Investigating the dynamic process of expressing breastmilk for very preterm infants and the influence of a relaxation intervention, with the aim of improving clinical recommendations
<p><strong>Background:</strong> Very preterm infants (born at less than 32 weeks of pregnancy) have higher morbidity and mortality than more mature infants. Even small increases in mother’s own milk quantity are associated with medium and long-term impacts on morbidity. Due to the...
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| Other Authors: | |
| Format: | Thesis |
| Language: | English |
| Published: |
2023
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| Subjects: |
| _version_ | 1797113234683068416 |
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| author | Levene, I |
| author2 | Quigley, M |
| author_facet | Quigley, M Levene, I |
| author_sort | Levene, I |
| collection | OXFORD |
| description | <p><strong>Background:</strong> Very preterm infants (born at less than 32 weeks of pregnancy) have higher morbidity and mortality than more mature infants. Even small increases in mother’s own milk quantity are associated with medium and long-term impacts on morbidity. Due to the infant’s oral immaturity, the mother must extract milk from the breasts (expressing), which is very challenging. Clinical recommendations to express 8-10 times per day are demanding and adherence is low. Relaxation has been identified as a promising intervention for lactation outcomes.</p>
<p><strong>Aim:</strong> To investigate determinants of the quantity of breastmilk expressed by mothers of very preterm infants, focusing on relaxation interventions and expressing pattern.</p>
<p><strong>Methods:</strong></p>
<p>1) Systematic review and meta-analysis of relaxation interventions and milk yield.</p>
<p>2) A multi-centre, randomised, controlled trial. Mothers giving birth between 23+0 and 31+6 weeks of pregnancy were recruited. The intervention was a 12-minute guided relaxation recording. The primary outcome was the highest 24-hour milk quantity recorded at day 4, 14 or 21 after birth.</p>
<p>3) Exploratory analysis of expressing pattern and lactation outcomes.</p>
<p><strong>Findings:</strong></p>
<p>1) The systematic review included 1982 participants in 18 studies with heterogeneous relaxation interventions. There was moderate certainty evidence that relaxation increased breastmilk quantity by a moderate amount.</p>
<p>2) The randomised trial recruited the target 132 participants. Mean gestational age at birth was 27.8 weeks (SD 2.4). Adjusted mean difference in the primary outcome was 73.9g (95% CI –61.7 to 209.5). The majority of participants liked the intervention and found it relaxing. There were trends within the trial (sub-group analysis) and between trials (meta-regression) suggesting lower effect of relaxation on milk quantity with lower gestation at birth.</p>
<p>3) Less than a quarter of participants expressed eight or more times per day. Expressing frequency was positively associated with 24-hour milk yield (94.4g adjusted increase per session at three weeks after birth, 95% CI 62.7 to 126.2). Expressing eight or more times per day was associated with higher milk yield than expressing less than six times per day, but not compared to 6-7 times per day.</p>
<p><strong>Conclusions:</strong> A weak recommendation can be made to offer relaxation interventions after very preterm birth. Many people value relaxation in this setting and there may be a small increase in milk quantity, which could be clinically important. Evidence for the recommendation to express 8-10 times per day is relatively weak, and this is difficult to achieve. These results can help improve individualised counselling for families.
