title: Electric breast pump use increases maternal milk volume in African nurseries.
abstract: Health experts worldwide recognize breastmilk as the superior infant food. Recommendations from the American Academy of Pediatrics and the World Health Organization (WHO) identify exclusive breastfeeding for the first half-year of life and continuation of breastfeeding into toddlerhood as offering maximum protection from illness, providing a substrate for immunological protection. Data from developed countries identify increasing morbidity and mortality rates for infants who have never received breastmilk in life and demonstrate that infants benefit from exclusive breastfeeding, especially, in areas of severe poverty. Preterm infants, most at risk for morbidity and mortality in developing countries, are identified as needing their own mother's milk for survival. Exclusive feeding of own mothers' milk (OMM) is associated with improved infant survival; however, inadequate maternal milk volume (MMV) often necessitates adding artificial feedings or exogenous substances to OMM. The objective of this study was to compare mean daily MMV for mothers of premature or sick infants in special care nurseries (SCN) using one of three methods of OMM expression: electric breast pump, non-electric pedal breast pump, and hand (manual) expression. We studied 65 mothers whose infants were cared for in two SCN in Africa (Kenya and Nigeria) and were unable to feed directly at the breast. In this randomized trial, mothers were randomly assigned to one of three milk expression groups at birth. MMV, the dependent variable, was measured for an average of 8.7 days. MMV for the electric and pedal pump and hand milk expression was 578 +/- 228 ml (n = 22), 463 +/- 302 ml (n = 24) and 323 +/- 199 ml (n = 19), respectively. Data were evaluated using a one-way ANOVA (p = 0.014). The Tukey revealed significant differences (p < 0.01) between electric breast pump expression and hand expression but not between the electric and pedal pump or the pedal pump and hand expression. Findings revealed greater MMV with electric breast pumps than hand-expression for mothers of infants in African nurseries. This data has important implications for international policy if exclusive OMM feeding is to be achieved for the vulnerable infant. Funded by West Virginia University Department of Research and Graduate Studies HSC Grant # 2U023U; Non-monetary donations of breast pumps and breast pump kits were made by Medela (Medela, Inc., McHenry, IL, USA).
authors.affiliation: Department of Pediatrics, University of Louisville, Louisville, KY, USA. tina.slusher@louisville.edu
authors.forename: Tina
authors.initials: T
authors.lastname: Slusher
authors.forename: Ida L
authors.initials: IL
authors.lastname: Slusher
authors.forename: Margaret
authors.initials: M
authors.lastname: Biomdo
authors.forename: Fidelia
authors.initials: F
authors.lastname: Bode-Thomas
authors.forename: Beverly A
authors.initials: BA
authors.lastname: Curtis
authors.forename: Paula
authors.initials: P
authors.lastname: Meier
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001942:Breast Feeding; D004867:Equipment Design; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007630:Kenya; D007774:Lactation; D008423:Maternal Age; D008895:Milk, Human / Q000378:metabolism*; D009549:Nigeria; D009725:Nurseries, Hospital