早产儿的母乳喂养进程受到婴儿、母亲及临床实践等多方面因素的影响：一项高母乳喂养启动率的全国队列研究结果
Breastfeeding progression in preterm infants is influenced by factors in infants, mothers and clinical practice: the results of a national cohort study with high breastfeeding initiation rates.
作者信息
Maastrup Ragnhild, Hansen Bo Moelholm, Kronborg Hanne, Bojesen Susanne Norby, Hallum Karin, Frandsen Annemi, Kyhnaeb Anne, Svarer Inge, Hallström Inger
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, Copenhagen, Denmark.
Department of Neonatology, Copenhagen University Hospital Herlev, Herlev, Denmark.
出版信息
PLoS One. 2014 Sep 24;9(9):e108208. doi: 10.1371/journal.pone.0108208. eCollection 2014.
BACKGROUND AND AIM
Many preterm infants are not capable of exclusive breastfeeding from birth. To guide mothers in breastfeeding, it is important to know when preterm infants can initiate breastfeeding and progress. The aim was to analyse postmenstrual age (PMA) at breastfeeding milestones in different preterm gestational age (GA) groups, to describe rates of breastfeeding duration at pre-defined times, as well as analyse factors associated with PMA at the establishment of exclusive breastfeeding.
METHODS
The study was part of a prospective survey of a national Danish cohort of preterm infants based on questionnaires and structured telephone interviews, including 1,221 mothers and their 1,488 preterm infants with GA of 24-36 weeks.
RESULTS
Of the preterm infants, 99% initiated breastfeeding and 68% were discharged exclusively breastfed. Breastfeeding milestones were generally reached at different PMAs for different GA groups, but preterm infants were able to initiate breastfeeding at early times, with some delay in infants less than GA 32 weeks. Very preterm infants had lowest mean PMA (35.5 weeks) at first complete breastfeed, and moderate preterm infants had lowest mean PMA at the establishment of exclusive breastfeeding (36.4 weeks). Admitting mothers to the NICU together with the infant and minimising the use of a pacifier during breastfeeding transition were associated with 1.6 (95% CI 0.4-2.8) and 1.2 days (95% CI 0.1-2.3) earlier establishment of exclusive breastfeeding respectively. Infants that were small for gestational age were associated with 5.6 days (95% CI 4.1-7.0) later establishment of exclusive breastfeeding.
CONCLUSION
Breastfeeding competence is not developed at a fixed PMA, but is influenced by multiple factors in infants, mothers and clinical practice. Admitting mothers together with their infants to the NICU and minimising the use of pacifiers may contribute to earlier establishment of exclusive breastfeeding.
背景与目的
许多早产儿从出生起就无法完全母乳喂养。为指导母亲进行母乳喂养，了解早产儿何时能够开始母乳喂养并取得进展非常重要。目的是分析不同早产孕周（GA）组在母乳喂养各关键节点时的月经后年龄（PMA），描述在预定时间的母乳喂养持续率，并分析与完全母乳喂养建立时的PMA相关的因素。
方法
该研究是对丹麦全国早产儿队列进行的前瞻性调查的一部分，基于问卷和结构化电话访谈，纳入了1221名母亲及其1488名GA为24 - 36周的早产儿。
结果
在这些早产儿中，99%开始母乳喂养，68%出院时完全母乳喂养。不同GA组在不同的PMA时通常能达到母乳喂养关键节点，但早产儿能够较早开始母乳喂养，GA小于32周的婴儿会有一些延迟。极早早产儿首次完全母乳喂养时的平均PMA最低（35.5周），中度早产儿在完全母乳喂养建立时的平均PMA最低（36.4周）。母亲与婴儿一起入住新生儿重症监护病房（NICU）以及在母乳喂养过渡期间尽量减少安抚奶嘴的使用分别与完全母乳喂养的提前建立相关，提前天数分别为1.6天（95%置信区间0.4 - 2.8）和1.2天（95%置信区间0.1 - 2.3）。小于胎龄儿与完全母乳喂养的建立延迟5.6天（95%置信区间4.1 - 7.0）相关。
结论
母乳喂养能力并非在固定的PMA时形成，而是受婴儿、母亲和临床实践中的多种因素影响。母亲与婴儿一起入住NICU以及尽量减少安抚奶嘴的使用可能有助于更早建立完全母乳喂养。
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