Combining hand techniques with electric pumping increases the caloric content of milk in mothers of preterm infants

Objective: We previously reported that preterm mothers' milk production can exceed levels of term mothers by using early hand expression and hands-on pumping (HOP) with the highest production (955 ml per day) in frequent users of hand expression. In this study, we compared milk composition between mothers stratified by early hand expression frequency. Study Design: A total of 67 mothers of infants <31 weeks gestation were instructed on hand expression and HOP. Subjects submitted expression records and 1-ml samples from each pumping session over 24 h once weekly for 8 weeks. Result: 78% (52/67) of mothers completed the study. But for Week 1, no compositional differences (despite production differences) were noted between the three groups. Protein and lactose tracked reported norms, but fat and energy of mature milk (Weeks 2-8) exceeded norms, 62.5 g l(-1) per fat and 892.7 cal l(-1) (26.4 cal oz(-1)), respectively. Conclusion: Mothers combining manual techniques with pumping express high levels of fat-rich, calorie-dense milk, unrelated to production differences. Journal of Perinatology (2012) 32, 791-796; doi:10.1038/jp.2011.195; published online 5 January 2012