Schiff Davida M, Wachman Elisha M, Philipp Barbara, Joseph Kathleen, Shrestha Hira, Taveras Elsie M, Parker Margaret G K
1 Department of Pediatrics, Boston Medical Center, Boston University School of Medicine , Boston, Massachusetts.
2 Division of General Academic Pediatrics, MassGeneral Hospital for Children , Boston, Massachusetts.
Breastfeed Med. 2018 May;13(4):266-274. doi: 10.1089/bfm.2017.0172. Epub 2018 Apr 9.
Among opioid-exposed newborns, breastfeeding is associated with less severe withdrawal signs, yet breastfeeding rates remain low. We determined the extent to which hospital, maternal, and infant characteristics are associated with breastfeeding initiation and continuation among opioid-exposed dyads.
We examined breastfeeding initiation and continuation until infants' discharge among opioid-exposed dyads from 2006 to 2016. Among dyads meeting hospital breastfeeding guidelines, we assessed hospital (changes in breastfeeding guidelines and improvement initiatives [using delivery year as a proxy]), maternal (demographics, comorbid conditions, methadone versus buprenorphine treatment, and delivery mode), and infant (gestational age and birth weight) characteristics. We used multivariable logistic regression to examine independent associations of characteristics with breastfeeding initiation and continuation.
Among 924 opioid-exposed dyads, 61% (564) met breastfeeding criteria. Overall, 50% (283/564) of dyads initiated and 33% (187/564) continued breastfeeding until discharge. Breastfeeding initiation and continuation rates increased from 38% and 8% in 2006, to 56% and 34% in 2016, respectively. In adjusted models, infants born after reducing restrictions in hospital breastfeeding guidelines and prenatal breastfeeding education (adjusted odds ratio, aOR 2.6 [95% confidence interval, CI 1.5-4.5]) had increased odds of receiving any maternal breast milk versus infants born with earlier hospital policies. Cesarean versus vaginal delivery (aOR 0.3 [95% CI 0.2-0.6]) and length of infant hospitalization (aOR 0.94 [95% CI 0.92-0.97]) were negatively associated with breastfeeding continuation.
Despite increasing breastfeeding rates among opioid-exposed dyads, rates remain suboptimal. Hospital-level factors were the greatest predictor of breastfeeding initiation. The findings suggest that changes in hospital guidelines and initiatives can impact breastfeeding initiation among this vulnerable population.
在暴露于阿片类药物的新生儿中，母乳喂养与较轻的戒断症状相关，但母乳喂养率仍然较低。我们确定了医院、母亲和婴儿特征在多大程度上与暴露于阿片类药物的母婴对开始和持续母乳喂养有关。
我们研究了2006年至2016年期间暴露于阿片类药物的母婴对开始和持续母乳喂养直至婴儿出院的情况。在符合医院母乳喂养指南的母婴对中，我们评估了医院（母乳喂养指南的变化和改进措施[以分娩年份作为代理]）、母亲（人口统计学、合并症、美沙酮与丁丙诺啡治疗以及分娩方式）和婴儿（胎龄和出生体重）特征。我们使用多变量逻辑回归来研究这些特征与开始和持续母乳喂养的独立关联。
在924对暴露于阿片类药物的母婴对中，61%（564对）符合母乳喂养标准。总体而言，50%（283/564）的母婴对开始母乳喂养，33%（187/564）持续母乳喂养直至出院。母乳喂养的开始率和持续率分别从2006年的38%和8%增加到2016年的56%和34%。在调整模型中，在医院母乳喂养指南限制减少和接受产前母乳喂养教育后出生的婴儿（调整后的优势比，aOR 2.6[95%置信区间，CI 1.5 - 4.5]）与采用早期医院政策时出生的婴儿相比，接受任何母乳的几率增加。剖宫产与阴道分娩（aOR 0.3[95% CI 0.2 - 0.6]）以及婴儿住院时间（aOR 0.94[95% CI 0.92 - 0.97]）与母乳喂养的持续呈负相关。
尽管暴露于阿片类药物的母婴对的母乳喂养率有所上升，但仍未达到最佳水平。医院层面的因素是母乳喂养开始的最大预测因素。研究结果表明，医院指南和措施的改变会影响这一弱势群体的母乳喂养开始情况。
