出生住院期间新生儿体重减轻及1月龄前的母乳喂养结局
Newborn Weight Loss During Birth Hospitalization and Breastfeeding Outcomes Through Age 1 Month.
作者信息
Flaherman Valerie J, Schaefer Eric W, Kuzniewicz Michael K, Li Sherian, Walsh Eileen, Paul Ian M
机构信息
1 Department of Pediatrics, University of California, San Francisco, CA, USA.
2 Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
出版信息
J Hum Lact. 2017 Feb;33(1):225-230. doi: 10.1177/0890334416680181. Epub 2017 Jan 20.
BACKGROUND
Weight loss is universal for exclusively breastfed newborns in the first few days after birth. Many newborns exclusively breastfed during birth hospitalization receive formula in the first month after discharge and thus cease exclusive breastfeeding. However, the relationship between early weight loss and subsequent cessation of breastfeeding and exclusive breastfeeding is unknown. Research aim: This study aimed to determine the relationship between newborn weight loss and duration and exclusivity of breastfeeding among newborns breastfed exclusively during the birth hospitalization.
METHODS
Retrospective cohort study at Kaiser Permanente Northern California hospitals between 2009 and 2013. The main predictor variable was weight loss during birth hospitalization. The main outcomes were cessation of breastfeeding and cessation of exclusive breastfeeding in the first 25 days after discharge.
RESULTS
Among our sample, 83,344 were exclusively breastfed during birth hospitalization. At 25 days after discharge, 15.6%, 95% confidence interval (CI) [14.6%, 16.6%], of those delivered vaginally and 17.6%, 95% CI [14.5%, 20.6%], of those delivered by cesarean section were estimated to have completely ceased breastfeeding; 57.0%, 95% CI [55.5%, 58.4%], and 57.9%, 95% CI [53.6%, 61.8%], respectively, had ceased exclusive breastfeeding. Survival curves depicting rates of breastfeeding cessation through 1 month did not differ by degree of weight loss or by weight loss trajectory. However, curves depicting rates of exclusive breastfeeding demonstrated significantly more formula use among those with more weight loss at discharge.
CONCLUSION
Among those exclusively breastfed during birth hospitalization, weight loss nomograms may help identify newborns at higher risk of cessation of exclusive breastfeeding. Lactation support targeted to those with exacerbated weight loss trajectories may improve duration of exclusive breastfeeding.
背景
出生后的头几天，纯母乳喂养的新生儿普遍会出现体重下降。许多在出生住院期间纯母乳喂养的新生儿在出院后的第一个月接受了配方奶喂养，从而停止了纯母乳喂养。然而，早期体重下降与随后停止母乳喂养及纯母乳喂养之间的关系尚不清楚。研究目的：本研究旨在确定出生住院期间纯母乳喂养的新生儿体重下降与母乳喂养持续时间及纯母乳喂养之间的关系。
方法
对2009年至2013年期间北加利福尼亚州凯撒医疗机构的医院进行回顾性队列研究。主要预测变量是出生住院期间的体重下降。主要结局是出院后前25天停止母乳喂养和停止纯母乳喂养。
结果
在我们的样本中，83344名新生儿在出生住院期间纯母乳喂养。出院25天时，经阴道分娩的新生儿中有15.6%（95%置信区间[CI][14.6%，16.6%]）、剖宫产分娩的新生儿中有17.6%（95%CI[14.5%，20.6%]）估计已完全停止母乳喂养；分别有57.0%（95%CI[55.5%，58.4%]）和57.9%（95%CI[53.6%，61.8%]）已停止纯母乳喂养。描绘至1个月时母乳喂养停止率的生存曲线在体重下降程度或体重下降轨迹方面没有差异。然而，描绘纯母乳喂养率的曲线显示，出院时体重下降较多的婴儿使用配方奶的情况明显更多。
结论
在出生住院期间纯母乳喂养的婴儿中，体重下降图表可能有助于识别纯母乳喂养停止风险较高的新生儿。针对体重下降轨迹加剧的婴儿提供的泌乳支持可能会延长纯母乳喂养的持续时间。
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