Hoban Rebecca, Bigger Harold, Schoeny Michael, Engstrom Janet, Meier Paula, Patel Aloka L
1 Section of Neonatology, Department of Pediatrics, Rush University Medical Center , Chicago, Illinois.
2 Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children , Toronto, Canada .
Breastfeed Med. 2018 Mar;13(2):135-141. doi: 10.1089/bfm.2017.0159. Epub 2018 Jan 29.
This study sought to determine the maternal prepregnancy, pregnancy, and delivery risk factors that predicted coming to volume (CTV; achieving pumped mother's own milk [MOM] volume ≥500 mLs/day) and the continuation of MOM provision through to discharge from the neonatal intensive care unit (NICU) in mothers and their very low birthweight (VLBW; <1,500 g at birth) infants.
Secondary analysis of prospectively collected data from 402 mothers of VLBW infants admitted to an urban NICU, including detailed MOM pumping records for a subset (51%) of the cohort. Analyses included inverse probability weighting, multivariate regression, and chi-square statistics.
In this high-risk cohort (51.2% black, 27.1% Hispanic, 21.6% white/Asian; 72.6% low income; 61.4% overweight/obese prepregnancy), CTV by day 14 was the strongest predictor of MOM feeding at NICU discharge (odds ratio [OR] 9.70 confidence interval [95% CI] 3.86-24.38, p < 0.01.). Only 39.5% of mothers achieved CTV by postpartum day 14, an outcome that was predicted by gestational age at delivery (OR 1.41, 95% CI 1.15-1.73, p < 0.01), being married (OR 3.66, 95% CI 1.08-12.39, p = 0.04), black race (OR 7.70, 95% CI 2.05-28.97, p < 0.01), cesarean delivery (OR 0.22, 95% CI 0.08-0.63, p = 0.01), and chorioamionitis (OR 0.14, 95% CI 0.02-0.82, p = 0.03).
Continued provision of MOM at NICU discharge can be predicted in the first 14 postpartum days on the basis of achievement of CTV. We posit that CTV can serve as a quality indicator for improving MOM feedings in the NICU and that lactation support resources should target this early critical postbirth period.
本研究旨在确定孕前、孕期和分娩的危险因素，这些因素可预测达到目标奶量（CTV；实现母亲自己挤出的母乳量≥500毫升/天）以及母亲及其极低出生体重（VLBW；出生时体重<1500克）婴儿在新生儿重症监护病房（NICU）直至出院时持续提供母乳的情况。
对前瞻性收集的402名入住城市NICU的VLBW婴儿母亲的数据进行二次分析，包括该队列中一部分（51%）的详细母乳挤出记录。分析包括逆概率加权、多变量回归和卡方统计。
在这个高危队列中（51.2%为黑人，27.1%为西班牙裔，21.6%为白人/亚裔；72.6%为低收入；61.4%孕前超重/肥胖），到第14天时达到CTV是NICU出院时进行母乳喂养的最强预测因素（优势比[OR]9.70，置信区间[95%CI]3.86 - 24.38，p<0.01）。只有39.5%的母亲在产后第14天达到CTV，这一结果可由分娩时的孕周（OR 1.41，95%CI 1.15 - 1.73，p<0.01）、已婚（OR 3.66，95%CI 1.08 - 12.39，p = 0.04）、黑人种族（OR 7.70，95%CI 2.05 - 28.97，p<0.01）、剖宫产（OR 0.22，95%CI 0.08 - 0.63，p = 0.01）和绒毛膜羊膜炎（OR 0.14，95%CI 0.02 - 0.82，p = 0.03）预测。
根据产后第14天是否达到CTV，可以预测NICU出院时能否持续提供母乳。我们认为CTV可作为改善NICU母乳喂养的质量指标，并且泌乳支持资源应针对这一出生后的关键早期阶段。
