Lactation Technologies

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A Comparison of the Efficiency, Efficacy, Comfort, and Convenience of Two Hospital-Grade Electric Breast Pumps for Mothers of Very Low Birthweight Infants

Citation: Meier P.P., Engstrom J.L., Hurst N.M., Ackerman B., Allen M., Motykowski J.E., Zuleger J.L., Jegier B.J. A Comparison of the Efficiency, Efficacy, Comfort, and Convenience of Two Hospital-Grade Electric Breast Pumps for Mothers of Very Low Birthweight Infants. The Journal of Breastfeeding Medicine Vol. 3 No. 3, 2008; 141-150. 

Objective: Many mothers of very low birthweight infants are breast pump-dependent for weeks or months and need a breast pump that is efficient, effective, comfortable, and convenient.
Study design: This multisite, blinded, randomized clinical trial compared the efficiency, efficacy, comfort, and convenience of the Symphony® breast pump (Medela, McHenry, IL) (SBP) to the Classic® breast pump (Medela)
(CBP) and also compared these same outcome measures for single- and multiphase suction patterns used in the SBP. All 100 mothers initiated lactation with the CBP and were randomized to single- and multiphase suction patterns in the SBP when daily milk output was at least 350 mL/day. Protocol I included 35 mothers who compared each of three suction patterns in the SBP on two separate occasions (six observations) in the neonatal
intensive care unit and used the CBP for all other pumpings. Protocol II included 65 mothers who compared single- and multiphase patterns in the SBP for 7 days and then returned to the CBP for 5 days.
Results: The onset of milk ejection was quicker (P < 0.05) for the single- versus multiphase patterns in the SBP, suggesting that mothers had become conditioned to the unphysiolologic single-phase pattern in the CBP. However, all other measures of efficiency and efficacy were not significantly different, including milk output at 5-minute intervals. When asked to compare the SBP and the CBP, mothers in Protocol 1 rated the SBP as significantly more efficient, effective, comfortable, and convenient than the CBP (P < 0.05), regardless of the suction pattern in the SBP. Similarly, mothers in Protocol II rated the SBP significantly (P < 0.05) more comfortable than the CBP, regardless of the specific pattern in the SBP.
Conclusions: These findings suggest that the SBP was as efficient and effective as the CBP but was significantly more comfortable to use for pump-dependent mothers of very low birthweight infants.

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Comparison of Milk Output from the Right and Left Breasts During Simultaneous Pumping in Mothers of Very Low Birthweight Infants

Citation: Engstrom J.L, Meier P.P., Jegier B.J., Motykowski J.E., Zuleger J.L. Comparison of Milk Output from the Right and Left Breasts During Simultaneous Pumping in Mothers of Very Low Birthweight Infants. The Journal of Breastfeeding Medicine Vol 2. No. 2, 2007: 83-91.

Purpose: Milk output from the right and left breasts was compared in mothers who were pumping exclusively and had not yet fed their infants at breast.
Methods: Thirty-five mothers of very low birthweight infants established lactation with a hospital grade, electric, dual pump, and recorded milk output separately for each breast during every pumping session from enrollment until completion of the study (mean = 19.8 days) using a standardized milk log. Milk output from each breast was also weighed during six observed milk expressions over a 2-week period during the study.
Results: For the observed pumping sessions (n = 210), milk output was greater from the right breast in 65.7% of the sessions. For the milk log data (n = 3099 pumping sessions) milk output was greater from the right breast in 47.6% of the sessions, greater from the left breast in 28.0%, and equal from both breasts in 24.4% of the sessions. The mean difference in milk output between the right and left breasts was 6.6 mL (SD =  12.1) for the observed sessions, and 5.0 mL for the milk log data (SD = 10.9). The mean right-to-left breastmilk output ratio was 1.20 for the observed sessions and 1.17 for the milk log data. The right-to-left breastmilk ratios were not associated with time of day, day of pumping, total milk output, maternal handedness or the breast pump suction pattern. The right-to-left breast differences were associated with parity and breastfeeding experience, with primiparous women and first-time breastfeeders demonstrating the greatest differences.
Conclusions: These findings suggest that differences in the milk output from the right and left breasts are common, and that milk output is often greater from the right breast. The differences appear early in lactation, are not related to total milk output, and are relatively consistent throughout the day and over the first weeks of lactation.

