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Comparison 1 Any type of pump versus hand expression, Outcome 2 Adverse effects for mother or infant.
Figuras y tablas -
Analysis 1.2

Comparison 1 Any type of pump versus hand expression, Outcome 2 Adverse effects for mother or infant.

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Comparison 1 Any type of pump versus hand expression, Outcome 3 Transfer to feeding at breast.
Figuras y tablas -
Analysis 1.3

Comparison 1 Any type of pump versus hand expression, Outcome 3 Transfer to feeding at breast.

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Comparison 2 Any manual pump versus hand expression, Outcome 4 Quantity of milk expressed.
Figuras y tablas -
Analysis 2.4

Comparison 2 Any manual pump versus hand expression, Outcome 4 Quantity of milk expressed.

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Comparison 4 Any electric pump with separate motor versus hand expression, Outcome 4 Quantity of milk expressed.
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Analysis 4.4

Comparison 4 Any electric pump with separate motor versus hand expression, Outcome 4 Quantity of milk expressed.

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Comparison 6 Any electric pump with separate motor versus manual pump, Outcome 4 Quantity of milk expressed.
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Analysis 6.4

Comparison 6 Any electric pump with separate motor versus manual pump, Outcome 4 Quantity of milk expressed.

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Comparison 6 Any electric pump with separate motor versus manual pump, Outcome 5 Time taken to express milk.
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Analysis 6.5

Comparison 6 Any electric pump with separate motor versus manual pump, Outcome 5 Time taken to express milk.

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Comparison 9 Any method with a specified protocol of simultaneous versus sequential pumping, Outcome 4 Quantity of milk expressed.
Figuras y tablas -
Analysis 9.4

Comparison 9 Any method with a specified protocol of simultaneous versus sequential pumping, Outcome 4 Quantity of milk expressed.

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Comparison 9 Any method with a specified protocol of simultaneous versus sequential pumping, Outcome 5 Time taken to express milk.
Figuras y tablas -
Analysis 9.5

Comparison 9 Any method with a specified protocol of simultaneous versus sequential pumping, Outcome 5 Time taken to express milk.

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Comparison 9 Any method with a specified protocol of simultaneous versus sequential pumping, Outcome 7 Maternal physiological effects ‐ hormone levels.
Figuras y tablas -
Analysis 9.7

Comparison 9 Any method with a specified protocol of simultaneous versus sequential pumping, Outcome 7 Maternal physiological effects ‐ hormone levels.

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Comparison 10 Any method with a specified relaxation technique versus no specified relaxation technique, Outcome 4 Quanity of milk expressed.
Figuras y tablas -
Analysis 10.4

Comparison 10 Any method with a specified relaxation technique versus no specified relaxation technique, Outcome 4 Quanity of milk expressed.

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Comparison 10 Any method with a specified relaxation technique versus no specified relaxation technique, Outcome 6 Nutrients in milk.
Figuras y tablas -
Analysis 10.6

Comparison 10 Any method with a specified relaxation technique versus no specified relaxation technique, Outcome 6 Nutrients in milk.

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Table 1. Expression and pumping methods

Type

Action

Equipment

Availability

Hand expression.

Hand action stimulates milk ejection reflex and compresses milk ducts.

None.

Universal.

Hot jar (base cooled with cold cloth).

Cooling creates a vacuum so that the milk flows from breast (higher pressure) to the jar (lower pressure). Suction pressure may be difficult to control.

Suitable glass jar, hot water, cold water, cloth.

Widespread.

Manual pump: compressing a bulb, pulling on two connected cylinders, or squeezing and releasing a handle.

Negative pressure created by hand/arm action of the pump causes milk to flow from breast to pump. Suction pressure may be difficult to control. Some brands designed to reduce arm/hand fatigue.
Some work on a 'draw and hold' principle rather than an even in‐out action.

Pump.
Cleaning supplies.
Most pumps have at least 3 parts.
One‐handed pumps available and 2 pumps can be used for double pumping.

Depends on market demand/distribution.

Battery pump: power provided by battery, manner of creating pressure may vary.

Negative pressure at pump causes milk to flow from breast to pump. Adjustable suction pressure and cycling time in some brands. Some work on a 'draw and hold' principle rather than even in‐out action.

Pump.
Batteries. New batteries may be needed after 2‐4 hours use. Some have AC adapters available.
Cleaning supplies.
Most pumps have at least 4 parts.
Most are hand‐held so weight of pump plus milk may be a concern.

Depends on market demand/distribution.

