新生儿重症监护室早产儿母乳喂养促进策略研究

doi:10.19723/j.issn.1671-167X.2019.04.020

摘要/Abstract

摘要：

目的:探讨母乳喂养促进策略对新生儿重症监护室(neonatal intensive care unit,NICU)早产儿住院期间临床结局的影响。方法:制定母乳喂养促进策略,包括建立多学科母乳喂养指导小组、母乳喂养家庭和社会支持、家庭参与式护理、袋鼠式护理、捐赠母乳库等。将2015年11月至2017年2月入住重庆市妇幼保健院NICU的符合纳入标准的胎龄<32周早产儿根据策略实施前后分为对照组和干预组,比较两组早产儿母乳喂养相关指标(开奶时间、开始母乳喂养时间、达完全母乳喂养时间、达完全肠内营养时间、母乳喂养率)、体格发育指标(宫外生长迟缓)、并发症等。结果:纳入研究的早产儿共123例,对照组61例,干预组62例,两组间性别、胎龄、出生体重、宫内生长迟缓、入院疾病状态等方面差异无统计学意义(P>0.05)。干预组与对照组相比,开奶时间[15.37 (10.00, 22.13) h vs. 20.25 (12.88, 26.33) h,P<0.01]、达完全母乳喂养时间[91.00 (69.75, 103.00) h vs. 94.00 (80.37, 118.75) h,P=0.04]、达完全肠内营养时间[12 (11, 15) d vs. 14 (12, 18) d,P<0.01]均显著提前;两组间开始母乳喂养时间、住院时间、体质量宫外生长迟缓发生率、母乳喂养率差异均无统计学意义(P>0.05);两组间喂养不耐受、新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)、支气管肺发育不良(bronchopulmonary dysplasia,BPD)、早产儿视网膜病(retinopathy of prematurity,ROP)等并发症的发生率及死亡率差异均无统计学意义(P>0.05)。结论:母乳喂养促进策略是对常规母乳喂养策略的质量改进,可显著提前NICU早产儿的开奶时间、达完全母乳喂养时间和完全肠内营养时间,但其是否对提高母乳喂养率,降低NEC、BPD、ROP等并发症发生率存在益处,需进一步研究证实。

关键词: 母乳喂养, 婴儿, 早产, 质量改进

Abstract:

Objective: To explore the effect of breastfeeding promotion strategies on neonatal clinical outcomes of preterm infants during hospitalization in the neonatal intensive care unit (NICU).Methods: We developed breastfeeding promotion strategies, including the establishment of a multidisciplinary breastfeeding steering team, breastfeeding support of families and society, family-integrated care, kangaroo mother care, donor human milk bank, and so on. Preterm infants meeting the inclusion standard, less than 32 weeks gestational age, who were admitted to NICU from November 2015 to February 2017 were enrolled, and the eligible infants were divided into two groups (control group and intervention group) before and after policy implementation. The data of preterm infants including breastfeeding related outcomes (time to initiation of enteral feeding, time to initiation of breastfeeding, time to achieve full breastfeeding, time to achieve full enteral feeding and rate of breastfeeding), growth (extrauterine growth restriction) and complications were compared between the two groups.Results: One hundred and twenty-three preterm infants were enrolled, including 61 in the control group and 62 in the intervention group. There were no significant differences in gender, gestational age, birth weight, intrauterine growth retardation (IUGR) and admission disease status between the two groups (P>0.05). Compared with the control group, there were significantly earlier time to initiation of enteral feeding [15.37 (10.00, 22.13) h vs. 20.25 (12.88, 26.33) h, P<0.01], time to achieve full breastfeeding [91.00 (69.75, 103.00) h vs. 94.00 (80.37, 118.75) h, P=0.04], and time to achieve full enteral feeding [12 (11, 15) d vs. 14 (12, 18) d, P<0.01] in the intervention group. Otherwise, there were no significant differences in time to initiation of breastfeeding, hospital stay, extrauterine growth restriction (EUGR) occurance rate of weight, the rate of breastfeeding, motality, and the incidence of complications including feeding intolerance, neonatal necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) (P>0.05).Conclusion: The breastfeeding promotion strategie was a quality improvement of ordinary breastfeeding protocol. It had significantly reduced time to initiation of enteral feeding, time to achieve full breastfeeding and time to achieve full enteral feeding for preterm infants in NICU. Further research is needed to confirm whether the strategies can improve the breastfeeding rate and reduce the occurrence of the complications, such as NEC, BPD, and ROP.

Key words: Breast feeding, Infant, premature, Quality improvement

中图分类号:

R723

李秀兰,吴艳,钟晓云,王敏,黄利. 新生儿重症监护室早产儿母乳喂养促进策略研究[J]. 北京大学学报（医学版）, 2019, 51(4): 711-715.

Xiu-lan LI,Yan WU,Xiao-yun ZHONG,Min WANG,Li HUANG. Breastfeeding promotion strategies study on preterm infants in the neonatal intensive care unit[J]. Journal of Peking University(Health Sciences), 2019, 51(4): 711-715.

图/表 2

表1

一般临床资料"

Items	Control group (n=61)	Intervention group (n=62)	Statistical value	P
Gender (male/female), n	34/27	36/26	χ²=0.07	0.79
Gestational age/week, $x ?$ ±s	29.78±1.36	29.92±1.48	t=-0.55	0.58
Birth weight/g, $x ?$ ±s	1 384.26±225.44	1 380.32±235.10	t=0.10	0.93
IUGR, n	0/61	2/62	χ²=0.49	0.50
Admission disease status, n	53/61	57/62	χ²=0.83	0.36

表1

表2

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Items	Control group (n=61)	Intervention group (n=62)	Statistical value	P
Time to initiation of enteral feeding/h, M (P₂₅, P₇₅)	20.25 (12.88, 26.33)	15.37 (10.00, 22.13)	Z=-3.12	<0.01
Time to initiation of breastfeeding/h, M (P₂₅, P₇₅)	57.25 (42.83, 89.94)	63.50 (49.50, 73.00)	Z=-0.32	0.75
Time to achieve full breastfeeding/h, M (P₂₅, P₇₅)	94.00 (80.37, 118.75)	91.00 (69.75, 103.00)	Z=-2.09	0.04
Time to achieve full enteral feeding/d, M (P₂₅, P₇₅)	14 (12, 18)	12 (11, 15)	Z=-4.01	<0.01
Hospital stay/d, M (P₂₅, P₇₅)	36 (25, 50)	32 (23, 46)	Z=-1.26	0.21
Rate of breastfeeding/%	80.30	85.50	χ²=0.58	0.45
EUGR, n (%)	34 (55.74)	28 (45.16)	χ²=1.38	0.24
Feeding intolerance, n (%)	11 (18.03)	6 (9.68)	χ²=1.80	0.18
NEC, n (%)	4 (6.56)	2 (3.23)	χ²=0.75	0.44
BPD, n (%)	13 (21.31)	6 (9.68)	χ²=3.19	0.07
ROP, n (%)	9 (14.75)	15 (24.19)	χ²=1.75	0.19
Severe ROP, n	0/61	2/62	χ²=0.51	0.50
Motality/%	3.29	3.23	χ²=0.00	>0.99