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Accuracy of a User-Friendly Centrifuge for Measuring Creamatocrits on Mothers’ Milk in the Clinical Setting

Citation: Meier P.P., Engstrom J.L., Zuleger J.L., Motykowski J.E., Vasan U., Meier W.A., Hartmann P.E., and Williams T.M. Accuracy of a User-Friendly Centrifuge for Measuring Creamatocrits on Mothers’ Milk in the Clinical Setting. The Journal of Breastfeeding Medicine Vol. 1 No. 2, 2006; 79-87.

Abstract: The creamatocrit (CRCT), a simple, accurate, and inexpensive technique for the estimation of lipid and caloric content in mothers’ milk, has been used extensively in lactation research, but has not been integrated into the routine management of clinical lactation problems such as slow weight gain in mothers’ milk-fed preterm and term infants. The Creamatocrit Plus™ is a lightweight, noiseless centrifuge with an embedded reader that automatically calculates lipid and calories from the CRCT value, making it ideal for use in the clinical setting. This study compared intra-user and inter-user reliability, the equivalence of the CRCT values obtained with the Creamatocrit Plus to the two standard techniques for performing CRCTs: the standard laboratory centrifuge with a hematocrit reader and the standard laboratory centrifuge with digital calipers, and the predictive accuracy of the Creamatocrit Plus for estimating the lipid and caloric content in mothers’ milk. CRCTs were performed using the three techniques on 36 milk specimens from 12 women. Laboratory analyses of lipid and calories were performed by investigators blinded to CRCT values. The mean absolute intra-user and inter-user differences were all <1% CRCT, and the mean CRCT measures were nearly identical for the three measurement techniques. Linear correlations between CRCT and laboratory measures for lipid (r = 0.95) and calories (r = 0.94) were very high. The authors conclude that the Creamatocrit Plus can replace cumbersome laboratory equipment for measuring CRCTs in the clinical setting.

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In-Home Measurement of Milk Intake Mothers Performing In-Home Measurement of Milk Intake During Breastfeeding of Their Preterm Infants: Maternal Reactions and Feeding Outcomes

Citation: Hurst N.M., Meier P.P., Engstrom J.L, Myatt A. In-Home Measurement of Milk Intake Mothers Performing In-Home Measurement of Milk intake During Breastfeeding of Their Preterm Infants: Maternal Reactions and Feeding Outcomes. Journal of Human Lactation 20(2), 2004; 178-187. 

Absract: This study compares feeding outcomes and perceptions of mothers using in-home test weights and those who did not use test weights to manage breastfeeding of their preterm infants during the first month after hospital discharge. There were no significant differences in daily weight gain between the 2 groups during the study period. Maternal concerns cited in both groups were similar, namely, knowing how much milk infant is taking, infant gaining adequate weight, and infant getting enough milk. All women in the experimental group and two-thirds in the control group reported that in-home measurement of milk intake by test-weighing had been orwould have been helpful. This prospective randomized study demonstrated that mothers of premature infants who performed in-home test-weighing procedures found the technique to be helpful and experienced no increased stress or lower achievement of breastfeeding goals when compared to mothers not performing test weighs. J Hum Lact. 20(2):178-187.

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Mothers’ Performing Creamatocrit Measures in the NICU: Accuracy, Reactions, and Cost

Citation: Griffin T.L, Meier P.P., Bradford L.P., Bigger H.R., Engstrom J.L. Mothers’ Performing Creamatocrit Measures in the NICU:Accuracy, Reactions, and Cost. JOGNN Vol. 29 No. 3, 2000; 249-257. 

