Department of Nursing and Midwifery, University of Stirling, Stirling FK9 4LA, UK.
Matern Child Nutr. 2010 Oct;6(4):306-17. doi: 10.1111/j.1740-8709.2009.00210.x.
Infants admitted to a neonatal unit (NNU) are frequently unable to feed by breast or bottle because of ill health or prematurity. These infants require nutritional support until they can start oral feeding. Breastfeeding is advocated for these infants, and mothers are frequently encouraged to express breast milk to be fed via the enteral tube. However, by discharge, breastfeeding rates tend to be low. Oral feeding requires careful management, and although practices may vary because of clinical need, some may be informed by unit norms. There is limited evidence for effective breastfeeding support in this environment and little exploration of the effect of routine feeding decisions. This study aimed to explore feeding decisions and considered how these might affect outcomes. The staff in the two large urban NNUs who participated in the feeding decisions were interviewed and the data were analysed using a theoretical framework. Feeding decisions were made mainly by the unit staff, with limited parental involvement. Subsequent management varied, with differences being related to staff experience and beliefs, unit norms, parent's expectations and physical constraints within the unit. The staff were overtly supportive of breastfeeding, but the need to monitor and quantify milk intake may undermine breastfeeding. Furthermore, feeding breastfed infants during the mothers' absence was controversial and provoked debate. There is a need for clear guidelines and increased parental involvement in feeding decisions. Routine practices within the system may discourage mothers from initiating and persisting with breastfeeding. A change in unit culture is required to fully support the parent's feeding choices.
婴儿因健康状况不佳或早产而经常无法通过母乳喂养或奶瓶喂养。这些婴儿需要营养支持，直到他们可以开始口服喂养。提倡对这些婴儿进行母乳喂养，并且经常鼓励母亲挤出母乳通过肠内管喂养。然而，在出院时，母乳喂养率往往较低。口服喂养需要精心管理，尽管由于临床需要，实践可能会有所不同，但有些可能是基于单位规范。在这种环境下，母乳喂养支持的有效证据有限，对常规喂养决策的影响也很少有探索。本研究旨在探讨喂养决策，并考虑这些决策如何影响结果。参与喂养决策的两家大型城市新生儿重症监护病房的工作人员接受了采访，并使用理论框架对数据进行了分析。喂养决策主要由单位工作人员做出，父母的参与度有限。随后的管理方式存在差异，差异与工作人员的经验和信念、单位规范、父母的期望以及单位内的身体限制有关。工作人员公开支持母乳喂养，但需要监测和量化奶量可能会破坏母乳喂养。此外，在母亲不在场的情况下喂养母乳喂养的婴儿存在争议并引发了争论。需要明确的指导方针和增加父母在喂养决策中的参与。系统内的常规做法可能会阻碍母亲开始和坚持母乳喂养。需要改变单位文化，以充分支持父母的喂养选择。
