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




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.


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.


Mothers combining manual techniques with pumping express high levels of fat-rich, calorie-dense milk, unrelated to production differences.

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We thank Medela for project facilitation, with particular thanks to Leon Mitoulas, Director of Research. Also, we acknowledge the study mothers both for their contributions to this study and for generously volunteering to participate in videos to demonstrate manual pumping techniques. Thanks also to Ronald S Cohen, MD for project support. This work was supported, in part, by the Clinical and Translational Science Award 1UL1 RR025744 for the Stanford Center for Clinical and Translational Education and Research (Spectrum) from the National Center for Research Resources, National Institutes of Health and in part by Medela AG, Medical Research, Switzerland.

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Correspondence to J Morton.

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Morton, J., Wong, R., Hall, J. et al. Combining hand techniques with electric pumping increases the caloric content of milk in mothers of preterm infants. J Perinatol 32, 791–796 (2012).

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  • hand expression
  • breastmilk
  • breastfeeding
  • lactation
  • preterm infants
  • milk composition

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