与早产儿纯母乳喂养相关的因素。一项前瞻性全国队列研究的结果。
Factors associated with exclusive breastfeeding of preterm infants. Results from a prospective national cohort study.
机构信息
Knowledge Centre for Breastfeeding Infants with Special Needs at Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark ; Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden ; Danish National Panel of Experts on Breastfeeding Infants with Special Needs.
Department of Neonatology, Copenhagen University Hospital Herlev, Herlev, Denmark.
出版信息
PLoS One. 2014 Feb 19;9(2):e89077. doi: 10.1371/journal.pone.0089077. eCollection 2014.
BACKGROUND AND AIM
Evidence-based knowledge of how to guide the mothers of preterm infants in breastfeeding establishment is contradictive or sparse. The aim was to investigate the associations between pre-specified clinical practices for facilitating breastfeeding, and exclusive breastfeeding at discharge as well as adequate duration thereof.
METHODS
A prospective survey based on questionnaires was conducted with a Danish national cohort, comprised of 1,221 mothers and their 1,488 preterm infants with a gestational age of 24-36 weeks. Adjusted for covariates, the pre-specified clinical practices were analysed by multiple logistic regression analyses.
RESULTS
At discharge 68% of the preterm infants were exclusively breastfed and 17% partially. Test-weighing the infant, and minimizing the use of a pacifier, showed a protective effect to exclusive breastfeeding at discharge (OR 0.6 (95% CI 0.4-0.8) and 0.4 (95% CI 0.3-0.6), respectively). The use of nipple shields (OR 2.3 (95% CI 1.6-3.2)) and the initiation of breast milk expression later than 48 hours postpartum (OR 4.9 (95% CI 1.9-12.6)) were associated with failure of exclusive breastfeeding at discharge. The clinical practices associated with an inadequate breastfeeding duration were the initiation of breast milk expression at 12-24 hours (OR 1.6 (95% CI 1.0-2.4)) and 24-48 hours (OR 1.8 (95% CI 1.0-3.1)) vs. before six hours postpartum, and the use of nipple shields (OR 1.4 (95% CI 1.1-1.9)).
CONCLUSION
Early initiation of breast milk pumping before 12 hours postpartum may increase breastfeeding rates, and it seems that the use of nipple shields should be restricted. The use of test-weighing and minimizing the use of a pacifier may promote the establishment of exclusive breastfeeding, but more research is needed regarding adequate support to the mother when test-weighing is ceased, as more of these mothers ceased exclusive breastfeeding at an early stage after discharge.
背景与目的
关于如何指导早产儿母亲进行母乳喂养建立的循证知识存在矛盾或缺乏。本研究旨在调查促进母乳喂养的特定临床实践与出院时纯母乳喂养及母乳喂养持续时间的关系。
方法
采用基于问卷的前瞻性调查，对丹麦全国队列中的 1221 名母亲及其 1488 名胎龄为 24-36 周的早产儿进行调查。调整协变量后，采用多因素逻辑回归分析对特定的临床实践进行分析。
结果
出院时，68%的早产儿纯母乳喂养，17%的早产儿部分母乳喂养。对婴儿进行测试称重和尽量减少使用奶嘴，可保护婴儿在出院时纯母乳喂养（比值比 0.6（95%置信区间 0.4-0.8）和 0.4（95%置信区间 0.3-0.6））。使用奶嘴（比值比 2.3（95%置信区间 1.6-3.2））和产后 48 小时后开始挤奶（比值比 4.9（95%置信区间 1.9-12.6））与出院时未能实现纯母乳喂养相关。与母乳喂养持续时间不足相关的临床实践包括产后 12-24 小时（比值比 1.6（95%置信区间 1.0-2.4））和 24-48 小时（比值比 1.8（95%置信区间 1.0-3.1））开始挤奶，而不是在产后 6 小时内开始，以及使用奶嘴（比值比 1.4（95%置信区间 1.1-1.9））。
结论
在产后 12 小时内尽早开始挤奶可能会提高母乳喂养率，而且似乎应该限制使用奶嘴。对婴儿进行测试称重和尽量减少使用奶嘴可能会促进纯母乳喂养的建立，但当停止测试称重时，需要更多的研究来支持母亲，因为更多的母亲在出院后早期就停止了纯母乳喂养。
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