Colaizy T T, Morriss F H
Department of Pediatrics, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
J Perinatol. 2008 Jul;28(7):505-10. doi: 10.1038/jp.2008.32. Epub 2008 Mar 27.
We hypothesized that neonatal intensive care unit (NICU) admission reduces breastfeeding in a recent population of US infants, adjusting for confounding factors.
Using pregnancy risk assessment monitoring system data from 27 states for the years 2000 to 2003, we determined the relationship between breastfeeding and gestational age (GA) stratified by NICU status. We fitted a proportional odds model for breastfeeding duration as a function of NICU status adjusted for other covariates. SAS 9.1.3 and SUDAAN 9.0 were used for the weighted analyses.
In total 138 359 surveys, including 29 940 NICU-admitted infants, were analyzed. A total of 73% of mothers of nonadmitted infants initiated breastfeeding vs 70% of mothers of NICU-admitted infants. Mothers of GA <38 weeks NICU-admitted infants were 34% more likely to initiate breastfeeding and 21% more likely to breastfeed for 4 weeks than were mothers of nonadmitted preterm infants (P<0.001). However, mothers of term NICU-admitted infants were less likely to initiate and continue breastfeeding to 4 weeks than were mothers of term nonadmitted infants (P<0.001). Adjusting for GA, race, maternal age, maternal education, mode of delivery and Medicaid status, NICU admission was associated with increasing duration of breastfeeding (OR 1.10, CI 1.03, 1.17). Compared with mothers of term infants, mothers of <32-week infants were 40% more likely to continue breastfeeding for 4 weeks, mothers of 32 to 34 week infants were 13% less likely to continue and mothers of 35-37 week infants were 22% less likely to continue for at least 4 weeks (P<0.001).
NICU admission is now a positive influence on breastfeeding continuation, improving the overall likelihood by 10%. Mothers of preterm NICU-admitted infants were more likely than mothers of nonadmitted infants to continue breastfeeding for 4 weeks, while mothers of term NICU-admitted infants were less likely to continue. Breastfeeding support should be enhanced for term and late preterm infants.
我们假设，在美国近期的婴儿群体中，新生儿重症监护病房（NICU）收治会减少母乳喂养情况，同时对混杂因素进行校正。
利用2000年至2003年27个州的妊娠风险评估监测系统数据，我们确定了按NICU收治情况分层的母乳喂养与胎龄（GA）之间的关系。我们针对母乳喂养持续时间拟合了一个比例优势模型，该模型将NICU收治情况作为因变量，并对其他协变量进行了校正。加权分析使用了SAS 9.1.3和SUDAAN 9.0。
共分析了138359份调查问卷，其中包括29940名入住NICU的婴儿。未入住NICU婴儿的母亲中，共有73%开始母乳喂养，而入住NICU婴儿的母亲中这一比例为70%。与未入住NICU的早产婴儿母亲相比，入住NICU的GA<38周婴儿的母亲开始母乳喂养的可能性高34%，母乳喂养4周的可能性高21%（P<0.001）。然而，与未入住NICU的足月儿母亲相比，入住NICU的足月儿母亲开始并持续母乳喂养至4周的可能性较小（P<0.001）。在校正GA、种族、母亲年龄、母亲教育程度、分娩方式和医疗补助状态后，NICU收治与母乳喂养持续时间增加相关（比值比1.10，可信区间1.03，1.17）。与足月儿母亲相比，<32周婴儿的母亲继续母乳喂养4周的可能性高40%，32至34周婴儿的母亲继续母乳喂养的可能性低13%，35 - 37周婴儿的母亲继续母乳喂养至少4周的可能性低22%（P<0.001）。
目前，NICU收治对母乳喂养的持续有积极影响，将总体可能性提高了10%。入住NICU的早产婴儿母亲比未入住NICU的婴儿母亲更有可能持续母乳喂养4周，而入住NICU的足月儿母亲持续母乳喂养的可能性较小。应加强对足月儿和晚期早产儿的母乳喂养支持。
