Boccolini Cristiano Siqueira, Carvalho Márcia Lázaro de, Oliveira Maria Inês Couto de, Leal Maria do Carmo, Carvalho Marilia Sá
Secretaria Municipal de Saúde de Queimados, Queimados, Brasil.
Cad Saude Publica. 2008 Nov;24(11):2681-94. doi: 10.1590/s0102-311x2008001100023.
The current study investigated factors associated with time between birth and first breastfeeding. A representative sample of mothers (10% of deliveries in 47 maternity hospitals in Rio de Janeiro, Brazil) was interviewed (n = 10,077). A random effects proportional risks survival model (at the maternity ward level) was employed, in a three-tier hierarchical approach. Models were fitted separately for normal and cesarean delivery. Time to initiation of breastfeeding in the first 24 hours of life differed between mothers with vaginal delivery (median 4 hours) versus cesarean section (10 hours). Common risk and protective factors were identified: maternal age; neonatal complications; neonatal care considered sub-optimal by the mother; admission of the newborn to the nursery; parity; birth weight. The model predicted 33% of variance in first breastfeeding. In conclusion, time from delivery to first breastfeeding was increased by biological factors, high cesarean rates, and inadequate childbirth and neonatal care practices.
本研究调查了与出生至首次母乳喂养间隔时间相关的因素。对母亲进行了抽样访谈（n = 10,077），样本具有代表性（占巴西里约热内卢47家妇产医院分娩量的10%）。采用随机效应比例风险生存模型（在产科病房层面），采用三层分层方法。分别针对顺产和剖宫产拟合模型。顺产母亲（中位数4小时）与剖宫产母亲（10小时）在出生后24小时内开始母乳喂养的时间有所不同。确定了常见的风险和保护因素：产妇年龄；新生儿并发症；母亲认为次优的新生儿护理；新生儿入住新生儿重症监护室；产次；出生体重。该模型预测了首次母乳喂养中33%的方差。总之，分娩至首次母乳喂养的时间因生物学因素、高剖宫产率以及分娩和新生儿护理措施不足而增加。
