A randomised controlled trial to compare methods of milk expression after preterm delivery

Objectives-Primary: to compare sequential and simultaneous breast pumping o n volume of milk expressed and its fat content. Secondary: to measure the e ffect of breast massage on milk volume and fat content. Design-Sequential randomised controlled trial. Setting-Neonatal intensive care unit, North Staffordshire Hospital NHS Trus t. Subjects-Data on 36 women were analysed; 19 women used simultaneous pumping and 17 used sequential pumping. Interventions-Women were randomly allocate d to use either simultaneous (both breasts simultaneously) or sequential (o ne breast then the other) milk expression. Stratification was used to ensur e that the groups were balanced for parity and gestation. A crossover desig n was used for massage, with patients acting as their own controls. Women w ere randomly allocated to receive either massage or non-massage first. Main outcome measures-Volume of milk expressed per expression and its fat c ontent (estimated by the creamatocrit method). Results-Milk yield per expression was: sequential pumping with no massage, 51.32 g (95% confidence interval (CI) 56.57 to 46.07); sequential pumping w ith massage, 78.71 g (95% CI 85.19 to 72.24); simultaneous pumping with no massage, 87.69 g (95% CI 96.80 to 78.57); simultaneous pumping with massage , 125.08 g (95% CI 140.43 to 109.74). The fat concentration in the milk was not affected by the increase in volume achieved by the interventions. Conclusions-The results are unequivocal and show that simultaneous pumping is more effective at producing milk than sequential pumping and that breast massage has an additive effect, improving milk production in both groups. As frequent and efficient milk removal is essential for continued productio n of milk, mothers of preterm infants wishing to express milk for their sic k babies should be taught these techniques.