低收入新冠病毒检测呈阳性的母乳喂养母亲的婴儿的保护措施可行性：一项前瞻性多中心队列研究。
Protective measures feasibility for infants of low-income SARS-CoV-2 positive breastfeeding mothers: A prospective multicentre cohort study.
作者信息
Gonçalves-Ferri Walusa Assad, Coca Kelly Pereira, Martins-Celini Fábia Pereira, Chang Yan-Shing, Ferreira Raquel Santos, de Siqueira Caldas Jamil Pedro, Ferreira Rodrigo Duarte, Marques Patrícia Franco, Sonini Thaise Cristina Branchee, Moraes Viviane Christina Cortez, de Carvalho Pelicia Simone Manso, Nunes Leandro Meireles, Contrucci Bruno Antunes, Suzuki Edson Koji, Magalhães Maurício, de Jesus Hartmann Nader Paulo, de Lima Mota Ferreira Daniela Marques, Javorsky Juliane Barleta, de Fátima Afonso Dias Laura, Cavasin Bruna Pinto Dias, de Mesquita Ana Ruth Antunes, de Oliveira Pinto Rebecca Meirelles, Fonseca Luciana Mara Monti, da Silva Gherardi-Donato Edilaine Cristina, Aragon Davi Casale, Roosch Anelise
机构信息
Department of Pediatrics, University of São Paulo, Ribeirão Preto, Brazil.
Departamento de Enfermagem na Saúde da Mulher, Ana Abrão Breastfeeding Center, Universidade Federal de São Paulo, São Paulo, Brazil.
出版信息
J Nurs Manag. 2022 Nov;30(8):4064-4070. doi: 10.1111/jonm.13854. Epub 2022 Oct 26.
AIM
The aim was to evaluate the feasibility of protective measures for infants of low-income SARS-CoV-2 positive breastfeeding mothers.
BACKGROUND
Breastfeeding mothers with SARS-CoV-2 positive should avoid exposing the infant through protective measures (PM), but it could be challenging in a low-income population.
METHODS
A prospective, multicentre study was conducted between July and October 2020 (BRACOVID). The participants were recruited at birth and interviewed through a structured questionnaire at 7 and 14 days in the home environment. The feasibility of PM during breastfeeding at home was defined by guidelines recommendations (mask using, handwashing, and distancing from newborn when not breastfeeding). Three groups according to the feasibility of guidelines: complete guidelines feasibility (CG): all PM; partial guidelines feasibility (PG): at least one PM feasible; no guidelines (NG): infeasibility to all of PM. Flu-like neonatal symptoms and breastfeeding practices were analyzed. We evaluated the association between PM feasibility and socioeconomic factors.
RESULTS
One hundred seventeen infected mothers from 17 Brazilian hospitals were enrolled. Forty-seven (40%) mothers followed all recommendations, 14 (11.9%) could not practice at least one recommendation, and 50 (42.7%) did not execute any of them. The breastfeeding rate was 98%. Factors associated with infeasibility were monthly family income <92.7 dollars/person, high housing density (>1 inhabitant/room), teenage mothers, responsive feeding, and poor schooling. Regarding infants' flu-like symptoms, 5% presented symptoms at 14 days (NG group).
CONCLUSION
The guidelines were not applied to infants of SARs-CoV-positive mothers in 54.6% of the dyads since the recommendations were unviable in their environments. During pandemics, we should look for feasible and effective guidelines to protect neonates from low-income populations.
IMPLICATIONS FOR NURSING MANAGEMENT
Poor socioeconomic conditions lead to the unfeasibility of protective measures for infants of low-income SARS-CoV-2 positive breastfeeding mothers during the isolation period in the pandemics. The orientations and the support provided to dyad should consider the socioeconomic factors to guide feasible measures in the home environment and promote adequate protections; only an individual approach will allow a safe environment for low-income infants. The Research Ethics Committee approved the project of the Medicine School in Ribeirão Preto, University of São Paulo, Brazil (CAAE: 31357320.9.1001.5440-4.066.741/2020) and Brazilian hospitals and maternal services.
目的
评估对低收入的新冠病毒检测呈阳性的母乳喂养母亲的婴儿采取保护措施的可行性。
背景
新冠病毒检测呈阳性的母乳喂养母亲应通过保护措施（PM）避免感染婴儿，但在低收入人群中可能具有挑战性。
方法
2020年7月至10月进行了一项前瞻性多中心研究（BRACOVID）。参与者在出生时招募，并在7天和14天时在家庭环境中通过结构化问卷进行访谈。在家中母乳喂养期间保护措施的可行性根据指南建议定义（使用口罩、洗手以及非母乳喂养时与新生儿保持距离）。根据指南可行性分为三组：完全指南可行性（CG）：所有保护措施；部分指南可行性（PG）：至少一项保护措施可行；无指南（NG）：所有保护措施均不可行。分析了类似流感的新生儿症状和母乳喂养习惯。我们评估了保护措施可行性与社会经济因素之间的关联。
结果
来自巴西17家医院的117名感染母亲入组。47名（40%）母亲遵循了所有建议，14名（11.9%）母亲至少无法实施一项建议，50名（42.7%）母亲未执行任何一项建议。母乳喂养率为98%。与不可行相关的因素包括家庭月收入<92.7美元/人、住房密度高（>1人/房间）、青少年母亲、按需喂养和教育程度低。关于婴儿的类似流感症状，5%在14天时出现症状（NG组）。
结论
由于建议在其环境中不可行，54.6%的母婴对中，指南未应用于新冠病毒阳性母亲的婴儿。在大流行期间，我们应寻找可行且有效的指南来保护低收入人群的新生儿。
对护理管理的启示
社会经济条件差导致在大流行隔离期间，对低收入的新冠病毒检测呈阳性的母乳喂养母亲的婴儿采取保护措施不可行。为母婴对提供的指导和支持应考虑社会经济因素，以指导家庭环境中的可行措施并促进充分保护；只有个体化方法才能为低收入婴儿提供安全环境。研究伦理委员会批准了巴西圣保罗大学 Ribeirão Preto医学院的项目（CAAE：31357320.9.1001.5440 - 4.066.741/2020）以及巴西医院和产妇服务机构。
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