EXPRESS

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EXpressing in PREmaturity – Simple interventionS: Does a guided relaxation audio track increase yield of expressed milk in mothers of very preterm infants? A randomised controlled trial and nested exploratory work

Trial started: 2021 Trial ended: 2023

Summary

Objectives

To determine whether a self-directed audio relaxation and lactation-specific visualisation increases milk quantity after a very premature birth.

Methods

An unmasked, randomised, controlled trial conducted in four UK neonatal units involving 132 participants. Eligible women had given birth to one or two infants between 23+0 and 31+6 weeks' gestation. The intervention was a 12-minute voice recording including breathing exercises, muscle relaxation and lactation-specific visualisation.

Outcome measures

Primary outcome: The highest 24-hour breastmilk weight expressed on any of day 4, day 14 or day 21 after birth.

Results

Mean birth gestation was 27.8 weeks (SD 2.4), with 26% of participants giving birth under 26 weeks (34/132). The adjusted mean difference in the primary outcome was 73.9 g (95% confidence interval ?61.7 to 209.5; p = 0.28). The adjusted mean difference in Spielberger State-Trait Anxiety Index was ?1.9 (95% confidence interval ?8.2 to 4.3; p = 0.54). The majority of participants in the relaxation group felt the intervention was relaxing (32/42, 76%).

Conclusions

There was no beneficial effect of this relaxation intervention on milk quantity. Mothers of very premature infants may value relaxation interventions, but they are unlikely to have a large effect on milk quantity.

Adapted from: Levene I, Hardy P, Bell JL, et al. Lactation-focused audio relaxation versus standard care for mothers of very preterm infants (the EXPRESS randomised clinical trial). Pediatric Research. 2025;97:2035–2044. https://doi.org/10.1038/s41390-024-03577-7. Licensed under the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Adapted for presentation on this website.

Show Publications

Levene I, O'Brien F, Fewtrell M, Quigley MA. The relationship of early expressed milk quantity and later full breastmilk feeding after very preterm birth: A cohort study. Maternal & Child Nutrition. 2024;n/a(n/a):e13719.
https://doi.org/10.1111/mcn.13719
Levene I, Fewtrell M, Quigley MA, O’Brien F. The relationship of milk expression pattern and lactation outcomes after very premature birth: A cohort study. PLoS One. 2024;19(7):e0307522.
https://doi.org/10.1371/journal.pone.0307522
Levene I, Quigley MA, Fewtrell M, O’Brien F. Does extremely early expression of colostrum after very preterm birth improve mother’s own milk quantity? A cohort study. Archives of Disease in Childhood - Fetal and Neonatal Edition. 2024;109(5):475.
https://doi.org/10.1136/archdischild-2023-326784
Levene I, Hardy P, Bell JL, Cole C, Stanbury K, O’Brien F, Fewtrell M, Quigley MA. Lactation-focused audio relaxation versus standard care for mothers of very preterm infants (the EXPRESS randomised clinical trial). Pediatr Res. 2024.
https://doi.org/10.1038/s41390-024-03577-7
Levene I, Alderdice F, McCleverty B, O’Brien F, Fewtrell M, Quigley MA. A report on parent involvement in planning a randomised controlled trial in neonatology and lactation – insights for current and future research. International Breastfeeding Journal. 2022;17(1):69.
https://doi.org/10.1186/s13006-022-00509-1

Published Protocol

Levene I, Bell JL, Cole C, Stanbury K, O’Brien F, Fewtrell M, et al. Comparing the effect of a lactation-specific relaxation and visualisation intervention versus standard care on lactation and mental health outcomes in mothers of very premature infants (the EXPRESS trial): study protocol for a multi-centre, unmasked, randomised, parallel-group trial. Trials. 2022;23(1):611.
https://doi.org/10.1186/s13063-022-06570-9

Show Plain Language Summary of Results

EXPRESS Results Summary