Randomized Trial Comparing the Effectiveness of 2 Electric Breast Pumps in the NICU

Abstract

Original Research Well Established Mothers of preterm infants are strongly encouraged to express breast milk for their infant, and most neonatal intensive care units recommend double-pumping using an electric pump. Incorporating petal massage cushions into a manual pump has proven benefits for milk expression in this setting. Newly ExpressedAn electric pump incorporating massage cushions showed similar effectiveness to a standard hospital-grade electric pump for milk expression in the neonatal intensive care unit. Similar proportions of infants received breast milk at discharge, but mothers using the novel pump were more likely to be directly breastfeeding. BackgroundThe use of human milk is strongly recommended for preterm infants, 1,2 and an increasing number of mothers aim to provide breast milk for their infant. However, these infants are frequently too immature or sick to breastfeed and mothers may need to express milk for a considerable length of time. Breast pumps rely predominantly on suction to extract milk, which may be unphysiological and is sometimes unpleasant for mothers.3 In recent years, research to improve pump design has focused on the use of compression stimuli 3,4 and different frequency and vacuum patterns. [5][6][7] The Medela Symphony pump (pump S; Medela AG, Baar, Switzerland) Objective: This study aimed to compare the effectiveness of 2 electric pumps: Medela Symphony (pump S) and a novel pump (Philips AVENT Twin electronic pump; pump A). Both offer flexibility of rate and suction; pump A also incorporates petal compression cushions. Primary outcomes were (1) milk weight expressed during 10-day study period and (2) weight of milk expressed in a 15-minute test. Methods: Seventy-one mothers with preterm infants < 34 weeks were randomized. Mothers completed 10-day diaries including weight of milk expressed. Milk weight expressed during a single 15-minute test period and data on pumping mode, skin-to-skin contact, breastfeeding at infant discharge, and mothers' opinions of the pump were recorded. Results: There was no significant difference in milk expressed during the first 10 days between groups. Pump S mothers expressed significantly more milk during a fixed 15-minute period. Mothers using pump A awarded higher scores for certain characteristics of the pump, notably location of control button and ease of use. Similar proportions of infants received breast milk at discharge, but pump A mothers were more likely to be directly breastfeeding (odds ratio, 4.27 [95% confidence interval, 1.29, 14.1]). Conclusion:The breast pumps showed similar effectiveness in terms of milk expression and maternal opinions. The finding that breast pump design may influence breastfeeding at infant discharge merits further investigation.

Short‐term efficacy of two breast pumps and impact on breastfeeding outcomes at 6 months in exclusively breastfeeding mothers: A randomised trial

“…Mothers who used pump A awarded significantly more favourable scores for certain pump characteristics—ease of use, how pleasant the pump was to use, comfort, feel of the pump insert, and the need to lean forward—compared with mothers who used pump B, similar to findings in previous trials using manual or electric versions of these pumps in mothers of both preterm and term infants (Fewtrell, Lucas, Collier, Singhal, et al, ; Burton, Kennedy, et al, ; Fewtrell, Lucas, Collier, & Lucas, ). In mothers expressing milk for their preterm infant, we found that the score awarded for comfort of the pump on Day 10 was a significant predictor of total milk volume expressed whereas the infant was hospitalised (Burton, Kennedy, et al, ). However, in the current trial, opinions of the pump did not predict the amount of milk expressed, albeit on a single occasion at 5–6 weeks, nor breastfeeding practices at 6 months.…”

“…Secondary outcome measures were infant feeding practices reported at 3 and 6 months of age and opinions of the bottle if used. The hypotheses were based on the fact that Pump A combines two features previously shown to improve outcomes (a compression cushion and flexibility of speed and suction) whereas Pump B has one feature (flexibility of speed and suction) and on data from previous studies in which Pump A and bottle A received higher scores for certain characteristics (Fewtrell, Lucas, Collier, Singhal, et al, ; Burton, Kennedy, et al, ; Fewtrell, Lucas, Collier, & Lucas, ); Fewtrell, Kennedy, Nicholl, Khakoo, & Lucas, ).…”

“…Breast pump technology was historically based largely on suction, which may be unphysiological (Burton, Deng, MacDonald, & Fewtrell, ). Advances in pump technology have included the introduction of massage cushions in the pump insert which aim to mimic the compressive action of the infant during breastfeeding; a strategy shown to be effective and appreciated by mothers expressing milk for both preterm (Fewtrell, Lucas, Collier, Singhal, ; Burton et al, ) and term infants (Fewtrell, Lucas, Collier, Singhal, et al, ). Another development has been the introduction of two‐phase patterns of milk expression, with “let down” and “expression” phases to mimic an infant breastfeeding (Kent, Ramsay, Doherty, Larsson, & Hartmann, ).…”

Predictors of expressed breast milk volume in mothers expressing milk for their preterm infant

“…Eleven mothers had used a breast pump while feeding a previous infant. The median (25th, 75th centile) age at enrolment was 34 (22, 55) h. As previously reported,15 the type of breast pump used did not significantly influence milk production during the NICU stay, so data for all mothers were combined for analysis of predictors of milk production.…”

“…Details of the study design and procedures have been published previously,15 but are summarised here. The study was conducted in two UK NICUs.…”