Email Alert | RSS

北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (4): 711-715. doi: 10.19723/j.issn.1671-167X.2019.04.020

• 论著 • 上一篇    下一篇

新生儿重症监护室早产儿母乳喂养促进策略研究

李秀兰,吴艳(),钟晓云,王敏,黄利   

  1. 重庆市妇幼保健院新生儿科, 重庆 401147
  • 收稿日期:2018-08-20 出版日期:2019-08-18 发布日期:2019-09-03
  • 通讯作者: 吴艳 E-mail:19498874@qq.com
  • 基金资助:
    中国疾病预防控制中心妇幼保健中心科研项目(2016FYM002)

Breastfeeding promotion strategies study on preterm infants in the neonatal intensive care unit

Xiu-lan LI,Yan WU(),Xiao-yun ZHONG,Min WANG,Li HUANG   

  1. Department of Neonatology, Chongqing Health Center for Women and Children, Chongqing 401147, China
  • Received:2018-08-20 Online:2019-08-18 Published:2019-09-03
  • Contact: Yan WU E-mail:19498874@qq.com
  • Supported by:
    Supported by the Scientific Research Project of National Center for Women and Children, China CDC(2016FYM002)

RICH HTML

 94   

PDF (PC)

672

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

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2

两组早产儿临床结果比较"

