School of Nursing Midwifery and Social Work, University of Queensland, St Lucia, QLD, Australia.
Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Casuarina, NT, Australia.
J Hum Lact. 2023 May;39(2):226-235. doi: 10.1177/08903344221088789. Epub 2022 May 11.
Globally, 10% of all births are preterm. Access to human milk via manual breast expression is required to reduce the incidence of adverse outcomes related to prematurity. However, there is little evidence to recommend optimum timing to commence breast expression in mothers of preterm infants or the most effective method.
(1) To test feasibility of recruitment and compliance to the protocol and (2) to determine influence of using hand expressing and breast massage on milk production, engorgement, mastitis, and breastfeeding status at 3 months.
This study was an exploratory parallel two-group, pilot randomized controlled trial. Mothers of preterm infants at a metropolitan maternity hospital in Queensland Australia ( = 31) were randomized to receive either hand expressing and breast massage within the 1st hr of birth or standard care, hand expressing within 6 hr of birth, to determine the influence on milk production, engorgement, mastitis, and breastfeeding status at 3 months.
Feasibility targets were not met; however, valuable learning from this trial uncovered barriers facing midwives in the birth suite to commencing expressing in the 1st hr of birth. There was no difference in occurrence of secondary outcomes, although trends support future study.
Overall, unpredictability of preterm birth influenced our ability to recruit participants. Important directions for future study design would benefit from incorporating expressing times up to 6 hr with a replicable breast massage.
全球范围内，有 10%的分娩为早产儿。通过手动挤奶来获取人乳，可降低与早产相关的不良结局的发生率。然而，目前几乎没有证据推荐早产儿母亲开始挤奶的最佳时间或最有效的方法。
（1）测试本方案的招募和依从性的可行性；（2）确定在出生后 1 小时内使用手动挤奶和乳房按摩对乳汁分泌、乳房肿胀、乳腺炎和 3 个月时母乳喂养状况的影响。
本研究为探索性平行两组、初步随机对照试验。澳大利亚昆士兰州一家大都市妇产医院的早产儿母亲（n=31）被随机分为两组，一组在出生后 1 小时内接受手动挤奶和乳房按摩，另一组在出生后 6 小时内接受标准护理和手动挤奶，以确定对 3 个月时乳汁分泌、乳房肿胀、乳腺炎和母乳喂养状况的影响。
虽然未达到可行性目标，但从该试验中获得了有价值的经验，揭示了产房中助产士在出生后 1 小时内开始挤奶所面临的障碍。次要结局的发生没有差异，但趋势支持进一步研究。
总体而言，早产的不可预测性影响了我们招募参与者的能力。未来的研究设计应考虑到将挤奶时间延长至 6 小时，并采用可复制的乳房按摩，这将是重要的研究方向。
