Roussel C, Razafimahefa H, Shankar-Aguilera S, Durox M, Boileau P
Service de pédiatrie et de réanimation néonatales, hôpital Antoine-Béclère, AP-HP, 157, avenue de la porte de Trivaux, 92140 Clamart, France.
Arch Pediatr. 2012 Jun;19(6):663-9. doi: 10.1016/j.arcped.2012.03.003. Epub 2012 May 4.
Admission at birth to a Neonatal Intensive Care Unit (NICU) complicates breastfeeding especially for preterm babies despite hospital staff trained to encourage breastfeeding. The aim of this study was to find factors related to the mother, the pregnancy or the neonate influencing breastfeeding rate on a NICU.
This was a retrospective study including neonatal admissions to the NICU at Antoine-Béclère University Hospital from 1st May 2009 to 30th April 2010. Data was collected from medical notes. The breastfeeding rate (at initiation and at discharge) was analysed with regards to maternal age, method of procreation, type of pregnancy (single or multiple), parity, mode of delivery (vaginal delivery or C-section), birthweight, gestational age and intra-uterine growth restriction (IUGR).
The study was based on 460 neonates having complete documentation. The average maternal age was 32 years. Premature infants represented 74.8% of the population (median gestational age=34 weeks) of which 57% were less than 33 weeks (42.6% of all infants, n=196). The median birthweight was 1900 g with 17.6% of IUGR infants. Breastfeeding rate at initiation was 58.7 and 43.9% at discharge (mean admission days: 17.1 [0-180], median=8 days). For infants born of multiple pregnancies (24.3% of the population) 51.6% were born of medically assisted pregnancies (MAP) and 17.6% of spontaneous pregnancies. Breastfeeding rate among these infants was 57.1% at initiation and 45.5% at discharge. It was higher in infants born of MAP at initiation (70.3% versus 55.8% for spontaneous pregnancies, P<0.05) and at discharge (49.5% versus 42.5% for spontaneous pregnancies). For these infants, average maternal age was higher for breastfed infants (33.9 versus 32.1 years for the formula-fed, P<0.05). Breastfeeding rate in infants born to primipares was higher at initiation (64.9% versus 53.6% for multipares, P<0.05) and at discharge (48.5% versus 40.8% for multipares, P<0.05). The rate of infants breastfed was influenced neither by maternal age alone (31.8 ± 5.6 versus 31.4 ± 5.7 years for formula-fed), nor by type of delivery (56.7% for infants born by C-section versus 62.5% for infants born by vaginal delivery), nor gestational age (33.2 ± 4.3 weeks for breastfed, versus 33.4 ± 4.2 weeks for formula-fed infants), nor birthweight (2060 ± 978 g for breastfed versus 2055 ± 909 g for formula-fed infants), nor IUGR (58% versus 58.8% for eutrophes).
Our maternal population was different as 16.7% of deliveries were accounted for by MAP, superior to the French average (<10%). We describe for the first time MAP as a positive influencing factor on breastfeeding rates in newborns admitted to a NICU. A better breastfeeding information policy during pregnancy, higher maternal age and increased multiple pregnancies would explain a higher breastfeeding rate among the women who had MAP. An impact of increasing maternal age was found on the rate of breastfed infants born of MAP. Primiparity was also a contributing factor for breastfeeding. Professional formation for all hospital staff concerned would be essential to give out clear and consistent information to families and to encourage support and intimacy throughout hospitalisation as well as at discharge.
尽管医院工作人员接受过鼓励母乳喂养的培训，但新生儿出生时入住新生儿重症监护病房（NICU）仍会使母乳喂养变得复杂，尤其是对早产儿而言。本研究的目的是找出与母亲、妊娠或新生儿相关的影响NICU母乳喂养率的因素。
这是一项回顾性研究，纳入了2009年5月1日至2010年4月30日在安托万 - 贝克莱尔大学医院NICU住院的新生儿。数据从病历中收集。分析了母乳喂养率（开始时和出院时）与母亲年龄、生育方式、妊娠类型（单胎或多胎）、产次、分娩方式（阴道分娩或剖宫产）、出生体重、胎龄和宫内生长受限（IUGR）的关系。
该研究基于460例有完整记录的新生儿。母亲平均年龄为32岁。早产儿占研究人群的74.8%（中位胎龄 = 34周），其中57%小于33周（占所有婴儿的42.6%，n = 196）。中位出生体重为1900 g，IUGR婴儿占17.6%。开始时的母乳喂养率为58.7%，出院时为43.9%（平均住院天数：17.1 [0 - 180]，中位值 = 8天）。对于多胎妊娠出生的婴儿（占人群的24.3%），51.6%为医学辅助妊娠（MAP）出生，17.6%为自然妊娠出生。这些婴儿开始时的母乳喂养率为57.1%，出院时为45.5%。MAP出生的婴儿开始时的母乳喂养率更高（70.3%对比自然妊娠的55.8%，P < 0.05），出院时也是如此（49.5%对比自然妊娠的42.5%）。对于这些婴儿，母乳喂养婴儿的母亲平均年龄更高（33.9岁对比人工喂养的32.1岁，P < 0.05）。初产妇出生的婴儿开始时的母乳喂养率更高（64.9%对比经产妇的53.6%，P < 0.05），出院时也是如此（48.5%对比经产妇的40.8%，P < 0.05）。母乳喂养婴儿的比例既不受母亲年龄单独影响（人工喂养的为31.8 ± 5.6岁对比31.4 ± 5.7岁），也不受分娩方式影响（剖宫产出生的婴儿为56.7%对比阴道分娩出生的婴儿为62.5%），不受胎龄影响（母乳喂养婴儿为33.2 ± 4.3周对比人工喂养婴儿为33.4 ± 4. (2)周），不受出生体重影响（母乳喂养婴儿为2060 ± 978 g对比人工喂养婴儿为2055 ± 909 g），也不受IUGR影响（适于胎龄儿为58%对比58.8%）。
我们的母亲人群有所不同，因为16.7%的分娩是MAP，高于法国平均水平（<10%）。我们首次将MAP描述为入住NICU的新生儿母乳喂养率的一个积极影响因素。孕期更好的母乳喂养信息政策、母亲年龄较大以及多胎妊娠增加可以解释MAP女性中较高的母乳喂养率。发现母亲年龄增加对MAP出生的母乳喂养婴儿比例有影响。初产也是母乳喂养的一个促成因素。对所有相关医院工作人员进行专业培训对于向家庭提供清晰一致的信息以及在整个住院期间和出院时鼓励支持和亲密关系至关重要。
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