Golden Community, Lalitpur, Nepal.
Department of Women's and Children's Health, Uppsala University, Dag Hammarskjöldsväg 14B, Uppsala, Sweden.
Int Breastfeed J. 2021 Oct 29;16(1):85. doi: 10.1186/s13006-021-00431-y.
Timely initiation of breastfeeding can reduce neonatal morbidities and mortality. We aimed to study predictors for timely initiation of breastfeeding (within 1 h of birth) among neonates born in hospitals of Nepal.
A prospective observational study was conducted in four public hospitals between July and October 2018. All women admitted in the hospital for childbirth and who consented were included in the study. An independent researchers observed whether the neonates were placed in skin-to-skin contact, delay cord clamping and timely initiation of breastfeeding. Sociodemographic variables, obstetric and neonate information were extracted from the maternity register. We analysed predictors for timely initiation of breastfeeding with Pearson chi-square test and multivariate logistic regression.
Among the 6488 woman-infant pair observed, breastfeeding was timely initiated in 49.5% neonates. The timely initiation of breastfeeding was found to be higher among neonates who were placed skin-to-skin contact (34.9% vs 19.9%, p - value < 0.001). The timely initiation of breastfeeding was higher if the cord clamping was delayed than early cord clamped neonates (44.5% vs 35.3%, p - value < 0.001). In multivariate analysis, a mother with no obstetric complication during admission had 57% higher odds of timely initiation of breastfeeding (aOR 1.57; 95% CI 1.33, 1.86). Multiparity was associated with less timely initiation of breastfeeding (aOR 1.56; 95% CI 1.35, 1.82). Similarly, there was more common practice of timely initiation of breastfeeding among low birthweight neonates (aOR 1.46; 95% CI 1.21, 1.76). Neonates who were placed skin-to-skin contact with mother had more than two-fold higher odds of timely breastfeeding (aOR 2.52; 95% CI 2.19, 2.89). Likewise, neonates who had their cord intact for 3 min had 37% higher odds of timely breastfeeding (aOR 1.37; 95% CI 1.21, 1.55).
The rate of timely initiation of breastfeeding practice is low in the health facilities of Nepal. Multiparity, no obstetric complication at admission, neonates placed in skin-to-skin contact and delay cord clamping were strong predictors for timely initiation of breastfeeding. Quality improvement intervention can improve skin-to-skin contact, delayed cord clamping and timely initiation of breastfeeding.
及时开始母乳喂养可以降低新生儿的发病率和死亡率。我们旨在研究尼泊尔医院出生的新生儿及时开始母乳喂养（出生后 1 小时内）的预测因素。
2018 年 7 月至 10 月在四家公立医院进行了一项前瞻性观察性研究。所有在医院分娩并同意的产妇均纳入研究。独立研究人员观察新生儿是否进行皮肤接触、延迟脐带夹闭和及时开始母乳喂养。从产妇登记册中提取社会人口统计学变量、产科和新生儿信息。我们使用 Pearson 卡方检验和多变量逻辑回归分析及时开始母乳喂养的预测因素。
在观察的 6488 对母婴中，有 49.5%的新生儿及时开始母乳喂养。研究发现，与 19.9%的新生儿相比，进行皮肤接触的新生儿及时开始母乳喂养的比例更高（34.9% vs. 19.9%，p 值<0.001）。与早期夹闭脐带的新生儿相比，延迟夹闭脐带的新生儿及时开始母乳喂养的比例更高（44.5% vs. 35.3%，p 值<0.001）。在多变量分析中，在住院期间无产科并发症的母亲及时开始母乳喂养的几率高 57%（优势比 1.57；95%置信区间 1.33，1.86）。多胎妊娠与及时开始母乳喂养的可能性较低相关（优势比 1.56；95%置信区间 1.35，1.82）。同样，低出生体重儿更常见及时开始母乳喂养（优势比 1.46；95%置信区间 1.21，1.76）。与母亲进行皮肤接触的新生儿及时母乳喂养的几率高两倍以上（优势比 2.52；95%置信区间 2.19，2.89）。同样，脐带完整保留 3 分钟的新生儿及时母乳喂养的几率高 37%（优势比 1.37；95%置信区间 1.21，1.55）。
尼泊尔卫生机构及时开始母乳喂养的比例较低。多胎妊娠、入院时无产科并发症、与母亲进行皮肤接触、延迟脐带夹闭是及时开始母乳喂养的有力预测因素。质量改进干预可以改善皮肤接触、延迟脐带夹闭和及时开始母乳喂养。