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| first_indexed | 2024-04-23T08:25:35Z |
| format | Thesis |
| id | oxford-uuid:63d97ec0-7a07-47c2-8326-b47ef676cf8d |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-04-23T08:25:35Z |
| publishDate | 2023 |
| record_format | dspace |
| spelling | oxford-uuid:63d97ec0-7a07-47c2-8326-b47ef676cf8d2024-04-15T10:59:22ZInvestigating the dynamic process of expressing breastmilk for very preterm infants and the influence of a relaxation intervention, with the aim of improving clinical recommendationsThesishttp://purl.org/coar/resource_type/c_db06uuid:63d97ec0-7a07-47c2-8326-b47ef676cf8dPremature infantsLactationLactation--RegulationRelaxation--TechniqueEnglishHyrax Deposit2023Levene, IQuigley, MHardy, PFrances, OFewtrell, M<p><strong>Background:</strong> Very preterm infants (born at less than 32 weeks of pregnancy) have higher morbidity and mortality than more mature infants. Even small increases in mother’s own milk quantity are associated with medium and long-term impacts on morbidity. Due to the infant’s oral immaturity, the mother must extract milk from the breasts (expressing), which is very challenging. Clinical recommendations to express 8-10 times per day are demanding and adherence is low. Relaxation has been identified as a promising intervention for lactation outcomes.</p> <p><strong>Aim:</strong> To investigate determinants of the quantity of breastmilk expressed by mothers of very preterm infants, focusing on relaxation interventions and expressing pattern.</p> <p><strong>Methods:</strong></p> <p>1) Systematic review and meta-analysis of relaxation interventions and milk yield.</p> <p>2) A multi-centre, randomised, controlled trial. Mothers giving birth between 23+0 and 31+6 weeks of pregnancy were recruited. The intervention was a 12-minute guided relaxation recording. The primary outcome was the highest 24-hour milk quantity recorded at day 4, 14 or 21 after birth.</p> <p>3) Exploratory analysis of expressing pattern and lactation outcomes.</p> <p><strong>Findings:</strong></p> <p>1) The systematic review included 1982 participants in 18 studies with heterogeneous relaxation interventions. There was moderate certainty evidence that relaxation increased breastmilk quantity by a moderate amount.</p> <p>2) The randomised trial recruited the target 132 participants. Mean gestational age at birth was 27.8 weeks (SD 2.4). Adjusted mean difference in the primary outcome was 73.9g (95% CI –61.7 to 209.5). The majority of participants liked the intervention and found it relaxing. There were trends within the trial (sub-group analysis) and between trials (meta-regression) suggesting lower effect of relaxation on milk quantity with lower gestation at birth.</p> <p>3) Less than a quarter of participants expressed eight or more times per day. Expressing frequency was positively associated with 24-hour milk yield (94.4g adjusted increase per session at three weeks after birth, 95% CI 62.7 to 126.2). Expressing eight or more times per day was associated with higher milk yield than expressing less than six times per day, but not compared to 6-7 times per day.</p> <p><strong>Conclusions:</strong> A weak recommendation can be made to offer relaxation interventions after very preterm birth. Many people value relaxation in this setting and there may be a small increase in milk quantity, which could be clinically important. Evidence for the recommendation to express 8-10 times per day is relatively weak, and this is difficult to achieve. These results can help improve individualised counselling for families. |
| spellingShingle | Premature infants Lactation Lactation--Regulation Relaxation--Technique Levene, I Investigating the dynamic process of expressing breastmilk for very preterm infants and the influence of a relaxation intervention, with the aim of improving clinical recommendations |
| title | Investigating the dynamic process of expressing breastmilk for very preterm infants and the influence of a relaxation intervention, with the aim of improving clinical recommendations |
| title_full | Investigating the dynamic process of expressing breastmilk for very preterm infants and the influence of a relaxation intervention, with the aim of improving clinical recommendations |
| title_fullStr | Investigating the dynamic process of expressing breastmilk for very preterm infants and the influence of a relaxation intervention, with the aim of improving clinical recommendations |
| title_full_unstemmed | Investigating the dynamic process of expressing breastmilk for very preterm infants and the influence of a relaxation intervention, with the aim of improving clinical recommendations |
| title_short | Investigating the dynamic process of expressing breastmilk for very preterm infants and the influence of a relaxation intervention, with the aim of improving clinical recommendations |
| title_sort | investigating the dynamic process of expressing breastmilk for very preterm infants and the influence of a relaxation intervention with the aim of improving clinical recommendations |
| topic | Premature infants Lactation Lactation--Regulation Relaxation--Technique |
| work_keys_str_mv | AT levenei investigatingthedynamicprocessofexpressingbreastmilkforverypreterminfantsandtheinfluenceofarelaxationinterventionwiththeaimofimprovingclinicalrecommendations |