French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.
Department of Neonatal Medicine, CHU Lille, Jeanne de Flandre Hospital, Lille, France.
Matern Child Nutr. 2019 Oct;15(4):e12875. doi: 10.1111/mcn.12875. Epub 2019 Aug 13.
Facilitating factors and barriers to breast milk feeding (BMF) for preterm infants have been mainly studied in very preterm populations, but little is known about moderate preterm infants. We aimed to analyze hospital unit characteristics and BMF policies associated with BMF at discharge for infants born at 32 to 34 weeks' gestation. EPIPAGE-2, a French national cohort of preterm births, included 883 infants born at 32 to 34 weeks' gestation. We investigated kangaroo care in the first 24 hr, early involvement of parents in feeding support, volume of the unit, BMF information given to mothers hospitalized for threatened preterm delivery, protocols for BMF, presence of a professional trained in human lactation, unit training in neurodevelopmental care, and regional BMF initiation rates in the general population. Multilevel logistic regression analysis was used to investigate associations between unit policies and BMF at discharge, adjusted for individual characteristics and estimating odds ratios (ORs) and 95% confidence intervals (CIs). Overall, 59% (490/828) of infants received BMF at discharge (27% to 87% between units). Rates of BMF at discharge were higher with kangaroo care (adjusted OR 2.03 [95% CI 1.01, 4.10]), early involvement of parents in feeding support (1.94 [1.23, 3.04]), unit training in a neurodevelopmental care programme (2.57 [1.18, 5.60]), and in regions with a high level of BMF initiation in the general population (1.85 [1.05, 3.28]). Creating synergies by interventions at the unit and population level may reduce the variability in BMF rates at discharge for moderate preterm infants.
促进早产儿母乳喂养（BMF）的因素和障碍主要在极早产儿人群中进行了研究，但对中度早产儿知之甚少。我们旨在分析与 32 至 34 周出生婴儿出院时 BMF 相关的医院科室特征和 BMF 政策。EPIPAGE-2 是一项法国全国性早产儿队列研究，纳入了 883 名 32 至 34 周出生的婴儿。我们调查了婴儿出生后 24 小时内的袋鼠式护理、父母尽早参与喂养支持、科室容量、向因早产威胁而住院的母亲提供 BMF 信息、BMF 方案、是否有经过母乳喂养培训的专业人员、科室在神经发育护理方面的培训以及一般人群中 BMF 启动率。多水平逻辑回归分析用于调查科室政策与出院时 BMF 之间的关联，调整了个体特征，并估计了比值比（OR）和 95%置信区间（CI）。总体而言，59%（490/828）的婴儿出院时接受了 BMF（科室间比例为 27%至 87%）。实施袋鼠式护理（调整后的 OR 2.03 [95%CI 1.01, 4.10]）、父母尽早参与喂养支持（1.94 [1.23, 3.04]）、科室接受神经发育护理方案培训（2.57 [1.18, 5.60]）以及婴儿出生地区一般人群中 BMF 启动率高（1.85 [1.05, 3.28]）的科室，出院时 BMF 率更高。通过在科室和人群层面进行干预来创造协同作用，可能会降低中度早产儿出院时 BMF 率的差异。