Small electric: diaphragm pump.

Negative pressure created by pump action of the pump causes milk to flow from breast to pump. Adjustable suction pressure and cycling time in some brands.

Pump.
Electricity supply.
Cleaning supplies.
Most pumps have many parts.
Two collection sets can be used for double pumping for most brands.

Depends on market demand/distribution.

Large electric: piston pump, rotary vane pump, diaphragm pump. Power may be provided by car battery or by foot treadle.

Negative pressure created by action of the pump causes milk to flow from breast to pump. Suction pressure may be difficult to control. Some brands designed to reduce arm/hand fatigue. Some work on a 'draw and hold' principle rather than an even in‐out action.

Pump.
Electricity supply or other power source.
Cleaning supplies.
Most pumps have 10 or more parts.
Two collection sets can be used for double pumping.

Depends on market demand/distribution.
Larger pumps generally purchased by hospitals or rental companies for loan to mothers.

Note: Some brands of pumps have a flexible breast cup that compresses the breast and some have a choice of sizes of breast cup. Multi‐user pumps require high‐quality cleaning procedures and frequent servicing.
There is no one type of pump that is suitable for all mothers and all circumstances. To obtain quantities of milk by any method requires an effective milk ejection reflex.

Figuras y tablas -
Table 1. Expression and pumping methods
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Table 2. Pumps used in trials

Study

Equipment/ method

Group (mothers of)

Length of trial

Funding

Auerbach 1990

SIM vs SEQ with Medela electric pump

Healthy, full‐term infants 5‐35 weeks of age

One expression per pump

Received support from the company whose product they were testing

Boo 2001

Hand expression vs mother's own choice of manual pump

Infants < 1501 g birth weight in neonatal unit

While infants were in NICU

Boutte 1985

Egnell electric pump vs Medela piston manual pump

Healthy, full‐term infants mean age 3.2 months

24‐hour period per pump

Costa 1989

Pumps not compared, hygiene procedure

Preterm infants in neonatal unit

One expression

Received support from the company whose product they were testing

Feher 1989

Pumps not compared, relaxation tape

Preterm infants in neonatal unit

One expression

Fewtrell Preterm

Egnell Ameda electric pump vs Avent Isis manual pump

Preterm infants in neonatal unit

Not stated

Received support from the company whose product they were testing

Fewtrell Term

Avent Isis manual pump vs Medela Mini‐electric pump

Healthy, full‐term infants at home, 8 weeks old

One expression per pump

Received support from the company whose product they were testing

Groh‐Wargo 1995

SIM vs SEQ with Medela electric pump

Infants < 1500 g birth weight in neonatal unit

Minimum 4 weeks

Received support from the company whose product they were testing

Hill 1999

SIM vs SEQ with Medela electric pump

Infants < 1500 g birth weight or preterm in neonatal unit

6 weeks

Received support from the company whose product they were testing

Jones 2001

SIM vs SEQ with Egnell Ameda Electric Elite pump

Preterm infants in neonatal unit

4 days

Received support from the company whose product they were testing

Slusher 2007

Hand expression vs double collection Medela Lactina electric pump vs. double collection foot pedal powdered Medela Lactina pump

Preterm or ill infants in special care unit

Minimum 6 days

Received support from the company whose product they were testing

Zinaman 1992

Hand expression Marmet technique vs. double collection White River Electric pump medium setting vs. Gentle Expression battery‐operated pump vs. Medela Manuelectric pump used manually vs infant suckling

Healthy, full‐term infants, 28‐42 days old

One expression per pump

(SIM = simultaneous pumping SEQ = sequential pumping)
Figuras y tablas -
Table 2. Pumps used in trials
Ir a la tabla de la revisión
Table 3. Pumping frequency recommended and achieved

Study

Recommendation

Mean expressions I

Mean expressions II

Fewtrell 2001b

6 times/day

3.96 + 1.66/day Electric Pump

3.74 + 1.15/day Manual Pump

Groh‐Wargo 1995

Minimum of 4 times/24 hours

28.4 + 5.5/week Sequential

28.8 + 5.5/week Simultaneous

Hill 1999

8 times/day

40.18+8.77/week Sequential

42.87+9.75/week Simultaneous

Jones 2001

8 times/day

Mean 5 times/day over both groups Sequential

Simultaneous

Slusher 2007

2‐3 hourly [8‐12/24]

Not reported
Figuras y tablas -
Table 3. Pumping frequency recommended and achieved
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Comparison 1. Any type of pump versus hand expression

