Early initiation and regular breast milk expression reduces risk of lactogenesis II delay in at-risk Singaporean mothers in a randomised trial.

Doris Fok; Izzuddin Mohd Aris; Jiahui HO; Yiong-huak Chan; Mary Rauff; James KC Lui; Mark D Cregan; Peter Hartmann; Yap Seng Chong; Citra NZ Mattar

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Early initiation and regular breast milk expression reduces risk of lactogenesis II delay in at-risk Singaporean mothers in a randomised trial.

Author: Doris FOK ¹ ; Izzuddin Mohd ARIS ² ; Jiahui HO ¹ ; Yiong-Huak CHAN ³ ; Mary RAUFF ¹ ; James KC LUI ⁴ ; Mark D CREGAN ⁵ ; Peter HARTMANN ⁵ ; Yap Seng CHONG ¹ ; Citra NZ MATTAR ¹
Author Information

1. Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
2. Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore.
3. Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
4. Proteomics International, Broadway, Nedlands.
5. School of Chemistry and Biochemistry, The University of Western Australia, Australia.
Publication Type:Journal Article
Keywords: breast pump; breastfeeding initiation; lactation delay; lactogenesis; regular expression
MeSH: Adult; Breast Feeding; methods; Breast Milk Expression; methods; Citrates; analysis; Female; Humans; Infant Formula; Infant, Newborn; Lactation; physiology; Milk, Human; chemistry; physiology; Mothers; Proteins; analysis; Sodium; analysis; Young Adult
From:Singapore medical journal 2019;60(2):80-88
CountrySingapore
Language:English
Abstract: INTRODUCTION:Lactogenesis II (LaII) failure can be prevented in at-risk mothers with simple proactive interventions. In a randomised trial, we investigated the efficacy of early and regular breast milk expression in establishing LaII, using an electric double-breast pump.
METHODS:Mothers with uncomplicated singleton deliveries were randomised to intervention (n = 31) or control (n = 29) groups. The former commenced breast milk expression with an electric pump within one hour of delivery and maintained regular expression with direct breastfeeding. Control mothers directly breastfed without regular pump expression. Expressed milk volumes were analysed for citrate, lactose, sodium and protein.
RESULTS:Median time of LaII was Day 3 (interquartile range [IQR] 1 day) with intervention and on Day 4 (IQR 1 day) among controls (p = 0.03). Biochemical steady-state concentrations were achieved around early Day 4 (sodium, total protein) and Days 4-5 (citrate, lactose). Sodium, protein and lactose levels were similar in both groups over seven days, at 5.80 mM, 0.68 mM and -13.38 mM, respectively. Mean daily milk volume with intervention was 73.9 mL on Day 3 and 225.2 mL on Day 7, greater than controls (25.4 mL on Day 3 and 69.2 mL on Day 7; p < 0.2). Mean infant weights were similar on Day 8 at 3,477 g with intervention and 3,479 g among controls.
CONCLUSION:LaII is established by postnatal Day 3 with early initiation of regular breast milk expression, a useful intervention for mothers at risk of early-onset breastfeeding failure.