in the majority of term infants, and that Birth 10-20 30 milk secretion usually occurs in all of them, begin- Age (days) ning on the 5th and 6th days of life, was made long Fig.
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