Crook Kimberley, Brandon Debra
Palliative Care, CarePartners, Asheville, North Carolina (Dr Crook); and Duke University School of Nursing, Durham, North Carolina (Dr Brandon).
Adv Neonatal Care. 2017 Aug;17(4):299-305. doi: 10.1097/ANC.0000000000000392.
Neonatal abstinence syndrome (NAS) is a growing problem in the United States, affecting 32,000 infants annually. Although breastfeeding would benefit infants with NAS, rates among these mothers are low.
The purpose of this quality improvement project was to increase breastfeeding rates and decrease hospital length of stay (LOS) for infants with NAS through prenatal breastfeeding initiatives.
A pre-/postquality improvement design was used to assess the relationship between breastfeeding initiatives on breastfeeding rates and LOS in infants with NAS. A 3-class curriculum was offered to pregnant women at risk for delivering an infant with NAS. Chart review was completed for all infants evaluated for NAS in a hospital at baseline (n = 56), after Baby Friendly Status (BFS) (n = 75), and after BFS plus breastfeeding education (n = 69).
Although not statistically significant, the BFS plus breastfeeding education cohort had the largest percentage of exclusively breastfed infants during hospitalization (24.6%) and at discharge (31.9%). There was a statistically significant decrease in LOS (P < .001) between cohorts.
The small sample made it not possible to infer direct impact of the intervention. However, results suggest that prenatal education may contribute to an increase in the numbers of infants with NAS who receive human milk and a decrease in hospital LOS.
Refinement of best practices around breastfeeding education and support for mothers at risk of delivering an infant with NAS is recommended so that breastfeeding may have the greatest impact for this subgroup of women and their infants.
新生儿戒断综合征(NAS)在美国是一个日益严重的问题,每年影响32000名婴儿。尽管母乳喂养对患有NAS的婴儿有益,但这些母亲的母乳喂养率很低。
本质量改进项目的目的是通过产前母乳喂养倡议提高母乳喂养率,并缩短患有NAS的婴儿的住院时间(LOS)。
采用前后质量改进设计,评估母乳喂养倡议与患有NAS的婴儿的母乳喂养率和住院时间之间的关系。为有分娩患有NAS婴儿风险的孕妇提供了一个三级课程。对一家医院中所有接受NAS评估的婴儿进行了病历审查,基线时(n = 56)、获得爱婴医院地位(BFS)后(n = 75)以及BFS加母乳喂养教育后(n = 69)。
尽管无统计学意义,但BFS加母乳喂养教育队列在住院期间(24.6%)和出院时(31.9%)纯母乳喂养婴儿的比例最高。各队列之间的住院时间有统计学显著下降(P <.001)。
样本量小使得无法推断干预的直接影响。然而,结果表明产前教育可能有助于增加接受母乳的患有NAS的婴儿数量,并缩短住院时间。
建议完善围绕母乳喂养教育的最佳实践,并为有分娩患有NAS婴儿风险的母亲提供支持,以便母乳喂养对这一女性亚组及其婴儿产生最大影响。