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Comparison of Two Pumping Strategies to Improve Exclusive Breastfeeding at Discharge in Mothers of VLBW Infants with Low Milk Output - A Pilot Randomized Controlled Trial

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To compare the effect of two strategies of breast pumping –power pumping (PP) vs. routine pumping (RP) over one week in mothers of very low birth weight (VLBW) infants with low milk output to improve breastfeeding rates at discharge.


Mothers with low milk output, defined as inability to express sufficient breastmilk to meet the feeding requirements of their infant on or after post-natal day 14, were randomized to receive power pumping vs. routine pumping - once daily for 7 d coupled with routine lactation support and hand expression 3 hourly in both groups. The primary outcome was exclusive breastfeeding at discharge.


There was no difference in the two pumping strategies with respect to exclusive breastfeeding rates [61.1% in PP vs. 50% in RP group; (p = 0.477, RR 1.2; 95% CI 0.76 to 2.17)]. Median milk volume pumped in the individual power pumping session on 7th day of intervention was significantly higher than that in the individual routine pumping session on the 7th day (50 mL vs. 27 mL, p = 0.014). The cumulative median milk volume expressed per individual pumping session over the 7 sessions of power pumping was also higher than that with routine pumping (305 mL vs. 213 mL, p = 0.054).


In this pilot trial, expressed milk volume was significantly higher after each individual power pumping session compared to routine pumping. However, the exclusive breastfeeding rates at discharge were similar in the two groups.

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The authors are grateful to the families who entrusted the care of their infants to them. This work would not have been possible without the support of the entire lactation support team. The authors thank the Dean, LTMMC for allowing them to conduct this study.

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Authors and Affiliations



SM conceived the study. TK, SM, PK, SP, SK, JM developed study protocol. PK, TK, SP, HK & SK implemented the study and SM, JM supervised implementation. PK, TK, SP, HK & SK contributed to data collection and analysis. SM and JM contributed to data interpretation. SM, PK, TK, SP, HM & SK wrote the initial draft while JM edited the final manuscript. All authors have reviewed the manuscript and approve the submitted version. All authors meet the criteria for authorship. SM will act as guarantor for this manuscript.

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Correspondence to Swati Manerkar.

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Kalathingal, T., Manerkar, S., Mondkar, J. et al. Comparison of Two Pumping Strategies to Improve Exclusive Breastfeeding at Discharge in Mothers of VLBW Infants with Low Milk Output - A Pilot Randomized Controlled Trial. Indian J Pediatr (2023).

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