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
[1] American Academy of Pediatrics . Policy statement: breastfeeding and the use of human milk[J]. Pediatrics, 2012,129(3):e827-e841.
[2] 《中华儿科杂志》编辑委员会, 中华医学会儿科学分会新生儿学组, 中华医学会儿科学分会儿童保健学组. 早产/低出生体重儿喂养建议[J]. 中华儿科杂志, 2009,47(7):508-510.
[3] Agostoni C, Buonocore G, Carnielli VP , et al. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition[J]. J Pediatr Gastroenterol Nutr, 2010,50(1):85-91.
[4] 中国医师协会新生儿科医师分会营养专业委员会, 中国医师协会儿童健康专业委员会母乳库学组, 《中华儿科杂志》编辑委员会. 新生儿重症监护病房推行早产儿母乳喂养的建议[J]. 中华儿科杂志, 2016,54(1):13-16.
[5] Lee HC, Gould JB . Factors influencing breast milk versus formula feeding at discharge for very low birth weight infants in California[J]. J Pediatr, 2009,155(5):657-662.
[6] 早产儿营养调查协作组. 新生儿重症监护病房中早产儿营养相关状况多中心调查974例报告[J]. 中华儿科杂志, 2009,47(1):12-17.
[7] 吴艳, 钟晓云, 陈文 , 等. 超极低出生体重儿住院情况回顾性研究[J]. 重庆医科大学学报, 2016,41(1):98-102.
[8] Spatz DL . Ten steps for promoting and protecting breastfeeding for vulnerable infants[J]. J Perinat Neonatal Nurs, 2004,18(4):385-396.
[9] 施姝澎, 张玉侠 . NICU母乳喂养策略的研究现况[J]. 中华护理杂志, 2015,50(5):608-612.
[10] Cortez J, Makker K, Kraemer DF , et al. Maternal milk feedings reduce sepsis, necrotizing enterocolitis and improve outcomes of premature infants[J]. J Perinatol, 2017,38(1):71-74.
[11] 邵肖梅, 叶鸿瑁, 丘小汕 . 实用新生儿学 [M]. 4版. 北京: 人民卫生出版, 2013: 104.
[12] Zhou JG, Shukla VV, John D , et al. Human milk feeding as a protective factor for retinopathy of prematurity: a meta-analysis[J]. Pediatrics, 2015,136(6):e1576-e1586.
[13] Meier PP, Engstrom JL, Patel AL , et al. Improving the use of human milk during and after the nicu stay[J]. Clin Perinatol, 2010,37(1):217-245.
[14] Patel AL, Meier PP, Engstrom JL . The evidence for use of human milk in very low-birth weight preterm infants[J]. Neoreviews, 2007,8(11):e459-e466.
[15] 刘凤, 韩树萍, 余章斌 , 等. 母乳喂养质量改进对极低和超低出生体重儿亲母母乳喂养率的影响[J]. 中国当代儿科杂志, 2016,18(10):937-941.
doi: 10.7499/j.issn.1008-8830.2016.10.004
[16] 冯淑菊, 景亚琳, 陈杭健 , 等. 住院早产儿母乳喂养系统化管理的临床应用效果[J]. 协和医学杂志, 2014,5(4):399-404.
[17] Lee HC, Kurtin PS, Wight NE , et al. A quality improvement project to increase breast milk use in very low birth weight infants[J]. Pediatrics, 2012,130(6):e1679-e1687.
[18] Fugate K, Hernandez L, Ashmeade T , et al. Improving human milk and breastfeeding practices in the NICU[J]. J Obstet Gynecol Neonatal Nurs, 2015,44(3):426-438.
[19] Healy DB, Brennan AM , O’Donovan R, et al. Structured promotion of breastmilk expression is associated with shortened hospita-lisation for very preterm infants[J]. Acta Paediatr, 2016,105(6):e252-e256.
[20] Lewis ED, Richard C, Larsen BM , et al. The importance of human milk for immunity in preterm infants[J]. Clin Perinatol, 2017,44(1):23-47.
