调查 36 周以上胎龄婴儿新生儿重症监护病房短期住院作为出院时母乳喂养减少的风险因素：一项回顾性队列研究。

Investigating short-stay admission to a neonatal intensive care unit as a risk factor for reduced breast feeding at discharge in infants ≥36 weeks' gestation: a retrospective cohort study.

机构信息

Women's and Newborn Health, Westmead Hospital, Westmead, New South Wales, Australia

Reproduction and Perinatal Centre, The University of Sydney, Sydney, New South Wales, Australia.

出版信息

BMJ Open. 2023 Oct 19;13(10):e075658. doi: 10.1136/bmjopen-2023-075658.

DOI:10.1136/bmjopen-2023-075658

PMID:37857543

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10603420/

Abstract

OBJECTIVE

This study aims to determine the effect of infant-mother separation following a short-stay (≤72 hours) admission to a Level 5 neonatal unit versus no admission on infant-feeding outcomes at hospital discharge.

DESIGN

Retrospective cohort study.

SETTING

An Australian Level 5 neonatal unit within a tertiary referral hospital.

PARTICIPANTS

Mothers and their infants born between 1 January 2018 and 31 December 2020 had a short-stay admission to the neonatal unit or no admission. All participants met admission criteria to the postnatal ward and were discharged home at ≤72 hours (n=12 540). Postnatal ward admission criteria included ≥36 weeks' gestation and birth weight ≥2.2 kg.

MAIN OUTCOME MEASURES

Infant feeding at discharge from hospital. Multivariate logistic regression analysis was conducted, adjusting for confounders associated with known breastfeeding issues. These included age, ethnicity, parity, obesity, socioeconomic score, hypertensive disorders of pregnancy, diabetes, infant gestation and birthweight centile, caesarean section birth, postpartum haemorrhage and skin-to-skin contact.

RESULTS

Of the 12 540 live births meeting inclusion criteria, 1000 (8%) infants were admitted to the neonatal unit. The primary reasons for admission were suspicion of sepsis (24%), maternal diabetes (19%) and jaundice (16%). We found a reduction in full breast feeding at hospital discharge in cases of a short admission to the neonatal unit compared with no admission (aOR 0.40; 95% CI 0.34 to 0.47; p<0.001). We identified that women of different ethnicities had differing levels of risk for formula supplementation at hospital discharge. The ethnic grouping least likely to be fully breast feeding at discharge was Southeast Asian women (aOR 0.47; 95% CI 0.39 to 0.57; p<0.001).

CONCLUSIONS

Identifying mother-infant dyads at risk of non-exclusive breast feeding at hospital discharge will help target resources for practice improvement.

摘要

目的

本研究旨在确定婴儿与母亲在入住 5 级新生儿病房（住院时间≤72 小时）后分离与无入住相比，对出院时婴儿喂养结果的影响。

设计

回顾性队列研究。

地点

澳大利亚一家三级转诊医院的 5 级新生儿病房。

参与者

2018 年 1 月 1 日至 2020 年 12 月 31 日期间，在新生儿病房接受短期住院治疗或无住院治疗的母亲及其婴儿。所有参与者均符合产后病房入院标准，并在≤72 小时内出院回家（n=12540）。产后病房入院标准包括胎龄≥36 周和出生体重≥2.2kg。

主要结果测量

出院时的婴儿喂养情况。采用多变量逻辑回归分析，调整了与已知母乳喂养问题相关的混杂因素。这些因素包括年龄、种族、产次、肥胖、社会经济评分、妊娠高血压疾病、糖尿病、婴儿胎龄和出生体重百分位数、剖宫产、产后出血和皮肤接触。

结果

在符合纳入标准的 12540 例活产婴儿中，有 1000 例（8%）婴儿入住新生儿病房。住院的主要原因是疑似败血症（24%）、母亲糖尿病（19%）和黄疸（16%）。我们发现与无住院相比，新生儿病房短期住院会降低出院时完全母乳喂养的比例（调整优势比 0.40；95%置信区间 0.34 至 0.47；p<0.001）。我们发现不同种族的女性在出院时接受配方奶补充的风险程度不同。出院时最不可能完全母乳喂养的种族群体是东南亚女性（调整优势比 0.47；95%置信区间 0.39 至 0.57；p<0.001）。