title: Daily Breastmilk Volume in Mothers of Very Low Birth Weight Neonates: A Repeated-Measures Randomized Trial of Hand Expression Versus Electric Breast Pump Expression.
abstract: BACKGROUND
  There are no randomized trials comparing early exclusive hand expression (HE) with early exclusive electric pump expression (electric expression [EE]) for milk removal in mothers of very low birth weight (VLBW) infants.
  
  
  METHODS
  Mothers of VLBW infants were randomized to exclusively HE or EE for the first 7 days postpartum. Daily volumes of milk were compared between groups for the first 28 days, adjusting for repeated measures.
  
  
  RESULTS
  The HE (n=12) and the EE (n=14) groups did not differ with respect to age, parity, single versus multiple gestation, or number of expression sessions per day. There were 728 values for daily milk volumes in the first 28 days, including 105 HE and 623 EE. Mothers using exclusive HE had significantly (p<0.05) less cumulative daily milk production throughout the first 7 days postpartum compared with exclusive EE. Mean cumulative milk production among mothers using HE in the first postpartum week remained approximately half that of those using the electric pump throughout the first 28 days, without evident catch up. In multivariable analysis, each postpartum day was associated with an adjusted increase of 50 mL of human milk/day during the first 7 days postpartum and an increase of 13 mL/day between postpartum Days 8 and 28. After adjusting for repeated measures, number of expression sessions per day, and postpartum day, EE was associated with an advantage in milk production of 119 mL/day during the first 28 postpartum days compared with HE.
  
  
  CONCLUSIONS
  Compared with mothers using EE, mothers using HE had significantly less cumulative daily milk production during the first 7 days postpartum. This trend continued after the intervention had been discontinued, and the great majority of expressions in both groups were with EE. Further research to confirm and expand these findings is warranted.
authors.affiliation: 1 Connecticut Children's Medical Center , Hartford, Connecticut.|2 The Connecticut Human Milk Research Center , Hartford, Connecticut.|3 Divison of Neonatology, University of Connecticut School of Medicine , Farmington, Connecticut.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Lussier
authors.affiliation: 1 Connecticut Children's Medical Center , Hartford, Connecticut.|2 The Connecticut Human Milk Research Center , Hartford, Connecticut.|3 Divison of Neonatology, University of Connecticut School of Medicine , Farmington, Connecticut.|4 Department of Pediatrics, University of Connecticut School of Medicine , Farmington, Connecticut.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Brownell
authors.affiliation: 1 Connecticut Children's Medical Center , Hartford, Connecticut.|2 The Connecticut Human Milk Research Center , Hartford, Connecticut.|3 Divison of Neonatology, University of Connecticut School of Medicine , Farmington, Connecticut.
authors.forename: Tracey A
authors.initials: TA
authors.lastname: Proulx
authors.affiliation: 1 Connecticut Children's Medical Center , Hartford, Connecticut.|2 The Connecticut Human Milk Research Center , Hartford, Connecticut.|3 Divison of Neonatology, University of Connecticut School of Medicine , Farmington, Connecticut.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Bielecki
authors.affiliation: 1 Connecticut Children's Medical Center , Hartford, Connecticut.|2 The Connecticut Human Milk Research Center , Hartford, Connecticut.|3 Divison of Neonatology, University of Connecticut School of Medicine , Farmington, Connecticut.|4 Department of Pediatrics, University of Connecticut School of Medicine , Farmington, Connecticut.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Marinelli
authors.affiliation: 1 Connecticut Children's Medical Center , Hartford, Connecticut.|3 Divison of Neonatology, University of Connecticut School of Medicine , Farmington, Connecticut.|5 University of Connecticut School of Nursing , Storrs, Connecticut.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Bellini
authors.affiliation: 1 Connecticut Children's Medical Center , Hartford, Connecticut.|2 The Connecticut Human Milk Research Center , Hartford, Connecticut.|3 Divison of Neonatology, University of Connecticut School of Medicine , Farmington, Connecticut.|4 Department of Pediatrics, University of Connecticut School of Medicine , Farmington, Connecticut.
authors.forename: James I
authors.initials: JI
authors.lastname: Hagadorn
mesh_terms: D000328:Adult; D000818:Animals; D061186:Breast Milk Expression / Q000191:economics*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D019102:Infant, Very Low Birth Weight / Q000254:growth & development*; D007363:Intensive Care Units, Neonatal; D007774:Lactation; D008895:Milk, Human / Q000378:metabolism*; D009035:Mothers / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D049590:Postpartum Period; D011247:Pregnancy; D012044:Regression Analysis