新生儿重症监护病房针对极低出生体重儿的特定泌乳支持及母亲自身母乳供应情况

Neonatal Intensive Care Unit-Specific Lactation Support and Mother's Own Breast Milk Availability for Very Low Birth-Weight Infants.

作者信息

Mercado Kathryn, Vittner Dorothy, Drabant Bradlee, McGrath Jacqueline

机构信息

University of Connecticut, School of Nursing, Storrs (Dr Mercado); Pediatrix Medical Group, Affiliate of Mednax, Las Vegas, Nevada (Drs Mercado and Drabant); WakeMed Health & Hospitals, Raleigh, North Carolina (Dr Vittner); and University of Texas Health Science Center San Antonio, School of Nursing (Dr McGrath).

出版信息

Adv Neonatal Care. 2019 Dec;19(6):474-481. doi: 10.1097/ANC.0000000000000684.

DOI:10.1097/ANC.0000000000000684

PMID:31764136

Abstract

BACKGROUND

Mother's own milk (MOM) is the preferred nutrition for premature infants, particularly for the very low birth-weight (VLBW) cohort. Benefits are well documented; yet, numerous barriers exist for provision of MOM in the neonatal intensive care unit (NICU). Lactation consultants (LCs) can optimize breastfeeding support for NICU mothers; however, understanding of the impact of NICU-dedicated LCs is limited.

PURPOSE

Evaluate the effectiveness of NICU-dedicated LCs in improving breastfeeding outcomes and MOM provision in VLBW infants.

METHODS

A retrospective chart review of 167 VLBW infants comparing breastfeeding outcomes between 2 NICUs, one with NICU-dedicated LCs (hospital A; n = 48) and one without (hospital B; n = 119). Primary outcome measures included feeding percentages of MOM received by infants at 3 intervals, throughout hospitalization, and number of direct breastfeeding events. Secondary outcome measures included number of days to first enteral feed, days to reach full feeds, days of nil per os, days on total parenteral nutrition, and length of stay.

FINDINGS

Neonatal intensive care unit-specific lactation support increased the number of direct breastfeeding events on day of discharge (P = .048). No statistical significance was found at each of the 3 time intervals, or throughout hospitalization (week 1: P = .18; midpoint: P = .40; discharge: P = .16; total hospitalization: P = .19). No statistical significance was demonstrated in secondary outcome measures (days to first enteral feed: P = .22; days to full feeds: P = .25; nil per os days: P = .27; total parenteral nutrition days: P = .34; length of stay: P = .01). Length of stay not found to be significant after correcting for confounding variables.

IMPLICATION FOR PRACTICE

Increased direct breastfeeding events on day of discharge with exposure to NICU-dedicated LCs in the VLBW population.

IMPLICATION FOR RESEARCH

Prospective studies regarding NICU-specific lactation support with larger samples are warranted.

摘要

背景

母乳是早产儿的首选营养来源，尤其是对于极低出生体重（VLBW）的婴儿群体。其益处已有充分记录；然而，在新生儿重症监护病房（NICU）提供母乳存在诸多障碍。哺乳顾问（LC）可为NICU的母亲优化母乳喂养支持；然而，对于NICU专职LC的影响了解有限。

目的

评估NICU专职LC对改善VLBW婴儿母乳喂养结局及母乳提供情况的有效性。

方法

对167例VLBW婴儿进行回顾性病历审查，比较两个NICU的母乳喂养结局，一个设有NICU专职LC（医院A；n = 48），另一个没有（医院B；n = 119）。主要结局指标包括婴儿在3个时间点、整个住院期间接受母乳的喂养百分比以及直接母乳喂养事件的次数。次要结局指标包括首次肠内喂养天数、达到全量喂养天数、禁食天数、全胃肠外营养天数以及住院时长。

结果

NICU特定的泌乳支持增加了出院当天直接母乳喂养事件的次数（P = 0.048）。在3个时间点中的每个时间点以及整个住院期间均未发现统计学显著性差异（第1周：P = 0.18；中点：P = 0.40；出院：P = 0.16；总住院期间：P = 0.19）。次要结局指标未显示统计学显著性差异（首次肠内喂养天数：P = 0.22；全量喂养天数：P = 0.25；禁食天数：P = 0.27；全胃肠外营养天数：P = 0.34；住院时长：P = 0.01）。在校正混杂变量后，住院时长未发现显著差异。