早产儿出院后母婴皮肤接触对母乳喂养及其神经行为发育的影响

Effects of mother-infant skin-to-skin contact on breastfeeding and neurobehavioral development of premature infants after discharge from hospital

目的分析出院后实施母婴皮肤接触(SSC)对早产儿母乳喂养及其神经行为发育的影响,为提高早产儿的母乳喂养率提供依据。方法2021年6月1日—12月31日在合肥市妇幼保健机构建立早产儿出生队列,共103名早产儿进入队列,在早产儿出院后实施母婴皮肤接触。将出院后持续1个月实施母婴皮肤接触且完成随访的早产儿作为持续SSC组,将未坚持母婴皮肤接触但完成随访的早产儿作为间断SSC组。根据干预方案,分别在矫正1月龄、3月龄和6月龄时监测和评估早产儿母乳喂养及神经行为发育情况。结果103名早产儿中,持续SSC组40例,间断SCC组60例,失访3例。矫正1月龄时持续SSC组母乳喂养自我效能得分高于间断SSC组,差异有统计学意义(Z=3.390,P=0.001)。矫正3月龄和6月龄时,持续SSC组纯母乳喂养率高于间断SSC组,差异有统计学意义(χ^(2)=5.627、4.931,P<0.05);持续SSC组矫正6月龄内持续纯母乳喂养的比例(47.5%)明显高于间断SSC组(26.7%),差异有统计学意义(χ^(2)=4.579,P=0.032)。多因素Logistic回归分析显示,出院后持续SSC是早产儿母亲坚持母乳喂养的保护因素(OR=0.27,95%CI:0.09~0.80,P<0.05)。矫正3月龄、6月龄时持续SSC组和间断SSC组早产儿神经行为发育各能区得分差异均无统计学意义(P>0.05)。结论早产儿出院后持续实施母婴皮肤接触,可以提高早产儿母亲母乳喂养自我效能,提高持续母乳喂养率。未发现出院后持续母婴皮肤接触对早产儿神经行为发育有影响。

Objective To evaluate the effect of skin-to-skin contact(SSC)post-discharge on breastfeeding practices and neurobehavioral development among premature infants,in order to provide reference for promoting breastfeeding.Methods A cohort of 103 premature infants was established between June 1st and December 31st,2021,at maternal and child health institutions in Hefei.SSC was implemented following discharge.Participants were categorized into continuous SSC group if SSC was maintained for one month post-discharge with completed follow-ups,and intermittent SSC group if SSC was not consistently practiced but follow-ups were completed.Breastfeeding self-efficacy and neurobehavioral development were monitored and assessed at corrected ages of 1,3,and 6 months based on the intervention protocol.Results Among the 103 premature infants,40 were in the continuous SSC group,60 in the intermittent SSC group,and 3 were lost to follow-up.At the corrected age of 1 month,the continuous SSC group scored significantly higher on breastfeeding self-efficacy compared to the intermittent SSC group(Z=3.390,P=0.001).By corrected ages of 3 and 6 months,the exclusive breastfeeding rates were significantly higher in the continuous SSC group(χ^(2)=5.627,4.931,P<0.05);specifically,47.5%in the continuous SSC group maintained exclusive breastfeeding until 6 months,compared to 26.7%in the intermittent group(χ^(2)=4.579,P=0.032).Multivariate Logistic regression analysis identified post-discharge continuous SSC as a factor for promoting sustained breastfeeding(OR=0.27,95%CI:0.09-0.80,P<0.05).No statistically significant differences were found in neurobehavioral development scores across domains between the groups at 3 and 6 months(P>0.05).Conclusion Sustained SSC post-discharge enhances breastfeeding self-efficacy among mothers of premature infants and increases the rate of continued breastfeeding.No significant effect of prolonged SSC on the neurobehavioral development of premature infants post-discharge is observed.