Domperidone can increase milk supply for preterm infants

Clinical question: 
How effective are medications for increasing milk supply in mothers expressing breast milk for their preterm hospitalised infants?
Bottom line: 
There were modest improvements in short-term expressed breast milk volumes when a medication (domperidone) was used after insufficient expressed breast milk occurred in mothers following preterm delivery. Domperidone was commenced ≥14 days post delivery and following insufficient expressed breast milk supply with other lactation supports. Both trials gave the same dose of domperidone (10 mg three times per day) with a duration of seven days in the smaller trial and 14 days in the larger trial. Neither trial showed significant improvements in longer-term outcomes of breastfeeding in a preterm population. No adverse effects were reported.
Caveat: 
The review included only two studies involving 59 participants. Currently, no studies support prophylactic use of a galactagogue medication at any gestation. Use of such medications has only been examined at more than 14 days post delivery and after full lactation support has been given.
Context: 
Breast milk remains the optimal form of enteral nutrition for term and preterm infants until up to six months of age. Mothers of premature and sick infants are separated from their infants while they are receiving hospital-based care. These mothers often have difficulty supporting lactation, when milk production is solely maintained by breast expression.
Review CD#: 
CD005544
PEARLS No: 
363
Date: 
July, 2012
Authored by: 
Brian R McAvoy