Practices, predictors and consequences of expressed breast-milk feeding in healthy full-term infants.
To investigate the prevalence and predictors of expressed breast-milk feeding in healthy full-term infants and its association with total duration of breast-milk feeding.



Prospective cohort study.



In-patient postnatal units of four public hospitals in Hong Kong.



A total of 2450 mother-infant pairs were recruited in 2006-2007 and 2011-2012 and followed up prospectively for 12 months or until breast-milk feeding had stopped.



Across the first 6 months postpartum, the rate of exclusive expressed breast-milk feeding ranged from 5·1 to 8·0 % in 2006-2007 and from 18·0 to 19·8 % in 2011-2012. Factors associated with higher rate of exclusive expressed breast-milk feeding included supplementation with infant formula, lack of previous breast-milk feeding experience, having a planned caesarean section delivery and returning to work postpartum. Exclusive expressed breast-milk feeding was associated with an increased risk of early breast-milk feeding cessation when compared with direct feeding at the breast. The hazard ratio (95 % CI) ranged from 1·25 (1·04, 1·51) to 1·91 (1·34, 2·73) across the first 6 months.



Mothers of healthy term infants should be encouraged and supported to feed directly at the breast. Exclusive expressed breast-milk feeding should be recommended only when medically necessary and not as a substitute for feeding directly at the breast. Further research is required to explore mothers' reasons for exclusive expressed breast-milk feeding and to identify the health outcomes associated with this practice.
1School of Nursing, Li Ka Shing Faculty of Medicine,The University of Hong Kong,4/F William M.W. Mong Block,21 Sassoon Road,Hong Kong Special Administrative Region,People's Republic of China.
Dorothy Li
DL
Bai
1School of Nursing, Li Ka Shing Faculty of Medicine,The University of Hong Kong,4/F William M.W. Mong Block,21 Sassoon Road,Hong Kong Special Administrative Region,People's Republic of China.
Daniel Yee Tak
0000-0001-7365-9146
DY
Fong
1School of Nursing, Li Ka Shing Faculty of Medicine,The University of Hong Kong,4/F William M.W. Mong Block,21 Sassoon Road,Hong Kong Special Administrative Region,People's Republic of China.
Kris Yuet Wan
0000-0002-1938-8805
KY
Lok
1School of Nursing, Li Ka Shing Faculty of Medicine,The University of Hong Kong,4/F William M.W. Mong Block,21 Sassoon Road,Hong Kong Special Administrative Region,People's Republic of China.
Janet Yuen Ha
JY
Wong
2School of Nursing,University of British Columbia,Kelowna, British Columbia,Canada.
Marie
M
Tarrant
D001903:Bottle Feeding; D061186:Breast Milk Expression / Q000009:adverse effects*; D002585:Cesarean Section / Q000009:adverse effects; D005260:Female; D006723:Hong Kong; D006801:Humans; D007223:Infant; D041943:Infant Formula; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D009035:Mothers / Q000706:statistics & numerical data*; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D013997:Time Factors
Breast milk; Breast-feeding; Chinese; Expression; Pumping
Matern Child Nutr. 2009 Jul;5(3):199-210
19531047
J Obstet Gynecol Neonatal Nurs. 2009 May-Jun;38(3):259-68
19538614
Am J Public Health. 2011 Aug;101(8):1356-9
21680919
Soc Sci Med. 2006 Nov;63(10):2727-38
16879904
PLoS One. 2014 Feb 19;9(2):e89077
24586513
Public Health Nutr. 2015 Oct;18(14):2689-99
25721766
BMC Med Res Methodol. 2012 Nov 23;12:179
23176436
N Engl J Med. 2006 Oct 19;355(16):1682-9
17050892
BMC Pregnancy Childbirth. 2015 Nov 03;15:286
26531299
J Hum Lact. 2008 May;24(2):150-8
18436966
Breastfeed Med. 2010 Jun;5(3):135-7
20433365
Stat Med. 1997 May 15;16(9):965-80
9160492
Pediatr Clin North Am. 2001 Apr;48(2):425-42
11339162
Int Breastfeed J. 2011 May 17;6:5
21586109
Matern Child Health J. 2015 May;19(5):990-9
25095769
J Fam Pract. 2002 May;51(5):439-44
12019051
Pediatr Res. 2006 May;59(5):728-31
16627890
Res Nurs Health. 2006 Aug;29(4):256-68
16847899
Matern Child Nutr. 2013 Jul;9(3):425-30
22236401
Pediatrics. 2002 Apr;109(4):e57
11927730
Stud Fam Plann. 1990 Jul-Aug;21(4):226-30
2219227
Psychol Rev. 1977 Mar;84(2):191-215
847061
Breastfeed Med. 2012 Apr;7(2):112-7
21777073
J Adv Nurs. 2013 Mar;69(3):590-9
22607057
Breastfeed Med. 2011 Dec;6(6):433-4
21133763
Pediatrics. 2010 Jun;125(6):e1386-93
20457676
BMC Pregnancy Childbirth. 2013 Nov 19;13:212
24246046
Pediatr Res. 2006 Oct;60(4):450-5
16940236
Arch Pediatr Adolesc Med. 2012 May;166(5):431-6
22566543
Evid Rep Technol Assess (Full Rep). 2007 Apr;(153):1-186
17764214
Soc Sci Med. 2009 Sep;69(6):900-7
19646802
Midwifery. 1999 Dec;15(4):232-46
11216257
Nutr Rev. 2005 Apr;63(4):103-10
15869124
Pediatrics. 2008 Oct;122 Suppl 2:S56-62
18829832
J Hum Lact. 2013 Nov;29(4):527-36
23439865
Int Breastfeed J. 2009 Jun 16;4:6
19531253
Breastfeed Med. 2012 Aug;7:295-301
22047109
J Hum Lact. 2014 Feb;30(1):62-72; quiz 110-2
24166052
BMC Pregnancy Childbirth. 2010 May 29;10:27
20509959
J Hum Lact. 2010 Aug;26(3):258-65
20689102
Breastfeed Rev. 2006 Nov;14(3):5-9
17190014
Community Dent Health. 2004 Mar;21(1 Suppl):71-85
15072476
Pediatr Int. 2010 Feb;52(1):39-43
19519669
J Obstet Gynecol Neonatal Nurs. 2002 Jan-Feb;31(1):12-32
11843016
Matern Child Nutr. 2016 Apr;12(2):291-8
25134622
Int Breastfeed J. 2006 Dec 22;1:28
17184553
J Pediatr. 1995 Jun;126(6):S125-9
7776072
Cochrane Database Syst Rev. 2012 Sep 12;(9):CD006425
22972092
BMJ Open. 2015 May 07;5(5):e007512
25953728
Matern Child Nutr. 2017 Apr;13(2):
27103601
Pediatrics. 2008 Oct;122 Suppl 2:S63-8
18829833
Breastfeed Med. 2015 Nov;10(9):412-5
26393901
Matern Child Nutr. 2013 Apr;9(2):180-7
22625407
BMC Pregnancy Childbirth. 2015 Oct 20;15:268
26487378
J Hosp Infect. 2001 Dec;49(4):274-81
11740876
Breastfeed Rev. 2011 Mar;19(1):5-7
21608521
J Hum Lact. 2005 Nov;21(4):413-20
16280557
Ann Acad Med Singap. 2010 Feb;39(2):88-94
20237728
Cochrane Database Syst Rev. 2011 Dec 07;(12):CD006170
22161398
Thorax. 2009 Jan;64(1):62-6
19001004
Pediatrics. 2001 Jun;107(6):E94
11389292