一项针对城市低收入家庭的产前儿科就诊随机对照试验。

A randomized controlled trial of prenatal pediatric visits for urban, low-income families.

作者信息

Serwint J R, Wilson M E, Vogelhut J W, Repke J T, Seidel H M

机构信息

Department of Pediatrics, Johns Hopkins Children's Center, Baltimore, Maryland, USA.

出版信息

Pediatrics. 1996 Dec;98(6 Pt 1):1069-75.

PMID:8951255

Abstract

BACKGROUND

Prenatal pediatric visits have been recommended by the American Academy of Pediatrics to allow the pediatrician to counsel parents on infant care issues, establish a supportive relationship, and provide pediatric practice information to parents. We hypothesized that prenatal pediatric visits would have an impact on breastfeeding decisions, health care behaviors, health care utilization, and the doctor-patient relationship.

METHODS

We conducted a randomized controlled trial of prenatal pediatric visits for urban, low-income families to measure the impact on breastfeeding decisions, infant car safety seat use, circumcision, health maintenance, and emergency room visits and the pediatrician's perception that he/she would know the mother better. Pregnant women were recruited prenatally from the obstetrics clinic. Outcomes were measured by maternal interview prenatally and when the infant was 2 months old, in addition to review of the nursery record. Physicians were interviewed after the 2-month visit. Health care utilization was measured by chart review at 7 months.

RESULTS

A total of 156 pregnant women were enrolled and randomized, 81 to the intervention group and 75 to the control group. Of mothers who breastfed, 45% in the intervention group changed their mind in favor of breastfeeding after enrollment compared with 14% in the control group. Mothers in the intervention group compared with the control group were more likely to make fewer emergency room visits, 0.58 compared with 1.0. Pediatricians were more likely to think that they knew mothers in the intervention group well, 54% versus 29% in the control group, yet 67% of mothers in both groups agreed their pediatrician knew them well. There were no differences between groups in initiation or duration of breastfeeding at 30 or 60 days, infant car safety seat use, circumcision, or health maintenance visits.

CONCLUSIONS

Prenatal pediatric visits have potential impact on a variety of health care outcomes. Among urban, low-income mothers, we found beneficial effects on breastfeeding decisions, a decrease in emergency department visits, and an initial impact on the doctor-patient relationship. We suggest urban practices actively promote prenatal pediatric visits.

摘要

背景

美国儿科学会建议进行产前儿科就诊，以便儿科医生就婴儿护理问题为家长提供咨询，建立支持性的关系，并向家长提供儿科诊疗机构的信息。我们推测产前儿科就诊会对母乳喂养决策、医疗保健行为、医疗保健利用情况以及医患关系产生影响。

方法

我们针对城市低收入家庭开展了一项产前儿科就诊的随机对照试验，以衡量其对母乳喂养决策、婴儿汽车安全座椅使用情况、包皮环切术、健康维护以及急诊就诊的影响，以及儿科医生认为自己对母亲了解程度的变化。孕妇在产前从产科诊所招募。除了查阅新生儿护理记录外，在产前及婴儿2个月大时通过对母亲进行访谈来衡量结果。在婴儿2个月大的就诊后对医生进行访谈。通过7个月时的病历审查来衡量医疗保健利用情况。

结果

总共156名孕妇被纳入并随机分组，81人进入干预组，75人进入对照组。在进行母乳喂养的母亲中，干预组有45%的人在入组后改变主意支持母乳喂养，而对照组这一比例为14%。与对照组相比，干预组的母亲急诊就诊次数更少，分别为0.58次和1.0次。儿科医生更倾向于认为他们对干预组的母亲了解得很好，干预组为54%，对照组为29%，然而两组中67%的母亲都认为她们的儿科医生很了解自己。在30天或60天的母乳喂养开始或持续时间、婴儿汽车安全座椅使用情况、包皮环切术或健康维护就诊方面，两组之间没有差异。