Research Journal

Title: STRATEGIES TO INCREASE MILK VOLUME

IN MOTHERS OF VLBW INFANTS
Authors: Leslie A. Parker,PhD, NNP-BC, Sandra Sullivan, MD,
Charlene Krueger, PhD, ARNP, Teresa Kelechi, PhD, And Martina
Mueller, PhD
Source: Book MCN PGR 386

Objective Of The Study:

The purpose of this systematic review is to critique the evidence
regarding specific milk expression strategies that aim to improve milk
volume in mothers if VLBW Infants. These results may be used to
formulate specific strategies designed to increase breast volume in this
population.

Sample Population: Figure 1 Search Strategies

Search date: January 2011 through November 2011
Search Included: PubMed, CINAHL, SCIRUS, Institute, and ISI web of
knowledge

Review of the titles and exclusion of those

not meeting criteria

1000 + articles

173 abstract met initial

criteria

48 studies retrieved

10 studies included
from database
searches

Abstract reviewed. Those studies not meeting

criteria excluded. Full Study Information
retrieved on all those meeting criteria

Excluded studies not specific to VLBW infants,

milk expression strategies or milk volume as an
outcome or if they were not experimental, quasiexperimental, or observational studies

Additional two studies included rom hand

searches

Methodology:
Total numbers of studies reviewed is 12
A search was conducted of the electronic databases PubMed, CINAHL,
Scirus, Institute of scientific Knowledge Web of Knowledge as well as
the reference between 1980 and 2011. Databases were searched for
articles that included one or more of the following terms: VLBW or
premature infant and breast milk, human milk, milk expression, pumping,
breastfeeding, kangaroo care, milk volume, and lactation revealing 11
studies that met the criteria.

Results:
Study Characteristics
Twelve studies met inclusion criteria for evaluation Analysis revealed
seven strategies for increasing milk volume in months of VLBW infants:
1. Expression frequency
2. Timing of initiation of milk expression following delivery
3. Provision of KC
4. Simultaneous versus Sequential Milk Expression
5. Duration of the Pumping session
6. Type of pump used
7. Hand Expression
Studies are summarized in Supplemental Digital Content, Table 2
provided online.

Nursing Implication:
Nurses can use the results of this review in formulating strategies to assist
mothers of VLBW infants to optimize breast milk production. Frequent
milk expression and initiation of milk expression soon after delivery
should be included in lactation guidelines, and although evidencesupporting provision of KC to facilitate lactation is less robust, KC is a
bening procedure and should be considered for mothers of VLBW
infants. Information regarding timeliness of simultaneous expression
should be provided and the ability of an appropriate pump addressed. Due
to frequent inadequate location counseling staffing and lack of lactation
support on off-shirts, staff nurses are often required to provide lactation
counseling and therefore required knowledge regarding strategies to
optimize lactation in this vulnerable population. Because indirect factors

associated with an insufficient milk supply (e.g., ethnicity, socioeconomic

status, maternal health status, and education) are nonmodifiable,
guidelines should focus on realistic strategies to improve milk supply.

Personal Reaction:
Providing breast milk to VLBW infants is associated with
vast health benefits for mother and infants. This systematic review
highlights how strategies involving early initiation and increased
frequency of milk expression as well as provision of KC may positively
impact milk volume in mothers of VLBW infants.

Submitted by: Angelica Paula S.Tolentino