[21] Cacho NT, Parker LA, Neu J . Necrotizing enterocolitis and human milk feeding[J]. Clin Perinatol, 2017,44(1):49-67.
[22] Patel AL, Johnson TJ, Robin B , et al. Influence of own mother’s milk on bronchopulmonary dysplasia and costs[J]. Arch Dis Child Fetal Neonatal Ed, 2017,102(3):F256-F261.
[1] 姚晓莹,刘志科,李宁,马瑞,赵薛飞,张良,许国章,詹思延,方挺. 2015—2019年宁波市0~36月龄婴幼儿癫痫发病的流行病学研究[J]. 北京大学学报（医学版）, 2021, 53(3): 485-490.
[2] 宋沁峰,李宏田,杨静,原鹏波,程志浩,刘建蒙,赵扬玉. 双胎妊娠孕早期甲状腺功能及其与早产的关联性[J]. 北京大学学报（医学版）, 2021, 53(3): 473-478.
[3] 包菊,刘佳,曲元,穆东亮. 脐动脉血气pH值对剖宫产新生儿住院期间并发症的预测价值[J]. 北京大学学报（医学版）, 2019, 51(1): 159-164.
[4] 杨夕樱，朱灵平，刘雪芹，张春雨，姚勇，吴晔. 基因诊断Caroli综合征合并常染色体隐性遗传性多囊肾1例及文献回顾[J]. 北京大学学报(医学版), 2018, 50(2): 335-339.
[5] 王姝琪, 杨志仙, 李慧. Williams-Beuren综合征的临床及遗传学特点:2例报道[J]. 北京大学学报(医学版), 2017, 49(5): 899-903.
[6] 张欣, 茹喜芳, 王颖, 李星, 桑田, 冯琪. 新生儿重症监护病房中新生儿真菌败血症的临床特点[J]. 北京大学学报(医学版), 2017, 49(5): 789-793.
[7] 陈小贤，夏斌，葛立宏，袁峻伟. 喂养方式和口腔不良习惯对乳牙列牙合关系的影响[J]. 北京大学学报(医学版), 2016, 48(6): 1060-1066.
[8] 王立芳，周虹,张妍，王燕. 孕前体质指数与早产的关系[J]. 北京大学学报(医学版), 2016, 48(3): 414-417.
[9] 吴艳， 钟晓云， 蒋静， 龚华. 住院早产超低和极低出生体重儿强化母乳喂养的前瞻性对照研究[J]. 北京大学学报(医学版), 2016, 48(1): 143-148.
[10] 汪晓彤, 葛立宏. 喂养方式对儿童牙、牙列、颌骨生长发育的影响[J]. 北京大学学报（医学版）, 2015, 47(1): 191-195.
[11] 李子一1, 王金子, 张雅蓉, 余恺, 司徒文佑, 尤莉莉, 陈程, 李文军, 王培玉, 张玉梅. 家长自报4~36月龄婴幼儿挑食行为的准确性评价[J]. 北京大学学报（医学版）, 2014, 46(3): 383-388.
[12] 冯琪. 早产儿院内营养策略进展及其意义[J]. 北京大学学报（医学版）, 2013, 45(2): 333-.
[13] 周文娟, 梁爱民, 王凤芝, 崔文红, 王秀云, 刘秋明, 游红, 贺春燕, 彭金荣, 张迎武, . 北京市四区/县18月龄儿童发育迟缓的流行病学研究[J]. 北京大学学报（医学版）, 2013, 45(2): 211-.
[14] 姜毅, 侯新琳, 李昕, 林志淼, 崔晨. 新生儿遗传性营养不良性大疱性表皮松解症基因诊断1例[J]. 北京大学学报（医学版）, 2013, 45(2): 202-.
[15] 叶华, 陈适, 安媛. 系统性红斑狼疮患者的妊娠结局：41例患者情况分析[J]. 北京大学学报（医学版）, 2012, 44(2): 233-235.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 田增民, 陈涛, Nanbert ZHONG, 李志超, 尹丰, 刘爽. 神经干细胞移植治疗遗传性小脑萎缩的临床研究（英文稿）[J]. 北京大学学报（医学版）, 2009, 41(4): 456 -458 .
[2] 郭岩, 谢铮. 用一代人时间弥合差距——健康社会决定因素理论及其国际经验[J]. 北京大学学报（医学版）, 2009, 41(2): 125 -128 .
[3] 成刚, 钱振华, 胡军. 艾滋病项目自愿咨询检测的技术效率分析[J]. 北京大学学报（医学版）, 2009, 41(2): 135 -140 .
[4] 袁惠燕, 张苑, 范田园. 离子交换型栓塞微球及其载平阳霉素的制备与性质研究[J]. 北京大学学报（医学版）, 2009, 41(2): 217 -220 .
[5] 徐莉, 孟焕新, 张立, 陈智滨, 冯向辉, 释栋. 侵袭性牙周炎患者血清中抗牙龈卟啉单胞菌的IgG抗体水平的研究[J]. 北京大学学报（医学版）, 2009, 41(1): 52 -55 .
[6] 董稳, 刘瑞昌, 刘克英, 关明, 杨旭东. 氯诺昔康和舒芬太尼用于颌面外科术后自控静脉镇痛的比较[J]. 北京大学学报（医学版）, 2009, 41(1): 109 -111 .
[7] 祁琨, 邓芙蓉, 郭新彪. 纳米二氧化钛颗粒对人肺成纤维细胞缝隙连接通讯的影响[J]. 北京大学学报（医学版）, 2009, 41(3): 297 -301 .
[8] 李宏亮*, 安卫红*, 赵扬玉, 朱曦. 妊娠合并高脂血症性胰腺炎行血液净化治疗1例[J]. 北京大学学报（医学版）, 2009, 41(5): 599 -601 .
[9] 李伟军, 邢晓芳, 曲立科, 孟麟, 寿成超. PRL-3基因C104S位点突变体和CAAX缺失体的构建及表达[J]. 北京大学学报（医学版）, 2009, 41(5): 516 -520 .
[10] 丰雷, 王玉凤, 曹庆久. 哌甲酯对注意缺陷多动障碍儿童平衡功能影响的开放性研究[J]. 北京大学学报（医学版）, 2007, 39(3): 304 -309 .
ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
地址： 北京市海淀区学院路38号 北京大学医学部 《北京大学学报（医学版）》
邮编：100191
电话：010-82801551
Email： xbbjb2@bjmu.edu.cn

《北京大学学报（医学版）》
微信公众号
版权所有 © 2018 《北京大学学报（医学版）》编辑部