Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
J Hum Lact. 2012 Nov;28(4):535-42. doi: 10.1177/0890334412456603. Epub 2012 Sep 6.
Infant feeding-related health outcomes need to be consistently defined prior to inclusion in health services research.
To categorize conditions common in infants under 12 months old by their association with breastfeeding for use as outcome measures in a randomized, controlled trial of breastfeeding promotion.
A modified Delphi consensus method synthesized opinions of 13 physician experts on breastfeeding's association with ICD-9 infant diagnosis codes derived from literature review and medical center experience. A pilot round and 2 subsequent Delphi rounds were used. For the first round, consensus was achieved when more than 80% of experts agreed on a classification for a particular condition, with a predetermined level of certainty based on a 7-point Likert scale. For the second round, consensus was achieved when a majority of experts agreed on the classification from Round 1.
An initial 68 diagnosis codes were identified for evaluation by the expert panel. After a pilot round, the codes were refined and condensed, which resulted in 38 diagnoses for categorization into 1 of 3 categories: (1) breastfeeding protects against the condition; (2) breastfeeding may cause or worsen the condition; and (3) breastfeeding is unrelated to the condition. At the conclusion of the process, consensus was achieved on the classification of 31 conditions, and 7 conditions remained unclassified because of a lack of consensus.
This study provides a list of conditions common in infants under 12 months of age classified based on relationship to infant feeding method and validated by expert consensus. These conditions, based on readily available insurance claims data, contribute to the standardization of outcome measures used for health services research related to breastfeeding promotion.
在将婴儿喂养相关的健康结果纳入卫生服务研究之前，需要对其进行一致的定义。
通过将与母乳喂养相关的常见婴儿疾病分类，为促进母乳喂养的随机对照试验中的结果测量提供依据。
采用改良 Delphi 共识法，综合了 13 位医师专家对文献综述和医疗中心经验中得出的 ICD-9 婴儿诊断代码与母乳喂养关联的意见。采用一轮预试验和两轮 Delphi 法进行研究。在第一轮中，当超过 80%的专家对某一特定疾病的分类达成一致意见时，即可达成共识，同时根据 7 分 Likert 量表预设了一个确定性水平。在第二轮中，当大多数专家对第一轮的分类达成一致时，即可达成共识。
专家组最初对 68 个诊断代码进行了评估。经过一轮预试验，对代码进行了精炼和简化，最终将 38 个诊断分类为 3 个类别之一：（1）母乳喂养可预防该疾病；（2）母乳喂养可能导致或加重该疾病；（3）母乳喂养与该疾病无关。在研究结束时，31 种疾病的分类达成了共识，7 种疾病由于缺乏共识而未分类。
本研究提供了一份常见于 12 个月以下婴儿的疾病清单，根据与婴儿喂养方式的关系进行了分类，并通过专家共识进行了验证。这些疾病基于现成的保险索赔数据，有助于促进母乳喂养的卫生服务研究中使用结果测量的标准化。
