An Integrative Review of Exclusive Breast Milk Expression.
Kimberly Rosenbaum, Barbara McAlister
PMID 39618242WHAT IT FOUND
Exclusive expressing can be common in NICU and preterm families, but insufficient milk supply and early formula use are frequent.
Nurses should teach pumping routines early and refer supply or latch problems to a lactation consultant.
Key findings
01Exclusive expression prevalence varied widely, from 6.8% to 62% among healthy infants and up to 79% among infants who were premature, critically ill, or needed surgery.
02Women who exclusively expressed were more likely to have given birth preterm (52% vs 8%), have a NICU newborn (58% vs 11%), and have twin births (45.1% vs 29.3%).
03Women using EE were more likely than women using mixed feeding to report insufficient milk supply (91% vs 75%) and to start formula earlier (median 1 day vs 3 days).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review combined observational, qualitative, mixed-methods, and one true experimental study, so it cannot show that exclusive expression caused any outcome. 24 of the 27 studies were nonexperimental, and 6 were rated low quality. Prevalence and practices varied widely by country, setting, infant age, and study aim. EE was not defined by a minimum duration across studies, and some studies did not clearly separate EE from mixed feeding. The infant weight-gain finding came from a large study with only 34 infants fed by EE. The cognition and motor findings grouped women who chose EE with mixed feeding, so exclusive expression alone was not isolated. Only English-language studies from the previous 10 years were searched, so relevant work in other languages or older publications may have been missed. Publication bias and missed published literature were acknowledged by the authors. Some studies had small samples, so their findings may not be reliable. The included studies had different aims and comparison groups, so findings are hard to combine.
Declared interests
K.R. received funding for conference travel and attendance from Lansinoh Laboratories. B.M. declared no conflicts of interest.
The easy way to misread this
Do not read the 89 g monthly weight-gain finding or the cognitive and motor score differences as proof that exclusive expression causes better infant outcomes. The weight-gain study had only 34 infants fed by EE, and the cognition study grouped women who chose EE with mixed feeding, so the effect of exclusive expression alone was not separated.