Department of Pediatrics, Cooper Medical School, Rowan University and Children's Regional Hospital at Cooper, Cooper University Health Care, Camden, New Jersey;
Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia.
Pediatrics. 2020 Apr;145(4). doi: 10.1542/peds.2018-3696. Epub 2020 Mar 11.
The nutritional and immunologic properties of human milk, along with clear evidence of dose-dependent optimal health outcomes for both mothers and infants, provide a compelling rationale to support exclusive breastfeeding. US women increasingly intend to breastfeed exclusively for 6 months. Because establishing lactation can be challenging, exclusivity is often compromised in hopes of preventing feeding-related neonatal complications, potentially affecting the continuation and duration of breastfeeding. Risk factors for impaired lactogenesis are identifiable and common. Clinicians must be able to recognize normative patterns of exclusive breastfeeding in the first week while proactively identifying potential challenges. In this review, we provide new evidence from the past 10 years on the following topics relevant to exclusive breastfeeding: milk production and transfer, neonatal weight and output assessment, management of glucose and bilirubin, immune development and the microbiome, supplementation, and health system factors. We focus on the early days of exclusive breastfeeding in healthy newborns ≥35 weeks' gestation managed in the routine postpartum unit. With this evidence-based clinical review, we provide detailed guidance in identifying medical indications for early supplementation and can inform best practices for both birthing facilities and providers.
人乳的营养和免疫特性，以及明确的证据表明母亲和婴儿的健康结果呈剂量依赖性，这为支持纯母乳喂养提供了强有力的理由。美国越来越多的女性打算纯母乳喂养 6 个月。由于建立泌乳可能具有挑战性，因此通常会为了预防与喂养相关的新生儿并发症而妥协，这可能会影响母乳喂养的持续时间和时长。泌乳功能受损的风险因素是可识别的和常见的。临床医生必须能够在第一周识别出纯母乳喂养的正常模式，同时主动识别潜在的挑战。在这篇综述中，我们提供了过去 10 年与纯母乳喂养相关的以下主题的新证据：乳汁生产和转移、新生儿体重和产量评估、葡萄糖和胆红素管理、免疫发育和微生物组、补充以及卫生系统因素。我们专注于≥35 周胎龄的健康新生儿在常规产后病房中进行纯母乳喂养的早期阶段。通过基于证据的临床综述，我们提供了有关早期补充的医学指征的详细指导，并为分娩机构和提供者提供了最佳实践建议。