Obiective: To determine whether mothers of infants in the neonatal intensive-care unit could be taught to perform creamatocrits (CRCTs) accurately on own mothers‘ milk (OMM). These mothers‘ reactions to performing CRCTs also were measured.
Sample: Twenty-six mothers and four advancedpractice nurses (RNs) participated in this study.
Design: For Phase One of this blinded trial, mothers were taught to perform the CRCT by one of the two instructional RNs. For Phase Two, mothers
and one of the two validation RNs performed CRCTs simultaneously and independently on the same OMM sample, and the mother completed a Maternal Reactions questionnaire.
Results: Mothers’ CRCT measures were highly accurate. The mean absolute difference between RNs’ and mothers’ CRCTs was 0.69%, with 50% and
84.6% of these differences, respectively, 5 0.5% and 5 1 .O% CRCT. A strong linear correlation was noted between RNs‘ and mothers’ CRCTs. Ninety-six percent of the mothers reported that the CRCT was easy
to learn, they felt comfortable performing the procedure, and it made them feel more involved in infant care. A mean of 23.6 minutes was spent teaching the mother to perform CRCT, a figure that reflects the costeffectiveness of the approach.
Conclusion: Mothers can be taught to perform CRCTs accurately and easily on their OMM. This practice exemplifies high quality, cost-effective care
that maximizes maternal involvement and satisfaction.
JOGNN 29,249-257; 2000.

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Nipple Shields for Preterm Infants: Effect on Milk Transfer and Duration of Breastfeeding

Citation: Meier P.P., Brown L.P., Hurst N.M., Spatz D.L., Engstrom J.L, Borucki L.C., Krouse A.M. Nipple Shields for Preterm Infants: Effect on Milk Transfer and Duration of Breastfeeding. Journal of Human Lactation16(2), 2000; 106-114.

Abstract: This study re ports breast feed ing out comes for 34 pre term in fants whose mothers used ultra-thin silicone nipple shields to increase milk transfer. Mean milk transfer was compared for 2consecutive breast feed ings with out and with the nip ple shield. Total du ra tion of breast feeding was calculated for a maximum of 365 days. Mean milk transfer was significantly greater for feedings with the nip ple shield (18.4 ml vs. 3.9 ml), with all 34 infants con sum ing more milk with the nipple shield in place. Mean duration of nipple shield use was 32.5 days, and mean duration of breast feeding was 169.4 days; no association between these variables was noted. The nipple shield was used for 24.3% of the to tal breast feed ing ex perience, with no significant association between the percentage of time the shield was used and total duration of breastfeeding. These findings are the first to indicate that nipple shield use in creases milk in take without decreasing total duration of breast feeding for preterm in fants. J Hum Lact 2000;16(2): 106-114.

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Estimating Milk Intake of Hospitalized Preterm Infants Who Breastfeed

Citation: Meier P.P., Engstrom J.L., Fleming B.A., Streeter P.L., Lawrence P.B. Estimating Milk Intake of Hospitalized Preterm Infants Who Breastfeed. Journal of Human Lactation 12(1), 1996; 21-26.

Abstract: This study describes the accuracy of clinical indices to estimate the milk intake of breast fed preterm infants. Twenty-nine mother-infant pairs were studied for a total of 39 breastfeeding sessions. Two NICU nurses (RN1 and RN2) and one certified lactation educator (CLE) collected data, each blind to the others' measures. RN1 and RN2 performed test-weights using the Smart Model 20 electronic scale. The CLE observed the breastfeeding and estimated milk intake, using clinical indices of milk transfer. Clinical indices did not provide an accurate estimate of milk intake (r=.48). The mean absolute difference between the test-weights and clinical estimates was 5.79 mI, with a maximal difference of 20 mI. These differences were random in that clinical indices did not consistently over- or underestimate milk intake. None of 17 clinical indices of milk intake significantly lowered the magnitude of error in the clinical estimate. This data suggests that clinical indices cannot serve as a replacement for testweighing of pre term infants when an accurate estimate of milk intake is necessary. JHL
12:21-26, 1996.

