目的 研究母乳喂养质量改进措施对极低和超低出生体重儿母乳喂养率的作用,为临床推广应用提供依据。方法 回顾性分析2016年5月-2017年12月医院收治的258例极低和超低出生体重儿临床资料,根据是否实施母乳喂养质量改进措施将其分为对照组100例和改进组158例,对照组患儿采用常规母乳喂养,改进组患儿实施母乳喂养质量改进措施。比较两组患儿母乳喂养情况,住院期间亲母母乳喂养率、喂养量和患儿住院期间生长指标以及总并发症发生率。结果 改进组患儿首次亲母母乳喂养时间、母乳强化剂开始添加时间、达全肠道喂养时间及静脉营养时间均显著短于对照组患儿(P<0.05),亲母母乳喂养率和喂养量明显高于对照组,患儿住院期间体重、身长和头围增长均明显大于对照组(P＜0.05)。改进组患儿喂养不耐受发生率、总并发症发生率明显低于对照组患儿(P＜0.05)。结论 母乳喂养质量改进能明显改善极低和超低出生体重儿母乳喂养情况,提高母乳喂养率和喂养量,促进患儿生长,并可减少并发症发生。
Abstract
Objective To explore the effect of breast-feeding quality improvement measures on the breastfeeding rate of very low birth weight(VLBW) and extremely low birth weight infants(ELBW) infants,so as to provide basis for clinical application. Methods The clinical data of 258 VLBW and ELBW infants admitted to the hospital from May 2016 to December 2017 were retrospectively analyzed According to whether breastfeeding quality improvement measures were implemented,infants were divided into control group(n=100) and improvement group(n=158). The control group received routine breastfeeding,and the improvement group adopted breastfeeding quality improvement measures.The breast-feeding status,maternal breast-feeding rate during hospitalization,feeding quantity,growth index during hospitalization and incidence of total complications were compared between the two groups. Results The first breast-feeding time,the onset time of adding breast milk fortifier,the time for reaching total intestinal feeding and intravenous nutrition in the improvement group were significantly shorter than those in the control group(P<0.05),the maternal breast-feeding rate and the feeding quantity were significantly higher than those growth of the control group,and the weight,length and head circumference of the patients during hospitalization were significantly higher than those of the control group (P<0.05).The incidence of feeding intolerance and total complications in the improvement group were significantly lower than those in the control group(P< 0.05). Conclusion Breast-feeding quality improvement can significantly improve the breast-feeding situation of VLBW and ELBW infants,increase breast-feeding rate and volume,promote the growth of children,and reduce complications.
关键词
母乳喂养 /
质量改进 /
极低出生体重儿 /
超低出生体重儿 /
并发症
Key words
breast-feeding /
quality improvement /
very low birth weight infants /
extremely low birth weight infants /
complication
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参考文献
[1] 赵华,刘瑞芳,史红娟,等.家庭支持系统对母乳喂养影响的研究进展[J].现代预防医学,2018,45(7):1235-1238.
[2] Nayereh As′adi,Kariman N,Mojab F,et al.The effect of Saqez (Pistacia atlantica) ointment on nipple fissure improvement in breastfeeding women during one-month follow-up[J].Avicenna J Phytomed,2017,7(6):477-485.
[3] 黄俊美,吴远珏,汪静,等.0～3月龄不同喂养方式对婴儿期体格发育的影响[J].华中科技大学学报:医学版,2017,46(4):430-436.
[4] 闭宏娟,许靖,韦秋芬.捐献母乳喂养对极低出生体重儿院内感染发生的影响[J].中国当代儿科杂志,2018,20(2):102-105.
[5] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].4版.北京:人民卫生出版社,2011:340-663.
[6] Ghaheri BA,Cole M,Fausel SC,et al.Breastfeeding improvement following tongue-tie and lip-tie release:A prospective cohort study[J].Laryngoscope,2016,127(5):1217-1223.
[7] 陈小慧,余章斌,韩树萍.捐献母乳与配方奶喂养对极低、超低出生体质量儿的影响[J].中华实用儿科临床杂志,2016,31(19):1464-1467.
[8] Chowdhury R,Sinha B,Sankar MJ,et al.Breastfeeding and maternal health outcomes:a systematic review and meta-analysis[J].Acta Paediatr,2015,104(467):96-113.
[9] 高琦,张亚娟,田秀英,等.母乳强化剂添加时间对极低出生体质量儿早期生长发育及并发症发生率的影响[J].中华实用儿科临床杂志,2017,32(7):528-531.
[10] 张俊,刘凤,韩树萍.NICU母乳喂养质量改进进展[J].临床儿科杂志,2016,34(1):74-77.
[11] Dumphy D,Thompson J,Clark M.A breastfeeding quality improvement project in rural primary care[J].J Hum Lact,2016,32(4):633-641.
[12] Sethi A,Joshi M,Thukral A,et al.A quality improvement initiative:improving exclusive breastfeeding rates of preterm neonates[J].Indian J Pediatr,2017,84(4):1-4.
[13] Schwartz R,Ellings A,Baisden A,et al.Washington 'steps' up:a 10-step quality improvement initiative to optimize breastfeeding support in community health centers[J].J Hum Lact,2015,31(4):651-659.
[14] Ware JL,Schetzina KE,Morad A,et al.A statewide quality improvement collaborative to increase breastfeeding rates in tennessee[J].Breastfeed Med,2018,13(4):292-300.
[15] 易菁,马远珠,李志云,等.基于微信平台的孕妇学校教育在提高产后母乳喂养率中的应用价值[J].广东医学,2017,38(12):1944-1947.
[16] 李永伟,严超英,杨磊,等.母乳及配方奶喂养对NICU早产儿的影响[J].中国当代儿科杂志,2017,19(5):572-575.
基金
广西壮族自治区卫生和计划生育委员会基金项目(Z20170787,Z20170788,Z20170789)
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