Early Initiation of Milk Expression in Mothers of Very Low Birth Weight Infants

Compelling evidence exists that breast milk helps protect very premature infants from
prematurity-specific morbidities. Unfortunately, mothers of premature infants often exhibit
delayed lactogenesis stage II (when the milk "comes in") and decreased breast milk
production. Several studies have linked earlier initiation of breast milk expression
following delivery with a greater milk production. However, none conclusively determined the
optimal timing of breast milk expression. As a result these mothers continue to struggle with
inadequate breast milk production. This study will follow 180 mothers of premature infants
for 6 weeks following delivery to test

Earlier initiation of breast milk expression following delivery is associated with (1) an
earlier lactogenesis stage II, (2) greater volume of breast milk production during the first
6 weeks, (3) improved short-term infant health outcomes and (4) women who deliver at an
earlier gestation will have decreased milk production and a later lactogenesis stage II.
Following stratification according to the gestational age of the infant (23-27 weeks vs.
28-32 weeks), eligible women will be randomly assigned to one of three groups and instructed
to start mechanically expressing their r breasts, either in the first hour, 1-3 hours or 3-6
hours following delivery. The timing of lactogenesis stage II will be documented, and the
volume of breast milk produced will continue to be measured for the first 6 weeks following
delivery and at discharge. Infant nutritional outcomes will be measured throughout the 6-week
study. The impact of the differences in timing of initiation of milk expression following
delivery on timing of lactogenesis stage II, milk volume, short term nutritional outcomes,
amount of breast milk feedings at discharge, and impact of gestational age on milk volume and
lactogenesis stage II will be determined.