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A New Scale for In-Home Test-Weighing for Mothers of Preterm and High Risk Infants

Citation: Meier P.P., Engstrom J.L., Crichton C.L., Clark D.R., Williams M.M., Mangurten H.H. A New Scale for In-Home Test-Weighing for Mothers of Preterm and High Risk Infants. The Journal of Human LactationJ Hum Lact 10(3), 1994: 163-168.

Abstract: The purposes ofthis research were to describe the accuracy of test-weighing with the BabyWeighTM, a new infant scale suitable for use in the home, and to determine whether mothers and investigators could estimate intake accurately during breastfeeding sessions, using clinical cues that are recommended for this purpose. Within five days of projected NICU discharge, 30 preterm and/or high risk infants and their mothers were studied during a single breastfeeding session. A member ofthe research team performed test-weights with the Smart ModelZO infant scale, and mothers performed test-weights with the BabyWeigh scale. The mothers and investigators each estimated volume of intake for the breastfeeding session using clinical cues. Mothers and investigators were blind to each others' test-weights and clinical estimates. Results revealed that the BabyWeigh scale provided an accurate estimate of intake during breastfeeding across a large range of infant weights and intake volumes. In contrast, investigator and maternal estimates of intake were not sufficiently accurate.

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The Accuracy of Test Weighing for Preterm Infants
Citation: Meier P.P., Lysakowski T.Y., Engstrom J.L., Kavanaugh K.L., Mangurten H.H. The Accuracy of Test Weighing for Preterm Infants. Journal of Pediatric Gastroenterology and Nutrition Vol. 10 No. 1, 1990; 62-65.

Summary: A series of recent studies has suggested that preterm infants are capable of breast feeding at weights <1,500 g. However, estimating intake during breast feeding for these small infants is important for safe clinical practice and valid research. The purpose of this study was to compare the accuracy of test weighing as an estimate of intake for preterm infants using two types of scales: a mechanical scale (Toledo) commonly used in many special care nurseries, and a new electronic scale (SMART; Olympic Medical). Fifty clinically stable preterm infants, weighing between 1,088 and 2,440 g (mean = 1,599 g), who were clothed identically for all weights and feedings, were studied. Two experienced neonatal nurses (RN-I and RN-2) collected the data. Before feeding, each infant was weighed once on each scale by each nurse; the order of nurse and scale was assigned randomly.Then, RN-I administered a prescribed volume offeeding. After feeding, RN-2 weighed each infant twice on each scale; the order of scale was assigned randomly. RN-I was blind to postfeed weights, and RN-2 was blind to actual volume of intake. Results indicated that differences between the actual and estimated volumes of intake were smaller for the electronic than for the mechanical scale on all measures. These findings suggest that test weighing with an electronic scale provides an accurate estimate of intake for preterm infants, and support the use of this instrument in clinical practice and research.
KeyWords: Preterm infants-Test weighing-Breast feeding. return to top

Breast pump suction patterns that mimic the human infant during breastfeeding: greater milk output in less time spent on pumping for breast pump-dependent mothers with premature infants
Citation: Meier, P. P., Engstrom, J. L., Janes, J. E., Jegier, B. J., & Loera, F. (2011). Breast pump suction patterns that mimic the human infant during breastfeeding: greater milk output in less time spent on pumping for breast pump-dependent mothers with premature infants. Journal of Perinatology, 32, 103-110.
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High lipid and caloric content in milk from mothers of preterm infants
Citation: Jennings, T. L., Meier, P. P., & Meier, W. A. (1997). High lipid and caloric content in milk from mothers of preterm infants. Pediatric Research (abstracted), 41, 233A return to top