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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

Indian Journal of Pediatrics Aims and scope Submit manuscript

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Abstract

Objectives

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.

Methods

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.

Results

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).

Conclusions

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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References

  1. Pinelli J, Saigal S, Atkinson SA. Effect of breastmilk consumption on neurodevelopmental outcomes at 6 and 12 months of age in VLBW infants adv neonatal care. 2003;3:76–87.

    PubMed  Google Scholar 

  2. Hoddinott P, Tappin D, Wright C. Breast feeding. BMJ. 2008;336:881–7.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chen A, Rogan WJ. Breastfeeding and the risk of post neonatal death in the United States. Pediatrics. 2004;113:e435-9.

    Article  PubMed  Google Scholar 

  4. Hoban R, Bigger H, Patel AL, Rossman B, Fogg LF, Meier P. Goals for human milk feeding in mothers of very low birth weight infants: how do goals change and are they achieved during the NICU hospitalization? Breastfeed Med. 2015;10:305–11.

    PubMed  PubMed Central  Google Scholar 

  5. Sisk P, Quandt S, Parson N, Tucker J. Breast milk expression and maintenance in mothers of very low birth weight infants: supports and barriers. J Hum Lact. 2010;26:368–75.

    Article  PubMed  Google Scholar 

  6. Davanzo R, Monasta L, Ronfani L, Brovedani P, Demarini S, Breastfeeding in Neonatal Intensive Care Unit Study Group. Breastfeeding at NICU discharge: a multicenter italian study. J Hum Lact. 2013;29:374–80.

    Article  PubMed  Google Scholar 

  7. Meier P, Johnson T, Patel A, Rossman B. Evidence-based methods that promote human milk feeding of preterm infants an expert review. Clin Perinatol. 2017;44:1–22.

    Article  PubMed  Google Scholar 

  8. Hoban R, Bigger H, Schoeny M, Engstrom J, Meier P, Patel AL. Milk volume at 2 weeks predicts mother’s own milk feeding at neonatal intensive care unit discharge for very low birthweight infants. Breastfeed Med. 2018;13:135–41.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Mehta A, Rathi AK, Kushwaha KP, Singh A. Relactation in lactation failure and low milk supply. Sudan J Paediatr. 2018;18:39–47.

    PubMed  PubMed Central  Google Scholar 

  10. Bixby C, Baker-Fox C, Deming C, et al. A multidisciplinary quality improvement approach increases breastmilk availability at discharge from the neonatal intensive care for the very-low-birth-weight infant. Breastfeed Mod. 2016;11:75–9.

    Article  Google Scholar 

  11. Parker MG, Stellwagen LM, Noble L, Kim JH, Poindexter BB, Puopolo KM. Section on Breastfeeding, Committee on Nutrition, Committee on Fetus and Newborn. Promoting human milk and breastfeeding for the very low birth weight infant. Pediatrics. 2021;148:e2021054272.

    Article  PubMed  Google Scholar 

  12. Lussier MM, Brownell EA, Proulx TA, et al. Daily breastmilk volume in mothers of very low birth weight neonates: a repeated-measures randomized trial of hand expression versus electric breast pump expression. Breastfeed Med. 2015;10:312–7.

    Article  PubMed  Google Scholar 

  13. Becker GE, Cooney F, Smith HA. Methods of milk expression for lactating women. Cochrane Database Syst Rev. 2011;12:CD006170.

    Google Scholar 

  14. Morton J, Hall JY, Wong RJ, Thairu L, Benitz WE, Rhine WD. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. J Perinatol. 2009;29:757–64.

    Article  CAS  PubMed  Google Scholar 

  15. Mondkar J, Chawla D, Sachdeva RC, et al. Impact of mother-baby friendly initiative plus approach on improving human milk feeding for neonates in hospital: a quality improvement before-and-after uncontrolled study. Eur J Pediatr. 2022;181:107–16.

    Article  PubMed  Google Scholar 

  16. Prime DK, Garbin CP, Hartmann PE, Kent JC. Simultaneous breast expression in breastfeeding women is more efficacious than sequential breast expression. Breastfeed Med. 2012;7:442–7.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lechner BE, Vohr BR. Neurodevelopmental outcomes of preterm infants fed human milk: a systematic review. Clin Perinatol. 2017;44:69–83.

    Article  PubMed  Google Scholar 

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Acknowledgements

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

  1. Department of Neonatology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India

    Thaslima Kalathingal, Swati Manerkar, Jayashree Mondkar & Himani Khandekar

  2. Ex-faculty, Department of Neonatology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India

    Pavan Kalamdani, Saikat Patra & Samandeep Kaur

Authors
  1. Thaslima Kalathingal
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  2. Swati Manerkar
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  3. Jayashree Mondkar
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  4. Pavan Kalamdani
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  5. Saikat Patra
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  6. Samandeep Kaur
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  7. Himani Khandekar
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Contributions

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.

Corresponding author

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). https://doi.org/10.1007/s12098-023-04859-4

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  • DOI: https://doi.org/10.1007/s12098-023-04859-4

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