early initiation and regular breast milk expression reduces risk of lactogenesis ii delay in atrisk singaporean mothers in a randomised trial introduction lactogenesis ii laii failure can be prevented in atrisk mothers with simple proactive interventions in a randomised trial we investigated the efficacy of early and regular breast milk expression in establishing laii using an electric doublebreast pumpmethods mothers with uncomplicated singleton deliveries were randomised to intervention n 31 or control n 29 groups the former commenced breast milk expression with an electric pump within one hour of delivery and maintained regular expression with direct breastfeeding control mothers directly breastfed without regular pump expression expressed milk volumes were analysed for citrate lactose sodium and proteinresults median time of laii was day 3 interquartile range iqr 1 day with intervention and on day 4 iqr 1 day among controls p 003 biochemical steadystate concentrations were achieved around early day 4 sodium total protein and days 45 citrate lactose sodium protein and lactose levels were similar in both groups over seven days at 580 mm 068 mm and 1338 mm respectively mean daily milk volume with intervention was 739 ml on day 3 and 2252 ml on day 7 greater than controls 254 ml on day 3 and 692 ml on day 7 p 02 mean infant weights were similar on day 8 at 3477 g with intervention and 3479 g among controlsconclusion laii is established by postnatal day 3 with early initiation of regular breast milk expression a useful intervention for mothers at risk of earlyonset breastfeeding failure