Charkaluk M-L, Bomy H, Delguste S, Courdent M, Rousseau S, Zaoui-Grattepanche C, Pierrat V
Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne-Paris-Cité, DHU risques et grossesse, hôpital Tenon, université Paris-Descartes, 4, rue de la Chine, 75020 Paris, France; UC Lille, 59000 Lille, France; Groupement des hôpitaux de l'institut catholique Lillois, service de néonatologie, faculté de médecine et maïeutique, hôpital Saint-Vincent-de-Paul, 59000 Lille, France.
Réseau organisation mamans bébés de la région Lilloise (OMBREL), hôpital Jeanne-de-Flandre, rue Eugène-Avinée, 59037 Lille cedex, France.
Arch Pediatr. 2018 Jan;25(1):18-22. doi: 10.1016/j.arcped.2017.10.026. Epub 2017 Dec 14.
Structured programs have a positive impact on breastfeeding (BF) but have rarely been evaluated for preterm neonates, frequently combining prematurity and socioeconomic deprivation as risk factors of a low BF rate. We aimed to assess BF initiation rates in very preterm (<33 weeks' gestational age), moderately preterm (33-36 weeks), and term neonates from 2002 to 2011 in a French administrative district characterized by socioeconomic deprivation. Structured activities to promote and support BF have been implemented in this area since 2002; they all started in neonatal units. This retrospective population-based study analyzed 302,102 first health certificates. Overall, the BF initiation rate significantly increased, from 52.9% [95% CI: (52.3; 53.4)] in 2002 to 61.0% [95% CI: (60.4; 61.6)] in 2011. In 2002, BF initiation rates did not differ between groups, but in 2011, it was higher for very preterm than for term and moderately preterm neonates [74.7% (69.7; 79.6)] vs. 60.9% (60.3; 61.5) and 59.9% (57.6; 62.2), respectively, both P<0.001. In 2011, however, no difference was observed between moderately preterm children and term-born children (P=0.40). The 2.2% yearly increase observed in very preterm neonates significantly differed from the 0.9% yearly increase in the French general population (P<0.001).
Structured BF programs initiated in neonatal care units may have a positive impact on BF initiation rates in very preterm neonates, but not in moderately preterm neonates, whose specific needs should be further evaluated.
结构化项目对母乳喂养有积极影响，但很少针对早产新生儿进行评估，早产和社会经济贫困常被视为低母乳喂养率的风险因素。我们旨在评估2002年至2011年在一个以社会经济贫困为特征的法国行政区中，极早产（胎龄<33周）、中度早产（33 - 36周）和足月儿的母乳喂养启动率。自2002年起，该地区已开展促进和支持母乳喂养的结构化活动；这些活动均在新生儿病房启动。这项基于人群的回顾性研究分析了302,102份首次健康证明。总体而言，母乳喂养启动率显著提高，从2002年的52.9% [95%置信区间：(52.3; 53.4)] 升至2011年的61.0% [95%置信区间：(60.4; 61.6)]。2002年，各组之间的母乳喂养启动率无差异，但在2011年，极早产新生儿的启动率高于足月儿和中度早产新生儿，分别为74.7% (69.7; 79.6) 与60.9% (60.3; 61.5) 和59.9% (57.6; 62.2)，P均<0.001。然而，2011年，中度早产儿童和足月儿之间未观察到差异（P = 0.40）。极早产新生儿每年2.2%的增长率与法国总体人群每年0.9%的增长率显著不同（P<0.001）。
在新生儿护理病房启动的结构化母乳喂养项目可能对极早产新生儿的母乳喂养启动率有积极影响，但对中度早产新生儿没有，其特殊需求应进一步评估。
