Rodrigues Carina, Severo Milton, Zeitlin Jennifer, Barros Henrique
EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
Breastfeed Med. 2018 Jan/Feb;13(1):50-59. doi: 10.1089/bfm.2017.0135. Epub 2017 Dec 6.
To assess the influence of neonatal intensive care units (NICUs) on feeding practices at discharge of Portuguese very preterm infants. We analyzed data from 580 very preterm infants (<32 gestational weeks) discharged home from NICUs of two Portuguese regions and enrolled during 2011-2012 in population-based cohort. Maternal and infant characteristics were abstracted from medical records, and heads of NICUs provided the units characteristics. Feeding at discharge was classified as exclusive formula, exclusive breast milk or mixed, and differences among NICUs were obtained by comparison with pooled geometric mean odds of all NICUs, using multinomial logistic regression. Median odds ratios (MOR) were calculated to quantify variability among NICUs using multilevel logistic regression. At discharge, 25.2% very preterm infants were exclusively on breast milk, 34.1% exclusively on formula, and 40.7% had mixed feeding, with a wide variation among NICUs. Exclusive breast milk increased in NICUs that had higher numbers of admissions, provided parents eating facilities, and by having designated members to support mothers who were breastfeeding. The individual NICU odds of mixed versus exclusive formula feeding ranged from 0.36 to 2.07 and for exclusive breast milk versus exclusive formula ranged from 0.16 and 5.11. Adjusting for individual and unit characteristics, heterogeneity across NICUs remained evident, being the MOR 1.33 for mixed feeding and 1.35 for exclusive breast milk. NICUs influence feeding practices independently of individual characteristics, highlighting the importance of institution-based interventions to promote breast milk.
评估新生儿重症监护病房（NICUs）对葡萄牙极早产儿出院时喂养方式的影响。我们分析了来自葡萄牙两个地区NICUs出院回家的580例极早产儿（孕周<32周）的数据，这些婴儿于2011 - 2012年纳入基于人群的队列研究。母婴特征从医疗记录中提取，NICUs负责人提供科室特征。出院时的喂养方式分为纯配方奶喂养、纯母乳喂养或混合喂养，通过与所有NICUs的合并几何平均比值比进行比较，使用多项逻辑回归分析NICUs之间的差异。使用多水平逻辑回归计算中位数比值比（MOR）以量化NICUs之间的变异性。出院时，25.2%的极早产儿纯母乳喂养，34.1%纯配方奶喂养，40.7%混合喂养，各NICUs之间存在很大差异。在入院人数较多、为家长提供饮食设施以及有指定人员支持母乳喂养母亲的NICUs中，纯母乳喂养的比例增加。混合喂养与纯配方奶喂养的各NICU比值比范围为0.36至2.07，纯母乳喂养与纯配方奶喂养的比值比范围为0.16至5.11。在调整个体和科室特征后，NICUs之间的异质性仍然明显，混合喂养的MOR为1.33，纯母乳喂养的MOR为1.35。NICUs独立于个体特征影响喂养方式，突出了基于机构的干预措施对促进母乳喂养的重要性。
