质量改进计划对极低出生体重儿母乳使用情况的影响。

Impact of Quality Improvement Program on Expressed Breastmilk Usage in Very Low Birth Weight Infants.

作者信息

Thakur Anup, Kler Neelam, Garg Pankaj, Singh Anita, Gandhi Priya

机构信息

Department of Neonatology, Institute of Child health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India. Correspondence to: Dr Anup Thakur, Consultant Neonatologist, Institute of Child health, Sir Ganga Ram Hospital, New Delhi, India.

Department of Neonatology, Institute of Child health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India.

出版信息

Indian Pediatr. 2018 Sep 15;55(9):739-743.

PMID:30345975

Abstract

OBJECTIVE

To improve the usage of expressed breast milk in very low birth weight infants admitted in the neonatal intensive care unit of a tertiary centre in India.

METHODS

Between April 2015 and August 2016, various Plan-do-act-study cycles were conducted to test change ideas like antenatal counselling including help of brochure and video, post-natal telephonic reminders within 4-6 hours of birth, standardization of Kangaroo mother care, and non-nutritive sucking protocol. Data was analyzed using statistical process control charts.

RESULTS

156 very low birth weight infants were delivered during the study period, of which 31 were excluded due to various reasons. Within 6 months of implementation, the proportion of very low birth weight infants who received expressed breast milk within 48 hours improved to 100% from 38.7% and this was sustained at 100% for next 8 months. The mean time of availability and volume of expressed breast milk within 48 hours, improved gradually from 73.3 h to 20.9 h and 4.7 mL to 15.8 mL, respectively. The mean proportion of expressed breast milk once infant reached a feed volume of 100 mL/kg/day also improved from 61.3% to 82.3%.

CONCLUSIONS

Quality improvement interventions showed promising results of increased expressed breast milk usage in very low birth weight infants.

摘要

目的

提高印度一家三级医疗中心新生儿重症监护病房收治的极低出生体重儿的母乳挤出后使用率。

方法

在2015年4月至2016年8月期间，开展了多个计划-执行-行动-研究循环，以测试各种改进想法，如产前咨询（包括使用宣传册和视频）、出生后4-6小时内的产后电话提醒、袋鼠式护理标准化以及非营养性吸吮方案。使用统计过程控制图对数据进行分析。

结果

研究期间共分娩156例极低出生体重儿，其中31例因各种原因被排除。在实施后的6个月内，出生后48小时内接受母乳挤出后喂养的极低出生体重儿比例从38.7%提高到100%，并在接下来的8个月内维持在100%。48小时内母乳挤出后的可获得时间和量的平均值分别从平均73.3小时逐渐改善到20.9小时，从4.7毫升逐渐改善到15.8毫升。当婴儿达到每日每千克体重100毫升的喂养量时，母乳挤出后喂养的平均比例也从61.3%提高到了82.3%。