欧洲各地新生儿重症监护病房中支持基于提示的早产儿母乳喂养的实践。
Practices supporting cue-based breastfeeding of preterm infants in neonatal intensive care units across Europe.
作者信息
Tandberg Bente Silnes, Grundt Hege, Maastrup Ragnhild, Aloysius Annie, Nagy Livia, Flacking Renée
机构信息
Department of Paediatric and Adolescent Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Vestre Viken HT, Post Box 800, Drammen, 3004, Norway.
Lovisenberg Diaconal University College, Oslo, Norway.
出版信息
Int Breastfeed J. 2025 Jan 2;20(1):2. doi: 10.1186/s13006-024-00697-y.
BACKGROUND
Emerging knowledge about supportive neurodevelopmental neonatal care shows the need for an individual approach to establish breastfeeding. However, evidence on how cue-based breastfeeding is supported in neonatal intensive care units (NICUs) is scarce. Therefore, the aim was to describe supporting practices for cue-based breastfeeding.
METHOD
Through Delphi rounds, a questionnaire was developed comprising questions on the usage and occurrence of supportive practices for cue-based breastfeeding. A multinational online survey was distributed September to October in 2023 to NICUs in Europe using snowball sampling. Practices such as the practice of skin-to-skin contact (SSC), restrictions for breastfeeding, providing information to parents, observing and responding to infants' cues were explored.
RESULTS
The survey was completed by 105 neonatal units across 15 European countries. Less than half (46%) of the NICUs had no restrictions upon placing the infant in SSC with the parents. Approximately half (49%) of the NICUs stated that infants had SSC within the first hour after birth. Many units (68%) had some restriction for breastfeeding. One week after birth, 48% of the NICUs encouraged breastfeeding for infants at 33 postmenstrual age whenever the infant showed cues, regardless of scheduled tube feeding time. This percentage increased to 59% at 33-35 gestational age. Less than half of the units (47%) stated that they had the necessary tools/instruments to support the transition from tube feeding to breastfeeding. There were variations in how milk intake was assessed, such as weighing before and after breastfeeding or estimating milk intake by time spent sucking. Infants in 50% of the units had to be fed exclusively orally before discharge. Many units (65%) provided specific support to or enabled discharge before the infant was exclusively orally fed.
CONCLUSION
European NICUs employ supportive practices, SSC, early initiation of breastfeeding, and provide information to parents. Staff plays a significant role in fostering cue-based feeding in preterm infant-mother dyads. There still exist restrictions for SSC and breastfeeding. To understand the impact of different strategies and practices, there is need for evaluations by parents and testing of the implementation of cue-based feeding practices in neonatal care.
背景
关于支持性新生儿神经发育护理的新知识表明，需要采取个性化方法来建立母乳喂养。然而，关于新生儿重症监护病房（NICU）如何支持基于 cues 的母乳喂养的证据很少。因此，目的是描述基于 cues 的母乳喂养的支持性做法。
方法
通过德尔菲轮次，编制了一份问卷，其中包括关于基于 cues 的母乳喂养支持性做法的使用和发生情况的问题。2023 年 9 月至 10 月，采用滚雪球抽样法向欧洲的 NICU 进行了一项跨国在线调查。探讨了诸如皮肤接触（SSC）做法、母乳喂养限制、向父母提供信息、观察和回应婴儿 cues 等做法。
结果
来自 15 个欧洲国家的 105 个新生儿病房完成了调查。不到一半（46%）的 NICU 在让婴儿与父母进行 SSC 方面没有限制。大约一半（49%）的 NICU 表示婴儿在出生后第一小时内进行了 SSC。许多病房（68%）对母乳喂养有一些限制。出生一周后，48%的 NICU 鼓励胎龄 33 周的婴儿在出现 cues 时进行母乳喂养，无论预定的管饲时间如何。在胎龄 33 - 35 周时，这一比例增至 59%。不到一半的病房（47%）表示他们有支持从管饲过渡到母乳喂养的必要工具/仪器。在评估奶量摄入方面存在差异，例如母乳喂养前后称重或通过吸吮时间估计奶量摄入。50%的病房中的婴儿在出院前必须完全经口喂养。许多病房（65%）在婴儿完全经口喂养之前提供了特定支持或允许出院。
结论
欧洲的 NICU 采用支持性做法、SSC、早期开始母乳喂养，并向父母提供信息。工作人员在促进早产儿与母亲二元组中基于 cues 的喂养方面发挥着重要作用。在 SSC 和母乳喂养方面仍然存在限制。为了了解不同策略和做法产生的影响，需要父母进行评估，并对新生儿护理中基于 cues 的喂养做法的实施进行测试。
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