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

2 Adverse effects for mother or infant Show forest plot

1

28

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.62, 1.27]

2.1 At least 1 expressed milk sample contaminated

1

28

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.62, 1.27]

3 Transfer to feeding at breast Show forest plot

1

28

Risk Ratio (M‐H, Fixed, 95% CI)

1.35 [0.61, 2.99]
Figuras y tablas -
Comparison 1. Any type of pump versus hand expression
Ir a la tabla de la revisión
Comparison 2. Any manual pump versus hand expression

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

4 Quantity of milk expressed Show forest plot

1

48

Mean Difference (IV, Fixed, 95% CI)

‐212.10 [‐414.81, ‐9.39]

4.1 Mean volume 6 days pumping (ml)

1

48

Mean Difference (IV, Fixed, 95% CI)

‐212.10 [‐414.81, ‐9.39]
Figuras y tablas -
Comparison 2. Any manual pump versus hand expression
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Comparison 4. Any electric pump with separate motor versus hand expression

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

4 Quantity of milk expressed Show forest plot

1

43

Mean Difference (IV, Fixed, 95% CI)

‐373.1 [‐585.11, ‐161.09]

4.1 Mean volume 6 days pumping (ml)

1

43

Mean Difference (IV, Fixed, 95% CI)

‐373.1 [‐585.11, ‐161.09]
Figuras y tablas -
Comparison 4. Any electric pump with separate motor versus hand expression
Ir a la tabla de la revisión
Comparison 6. Any electric pump with separate motor versus manual pump

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

4 Quantity of milk expressed Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4.1 Mean volume 6 days pumping (ml)

1

53

Mean Difference (IV, Fixed, 95% CI)

‐161.0 [‐388.90, 66.90]

4.2 Mean volume per day pumped (ml)

1

145

Mean Difference (IV, Fixed, 95% CI)

5.08 [‐56.58, 66.74]

5 Time taken to express milk Show forest plot

1

145

Mean Difference (IV, Fixed, 95% CI)

‐20.28 [‐28.31, ‐12.25]

5.1 Mean time per day spent pumping (min)

1

145

Mean Difference (IV, Fixed, 95% CI)

‐20.28 [‐28.31, ‐12.25]
Figuras y tablas -
Comparison 6. Any electric pump with separate motor versus manual pump
Ir a la tabla de la revisión
Comparison 9. Any method with a specified protocol of simultaneous versus sequential pumping

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

4 Quantity of milk expressed Show forest plot

2

81

Mean Difference (IV, Fixed, 95% CI)

359.96 [‐967.83, 1687.74]

4.1 Total mls in weeks 2‐5

1

49

Mean Difference (IV, Fixed, 95% CI)

4298.94 [‐1056.80, 9654.68]

4.2 Total mls per week

1

32

Mean Difference (IV, Fixed, 95% CI)

102.0 [‐1268.57, 1472.57]

5 Time taken to express milk Show forest plot

1

32

Mean Difference (IV, Fixed, 95% CI)

‐3.5 [‐5.61, ‐1.39]

5.1 Hours per week

1

32

Mean Difference (IV, Fixed, 95% CI)

‐3.5 [‐5.61, ‐1.39]

7 Maternal physiological effects ‐ hormone levels Show forest plot

1

32

Mean Difference (IV, Fixed, 95% CI)

3.7 [‐3.22, 10.62]

7.1 Serum prolactin change, fold increase

1

32

Mean Difference (IV, Fixed, 95% CI)

3.7 [‐3.22, 10.62]
Figuras y tablas -
Comparison 9. Any method with a specified protocol of simultaneous versus sequential pumping
Ir a la tabla de la revisión
Comparison 10. Any method with a specified relaxation technique versus no specified relaxation technique

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

4 Quanity of milk expressed Show forest plot

1

71

Mean Difference (IV, Fixed, 95% CI)

‐34.70 [‐59.89, ‐9.51]

4.1 Volume at one expression (ml)

1

71

Mean Difference (IV, Fixed, 95% CI)

‐34.70 [‐59.89, ‐9.51]

6 Nutrients in milk Show forest plot

1

71

Mean Difference (IV, Fixed, 95% CI)

‐0.40 [‐1.63, 0.83]

6.2 Creamatocrit %

1

71

Mean Difference (IV, Fixed, 95% CI)

‐0.40 [‐1.63, 0.83]
Figuras y tablas -
Comparison 10. Any method with a specified relaxation technique versus no specified relaxation technique
Ir a la tabla de la revisión