Fugate Karen, Hernandez Ivonne, Ashmeade Terri, Miladinovic Branko, Spatz Diane L
J Obstet Gynecol Neonatal Nurs. 2015 May-Jun;44(3):426-38; quiz E14-5. doi: 10.1111/1552-6909.12563. Epub 2015 Apr 1.
To determine if systematic implementation of the Spatz Ten Steps for Promoting and Protecting Breastfeeding for Vulnerable Infants (Ten Steps) would result in an improvement in the percentage of infants receiving mother's own milk (MOM) at initiation of feedings and at hospital discharge.
Continuous quality improvement (QI) process.
Urban, 82-bed, Level-III NICU.
Very- low-birth-weight (VLBW) infants weighing fewer than 1500 grams.
The Ten Step method was implemented during a 3-year period.
Process measurements included percentage of VLBW infants receiving MOM at initiation of feeds, number of mothers of VLBW infants with hospital-grade electric breast pump at hospital discharge, and number of mothers of VLBW infants initiating pumping within 6 hours of delivery. Outcome measurements included percentage of VLBW infants with any human milk at discharge to home and parent satisfaction with nurses' support of mother's efforts to breastfeed. Balancing measurements included percentage of VLBW infants at less than the third percentile for growth on the Fenton growth chart at discharge and receiving pasteurized donor milk (PDM).
Significant improvements were achieved in the percentages of mothers expressing their milk within 6 hours of delivery, infants receiving MOM at initiation of feeds, and mothers with a hospital-grade pump at discharge. Improvements in these processes resulted in increased parent satisfaction with nurses' support of breastfeeding and a 3.1-fold greater odds of the VLBW infant receiving MOM at discharge in 2013 compared to 2010 (odds ratio [OR]= 3.01, 95% confidence interval [CI] [1.75, 5.17], p < .001). Despite an increase in the use of MOM, there was not a significant increase in VLBW infants discharged at less than the third percentile for growth, and initiation of PDM did not negatively affect the percentage of VLBW infants with any human milk at discharge.
Implementation of the Ten Steps method using QI methodology resulted in significantly improved rates of use of MOM at initiation of feeds and at hospital discharge.
确定系统实施针对脆弱婴儿促进和保护母乳喂养的斯帕茨十步法（十步法）是否会使开始喂养时以及出院时接受母乳的婴儿比例得到提高。
持续质量改进（QI）过程。
拥有82张床位的城市三级新生儿重症监护病房（NICU）。
出生体重极低（VLBW）且体重不足1500克的婴儿。
在3年期间实施十步法。
过程测量指标包括开始喂养时接受母乳的极低出生体重婴儿的比例、出院时拥有医院级电动吸奶器的极低出生体重婴儿母亲的数量，以及分娩后6小时内开始吸奶的极低出生体重婴儿母亲的数量。结果测量指标包括出院回家时接受任何母乳的极低出生体重婴儿的比例以及家长对护士支持母亲母乳喂养努力的满意度。平衡测量指标包括出院时在芬顿生长图表上生长低于第三百分位的极低出生体重婴儿的比例以及接受巴氏消毒捐赠母乳（PDM）的比例。
在分娩后6小时内挤奶的母亲比例、开始喂养时接受母乳的婴儿比例以及出院时拥有医院级吸奶器的母亲比例都有显著提高。这些过程的改善导致家长对护士支持母乳喂养的满意度提高，并且与2010年相比，2013年极低出生体重婴儿出院时接受母乳的几率高出3.1倍（优势比[OR]=3.01，95%置信区间[CI][1.75,5.17]，p<.001）。尽管母乳的使用有所增加，但生长低于第三百分位出院的极低出生体重婴儿数量没有显著增加，并且开始使用巴氏消毒捐赠母乳对出院时接受任何母乳的极低出生体重婴儿比例没有负面影响。
采用QI方法实施十步法导致开始喂养时以及出院时母乳使用率显著提高。
