Hendricks-Muñoz Karen D, Darwish Nada, Chahin Nayef, Newman-Lindsay Shoshana, Shaver Lisa, Dollings Melissa, Xu Jie, Coleman Valerie
Division of Neonatal Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
Department of Pediatrics, Children's Hospital of Richmond at VCU, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
Breastfeed Med. 2023 Dec;18(12):928-933. doi: 10.1089/bfm.2023.0147. Epub 2023 Nov 29.
Avoidance of early formula feeding (EFF) and advancement of mother's own milk (MOM) in very low birth weight (VLBW) infants are important health influencers to decrease serious morbidities. To present the challenges and feeding strategy successes implemented to counteract a decline in MOM at discharge after initiation of donor milk (DM) to avoid EFF in racially and ethnically diverse VLBW infants. Retrospective review of prospectively tracked inborn surviving VLBW infants and their mothers admitted to neonatal intensive care unit from 2010 to 2020 during three feeding strategy implementations baby friendly (BF), DM program, and MOM bundle. Analysis included type of feeding (MOM, DM, or formula) and maternal with descriptive and comparative statistical analysis as indicated. Analysis included 616 VLBW infants. Initiation of BF program resulted in 58.5% of infants discharged on MOM with 41.5% exposed to EFF. Initiation of the DM program resulted in a decline in EFF to 5% and decline in MOM at discharge to 26%. MOM bundle strategy resulted in an increase in MOM at discharge to 41% with sustained EFF exposure 0%. MOM at discharge varied among maternal racial and ethnic backgrounds in all epochs. Early DM use was not different among mothers by race or ethnicity with DM by African American (AA) mothers 89% > White mothers 83% > Other/Hispanic mothers 75%. MOM at discharge was lowest for AA mothers 33% < Hispanic mothers 40% < White mothers 55% < Asian/Other mothers at 60%. Changes in VLBW feeding strategies to avoid EFF utilizing DM can be successful among diverse maternal racial and ethnic populations. Nursing and maternal education coupled with early lactation support and attention to maternal individual long-term feeding plans were critical to improve MOM at discharge among mothers of all racial-ethnic backgrounds for successful attainment of MOM utilization in term corrected VLBW infants at discharge.
避免极低出生体重（VLBW）婴儿过早进行配方奶喂养（EFF）并增加其母亲自身母乳（MOM）的摄入量，是降低严重疾病发生率的重要健康影响因素。介绍为避免不同种族和族裔的极低出生体重婴儿出现过早配方奶喂养情况，在引入捐赠母乳（DM）后，为应对出院时母亲自身母乳摄入量下降所实施的挑战及喂养策略的成功经验。对2010年至2020年期间在新生儿重症监护病房接受治疗的、前瞻性跟踪的存活的VLBW 先天婴儿及其母亲进行回顾性研究，研究共进行了三项喂养策略实施，分别是爱婴医院倡议（BF）、捐赠母乳项目和母亲自身母乳综合干预措施。分析内容包括喂养类型（母亲自身母乳、捐赠母乳或配方奶）以及母亲情况，并根据需要进行描述性和比较性统计分析。分析纳入了616名极低出生体重婴儿。实施爱婴医院倡议项目后，58.5%的婴儿出院时接受母亲自身母乳喂养，41.5%的婴儿过早接受配方奶喂养。实施捐赠母乳项目后，过早配方奶喂养率降至5%，出院时母亲自身母乳的摄入量降至26%。母亲自身母乳综合干预措施使出院时母亲自身母乳的摄入量增至41%，过早配方奶喂养率持续为0%。在所有时期，出院时母亲自身母乳的摄入量在不同种族和族裔背景的母亲中有所不同。不同种族或族裔的母亲早期使用捐赠母乳情况无差异，非裔美国（AA）母亲使用捐赠母乳的比例为89%，高于白人母亲的83%，高于其他/西班牙裔母亲的75%。出院时，非裔美国母亲的母亲自身母乳摄入量最低，为33%，低于西班牙裔母亲的40%、白人母亲的55%以及亚洲/其他母亲的60%。利用捐赠母乳避免极低出生体重婴儿过早配方奶喂养的喂养策略变化，在不同种族和族裔的母亲群体中可能会取得成功。护理和对母亲的教育，再加上早期的泌乳支持以及对母亲个人长期喂养计划的关注，对于提高所有种族和族裔背景母亲出院时的母亲自身母乳摄入量至关重要，从而能够在足月校正的极低出生体重婴儿出院时成功实现母亲自身母乳的利用。
