Department of Pediatrics, School of Medicine, Washington University, St Louis, MO 63110, USA.
J Perinatol. 2011 Aug;31(8):540-5. doi: 10.1038/jp.2010.205. Epub 2011 Jan 27.
Rates of breast milk feeding at hospital discharge are low in premature infants due to the many associated challenges. Although there are many benefits associated with breast milk, the effects of direct breast-feeding in the neonatal intensive care unit (NICU) have not been identified. The purpose of this study was to investigate the relationship between direct breast-feeding (infant sucking directly from the breast) and duration and success with breast milk feedings until discharge in premature infants.
This retrospective cohort was conducted on 66 very-low birth weight infants whose mothers initiated breast milk feedings in the NICU. Chart review revealed documented type (breast milk with or without fortifiers or type of infant formula), volume and mode (nasogastric tube, breast or bottle) of all gastric feeds for each day of NICU hospitalization. From this documentation, whether the mother initiated breast milk feedings, the number of times the mother put the infant to breast, the gestational age of the first direct breast-feeding, whether the first oral feeding was at the breast, the duration of breast milk feedings and whether breast milk feedings continued until NICU discharge were determined. Associations between breast-feeding participatory factors and breast milk feeding outcomes were investigated using linear and logistic regression.
Positive associations were found between breast milk feedings at discharge and mothers putting their infants directly to breast in the NICU (P=0.0005). The duration of breast milk feedings was associated with: mothers putting their infants directly to breast (P=0.0110), whether the first oral sucking feeding was at the breast (P=0.0108) and the gestational age of the first breast-feeding attempt (P<0.0001).
Breast milk feedings are encouraged in most NICU's, but direct breast-feeding is often overlooked as an important area of research in the tightly controlled environment of the NICU. This study demonstrates a link between direct breast-feeding behaviors in the NICU and success with provision of milk at discharge, as well as how early participation can be an important factor in the breast-feeding process for mothers of NICU infants. More research on the effects of direct breast-feeding is warranted.
由于早产儿面临许多相关挑战，因此其在出院时的母乳喂养率较低。尽管母乳喂养有很多好处，但在新生儿重症监护病房（NICU）中直接进行母乳喂养的效果尚未确定。本研究旨在探讨直接母乳喂养（婴儿直接从乳房吸吮）与早产儿母乳喂养时间和成功率直至出院之间的关系。
本回顾性队列研究纳入了 66 名极低出生体重儿，其母亲在 NICU 中开始母乳喂养。通过病历回顾，记录了 NICU 住院期间每天所有胃饲的类型（含或不含强化剂的母乳或婴儿配方奶粉）、量和方式（鼻胃管、乳房或奶瓶）。根据这些记录，确定母亲是否开始母乳喂养、母亲让婴儿吸吮乳房的次数、第一次直接母乳喂养的胎龄、第一次口服喂养是否在乳房上、母乳喂养的持续时间以及母乳喂养是否持续到 NICU 出院。使用线性和逻辑回归分析了母乳喂养参与因素与母乳喂养结果之间的关系。
发现与出院时母乳喂养相关的正相关因素是母亲在 NICU 中将婴儿直接放在乳房上（P=0.0005）。母乳喂养的持续时间与：母亲将婴儿直接放在乳房上（P=0.0110）、第一次口腔吸吮喂养是否在乳房上（P=0.0108）和第一次母乳喂养尝试的胎龄（P<0.0001）有关。
大多数 NICU 都鼓励母乳喂养，但直接母乳喂养在 NICU 这种严格控制的环境中往往被忽视，是一个重要的研究领域。本研究表明，NICU 中直接母乳喂养行为与出院时提供牛奶的成功率之间存在联系，以及早期参与如何成为 NICU 婴儿母亲母乳喂养过程中的一个重要因素。需要更多关于直接母乳喂养效果的研究。
