Optimal Time to Initiate Breast Milk Expression in Mothers Delivering Extremely Premature Infants

Abstract

BACKGROUNDFeeding breastmilk to premature infants decreases morbidity but is often limited owing to an insufficient breast milk supply and delayed attainment of lactogenesis stage II. Early initiation of breast milk expression following delivery has been shown to increase breast milk production in mothers of very low‐birth‐weight (VLBW) infants. However no adequately powered randomized trials have been conducted to determine the optimal time to initiation of breast milk expression in mothers who deliver extremely premature infants. The purpose of this randomized controlled trial was to determine the optimal time to initiate breast milk expression in mothers of VLBW infants.SUBJECTS AND METHODS180 women were stratified according to their infant's gestational age and were randomized to initiate breast milk expression within 60 min (group 1), 60–179 min (Group 2) or 180–360 min (group 3) following delivery. Breast milk volume and timing of lactogenesis stage II was compared between groups using Wilcoxon's rank sum tests. Breast milk volume was measured daily for the first 7 days and weekly for the first 6 weeks. Timing of lactogenesis stage II was determined through mothers' perceptions of sudden breast fullness.RESULTSMothers who initiated BM expression 1–3 hours delivery were more likely to be lactating at 3 weeks (88%), 6 weeks (63%) and at discharge (62%) compared to those who initiated BM expression within 1 hour (68%, 60%, 33%) or 3–6 hours (70%, 54%, 35%) after delivery. In addition, mothers who initiated BM expression 1–3 hours following delivery had an earlier onset of lactogenesis stage II (p=0.013).CONCLUSIONInitiation of breast milk expression 1–3 h following delivery increases duration of lactation and decreases time to lactogenesis stage II in mothers of VLBW infants.Support or Funding InformationResearch reported in this publication was supported by the National Institute Of Nursing Research of the National Institutes of Health under Award Number R15NR01356