Nonpharmacologic Factors Affecting Milk Production in Pump-Dependent Mothers of Critically Ill Infants: State of the Science.
Marion M Bendixen, Larissa C Iapicca, Leslie A Parker
PMID 36700680WHAT IT FOUND
Pump-dependent NICU mothers who expressed more often tended to produce more milk.
Electric pumping, hands-on techniques, massage, warm compresses, music, and skin-to-skin care showed limited support.
Key findings
01Thirteen studies examined expression frequency, and 12 found a positive relationship between number of expressions per day and milk volume.
02In the reviewed comparisons, electric breast pumps produced more daily milk volume than hand expression in the first week, though differences were not consistent at later time points.
03Four studies investigated skin-to-skin care, and the review concluded it may have a positive effect on milk volume, but timing and number of episodes remain unclear.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Most included studies were observational or small pilot trials. They show associations more than cause. Many samples were small and had large individual variation in milk volume. This made it hard to detect true effects. Milk volume was often based on maternal self-report. This can be affected by recall bias. Attrition was substantial in some longitudinal studies, including a 47% attrition rate in one skin-to-skin cohort. Results may reflect mothers who were more motivated to continue. The review focused only on expression factors. It excluded galactagogues, pump brand comparisons, and post-discharge outcomes. The evidence base is mainly mothers of very low birthweight infants, so it may not apply to all NICU mothers or mothers of term infants.
The easy way to misread this
Do not treat the review's suggested practices as proven interventions. Most included studies were observational, small, or pilot trials, and expression frequency, timing, and method were often not separated.