manual method vs breast pump for breast milk expression in poorly sucking term babies in first postnatal week

STUDY OBJECTIVE

To compare breast milk volume between manual breast milk expression and breast pump expression among mothers of term infants with poor latch or poor suck at different time points on postnatal day 2 day 3 and day 4

STUDY DESIGN

Randomized controlled trial

STUDY SETTING

Postnatal ward of a tertiary care hospital

INCLUSION CRITERIA

Mothers of term infants equal to or more than 37 weeks gestation

Infants with poor latch or poor suck

Poor latch or poor suck determined by maternal interview review of lactation consultation and assessment by a study doctor or nurse

EXCLUSION CRITERIA

Mother age less than 18 years

History of breast surgery other than cyst removal

Infants with gestational age less than 37 weeks

Birth weight less than 2500 g

RANDOMIZATION

Eligible mother infant less than 7days were randomly assigned to one of two groups

Manual expression group

Pump expression group

INTERVENTIONS

PRE INTERVENTION PROCEDURE

Initial infant weight recorded using the same weighing scale

Mothers attempted breastfeeding with advice and support from a study doctor or nurse

MANUAL EXPRESSION GROUP

Mothers were taught Marmet hand expression technique

Hand expression performed for 15 minutes in a single supervised session

PUMP EXPRESSION GROUP

Mothers were taught breast pumping technique

Bilateral electric breast pump used for 15 minutes in a single supervised session

Vacuum setting started at 30 mm Hg and gradually increased as tolerated

OUTCOME MEASURES

Expressed breast milk volume measured after expression

Cumulative milk volume calculated

All expressed milk measured using a syringe

Expressed milk fed to infants using syringe cup or spoon

Infants reweighed on the same scale after feeding

QUESTIONNAIRES

Breastfeeding confidence assessment

Breastfeeding related pain assessed in breast lower abdomen back and perineum on a scale of 0 to 10

Assessment of social support for milk expression

Assessment of personal and learning experience of milk expression

FOLLOW UP

Phone follow up at 2 weeks 1 month and 2 months

Assessment of breastfeeding milk expression and formula use