Zhou Min, Guo Jin-Yi, Li Tai-Yang, Zhou Chun-Hua, Zhang Xiao-Qin, Wei Wei, Zhou Jie, Redding Sharon R, Ouyang Yan-Qiong, Chen Hui-Jun
Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, 430071, China.
School of Nursing, Wuhan University, 115 Donghu Road, Wuchang District, Wuhan, 430071, China.
Reprod Health. 2024 Dec 17;21(1):183. doi: 10.1186/s12978-024-01932-9.
The implementation of early essential newborn care (EENC) is important to maternal and neonatal health. However, few studies have conducted a complete procedure of EENC in cesarean section. This study aimed to systematically evaluate the effects of EENC during and after cesarean section.
A randomized controlled trial was conducted at a tertiary hospital in Wuhan, China. Full-term pregnant women who had no comorbidities and underwent elective cesarean section were recruited and received EENC intervention or routine health care. The Infant Breastfeeding Assessment Tool (IBFAT), the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), a questionnaire of the breastfeeding behavior, the Maternal Postnatal Attachment Scale (MPAS) and the Edinburgh Postnatal Depression Scale (EPDS) were used to collect data. The correlation between EENC implementation and breastfeeding, maternal-infant attachment, postpartum depression, and other maternal and neonatal outcomes was analyzed.
Mother-newborn pairs (N = 157) were enrolled in this study, 78 in the EENC group and 79 in the control group. A total of 155 (98.8%) were followed up at 14 days, 144 (91.7%) at 42 days, and 123 (78.3%) at 3 months. For the primary outcomes, generalized linear mixed model analysis showed that implementing EENC during cesarean section was beneficial for initiating breastfeeding (OR = 0.021), shortening the breastfeeding initiation time (β = - 45.321), improving the IBFAT scores (β = 2.740), and enhancing breastfeeding self-efficacy (β = 4.880). These effects were not influenced by time interaction. However, no difference was observed in the rate of exclusive breastfeeding between these two groups (P > 0.05). Implementing EENC during cesarean section significantly improved maternal-infant attachment (β = 9.668). Moreover, univariate analysis showed benefits of EENC in improving postpartum depression (P < 0.001) and decreasing maternal perinatal blood loss (P < 0.05).
According to our small sample study, there is a trend of improvement in breastfeeding related behavior and maternal infant attachment in women who received EENC during cesarean deliveries. The effects of EENC on exclusive breastfeeding should be further explored in the future.
Chinese Clinical Trial Register at www.chictr.org.cn , ChiCTR2300074760, retrospectively registration. Registration Date: August 15, 2023.
实施早期基本新生儿护理（EENC）对孕产妇和新生儿健康至关重要。然而，很少有研究在剖宫产中完整实施EENC流程。本研究旨在系统评估剖宫产期间及术后EENC的效果。
在中国武汉的一家三级医院进行了一项随机对照试验。招募无合并症且接受择期剖宫产的足月孕妇，分为EENC干预组或常规医疗组。使用婴儿母乳喂养评估工具（IBFAT）、母乳喂养自我效能量表简版（BSES-SF）、母乳喂养行为问卷、产后母婴依恋量表（MPAS）和爱丁堡产后抑郁量表（EPDS）收集数据。分析EENC实施与母乳喂养、母婴依恋、产后抑郁及其他母婴结局之间的相关性。
本研究共纳入母婴对157对，EENC组78对，对照组79对。14天时共随访155对（98.8%），42天时144对（91.7%），3个月时123对（78.3%）。对于主要结局，广义线性混合模型分析显示，剖宫产时实施EENC有利于启动母乳喂养（OR = 0.021）、缩短母乳喂养启动时间（β = -45.321）、提高IBFAT评分（β = 2.740）及增强母乳喂养自我效能感（β = 4.880）。这些效果不受时间交互作用影响。然而，两组之间纯母乳喂养率无差异（P > 0.05）。剖宫产时实施EENC显著改善了母婴依恋（β = 9.668）。此外，单因素分析显示EENC在改善产后抑郁（P < 0.001）和减少产妇围产期失血方面有好处（P < 0.05）。
根据我们的小样本研究，剖宫产时接受EENC的女性在母乳喂养相关行为和母婴依恋方面有改善趋势。EENC对纯母乳喂养的影响未来应进一步探索。
中国临床试验注册中心，网址www.chictr.org.cn，ChiCTR2300074760，回顾性注册。注册日期：2023年8月15日。
