Nyqvist K H, Sjödén P O, Ewald U
Department of Women's and Children's Health, University Children's Hospital, Uppsala, Sweden.
Early Hum Dev. 1999 Jul;55(3):247-64. doi: 10.1016/s0378-3782(99)00025-0.
Extensive scientific data are available on the development of sucking in term infants, but corresponding knowledge about preterm infants has been lacking. The aim was to describe the development of preterm infants' behavior at the breast, according to postmenstrual and postnatal age. Mothers co-operated as data collectors using the Preterm Infant Breastfeeding Behavior Scale for observations. Seventy-one singletons (born after 26.7-35.9 gestational weeks) were studied prospectively. Mothers received regular advice about breastfeeding and guidance about interaction and appropriate stimulation. Breastfeeding was initiated at a postmenstrual age (PMA) of 27.9-35.9 weeks. Mothers provided 4321 records of infants' behavior, 70% of the total breastfeeding sessions during the infants' hospital stay. Irrespective of PMA, the infants responded by rooting and sucking on the first contact with the breast. Efficient rooting, areolar grasp and latching on were observed at 28 weeks, and repeated bursts of > or = 10 sucks and maximum bursts of > or = 30 sucks at 32 weeks. Nutritive sucking appeared from 30.6 weeks. Sixty-seven infants were breastfed at discharge. Fifty-seven of them established full breastfeeding at a mean PMA of 36.0 weeks (33.4-40.0 weeks). Their early sucking behavior is interpreted as the result of learning, enhanced by contingent stimuli. We therefore suggest that guidelines for initiation of breastfeeding in preterm infants should be based on cardiorespiratory stability, irrespective of current maturity, age or weight.
关于足月儿吸吮发育的科学数据广泛可得，但关于早产儿的相应知识一直缺乏。目的是根据孕龄和出生后年龄描述早产儿在乳房处的行为发育情况。母亲们作为数据收集者，使用早产儿母乳喂养行为量表进行观察。对71例单胎婴儿（孕26.7 - 35.9周出生）进行了前瞻性研究。母亲们接受了关于母乳喂养的定期建议以及关于互动和适当刺激的指导。母乳喂养在孕龄27.9 - 35.9周时开始。母亲们提供了4321份婴儿行为记录，占婴儿住院期间总母乳喂养次数的70%。无论孕龄如何，婴儿在首次接触乳房时都会通过寻乳和吸吮做出反应。在28周时观察到有效的寻乳、乳晕抓握和 latch on（未明确准确含义，可能是衔接之类的专业动作），在32周时观察到重复的≥10次吸吮爆发和最大≥30次吸吮爆发。从30.6周开始出现营养性吸吮。67例婴儿出院时进行母乳喂养。其中57例在平均孕龄36.0周（33.4 - 40.0周）时建立了完全母乳喂养。他们早期的吸吮行为被解释为学习的结果，并受到偶然刺激的增强。因此，我们建议早产儿母乳喂养开始的指导方针应基于心肺稳定性，而不考虑当前的成熟度、年龄或体重。
