St David's Children's Hospital, Austin, Texas;
Texas A&M Health Science Center, Texas A&M University, Bryan, Texas.
Hosp Pediatr. 2020 Jun;10(6):502-508. doi: 10.1542/hpeds.2020-0056. Epub 2020 May 6.
Infants readmitted for neonatal hyperbilirubinemia requiring phototherapy are less likely to exclusively breastfeed than infants who are not readmitted for phototherapy. Our aim for this study was to increase breastfeeding exclusivity for infants admitted for neonatal hyperbilirubinemia.
Using the Model for Improvement, we conducted 3 plan-do-study-act cycles to improve exclusive breastfeeding (EB). Our outcome measure was to increase the percentage of EB for infants hospitalized for phototherapy from 30% to 80% in 12 months. Our process measure was to increase lactation consultations from 60% to 80%. Balancing measures included the development of >10% weight loss, acute bilirubin encephalopathy, readmissions, and length of stay. Interventions involved staff breastfeeding education, automated orders for lactation consultations, and use of bilirubin blankets during breastfeeding. Data were analyzed by using run charts and statistical process control.
A total of 92 infants with neonatal hyperbilirubinemia were admitted from December 2016 to August 2019, with 61 in the postintervention period. After implementation of an automated order for lactation consultation, EB improved from 30% to 60% and completed lactation consultations increased from 60% to 90%. Infants who received a lactation consultation within the first shift during their hospitalization were 4 times more likely to have EB during hospitalization than infants who did not (odds ratio 3.8; confidence interval: 1.17-12.39.) No infant experienced >10% weight loss, acute bilirubin encephalopathy, or a readmission, and length of stay did not significantly change.
Early involvement of trained lactation consultants safely improves rates of EB for infants hospitalized with neonatal hyperbilirubinemia.
与未因光疗而再次入院的患儿相比，因新生儿高胆红素血症再次入院接受光疗的婴儿更不可能进行纯母乳喂养。我们进行这项研究的目的是提高因新生儿高胆红素血症入院的婴儿的纯母乳喂养率。
我们采用改进模式（Model for Improvement）进行了 3 个计划-执行-研究-行动（plan-do-study-act）循环，以提高纯母乳喂养率。我们的主要结局指标是在 12 个月内将因光疗住院的婴儿纯母乳喂养率从 30%提高到 80%。次要结局指标是将母乳喂养咨询率从 60%提高到 80%。平衡措施包括体重减轻超过 10%、急性胆红素脑病、再入院和住院时间。干预措施包括对医护人员进行母乳喂养教育、自动下达母乳喂养咨询医嘱以及在母乳喂养期间使用胆红素毯。采用运行图和统计过程控制对数据进行分析。
2016 年 12 月至 2019 年 8 月期间共有 92 例新生儿高胆红素血症患儿入院，其中 61 例为干预后时期患儿。实施自动下达母乳喂养咨询医嘱后，纯母乳喂养率从 30%提高到 60%，母乳喂养咨询完成率从 60%提高到 90%。与未在住院期间第 1 班次接受母乳喂养咨询的患儿相比，在住院期间第 1 班次接受母乳喂养咨询的患儿住院期间进行纯母乳喂养的可能性增加了 4 倍（比值比 3.8；95%置信区间：1.17~12.39）。没有患儿体重减轻超过 10%、发生急性胆红素脑病或再入院，住院时间也没有明显变化。
尽早让经过培训的哺乳顾问参与，可以安全提高因新生儿高胆红素血症住院的婴儿的纯母乳喂养率。
