新生儿重症监护室中低出生体质量儿的母乳喂养现状分析及对策

Status quo and countermeasures of breast-feeding for low birth weight infants in neonatal intensive care unit

目的探讨新生儿重症监护室（NICU）收治的低出生体质量（LBW）儿的母乳喂养现状,并提出相应解决对策。方法选择2013年6月至2014年1月在四川大学华西第二医院NICU住院治疗的240例LBW儿为研究对象,其日龄为生后即刻至3d,出生体质量为730-2 400g,其中早产LBW儿为236例（98.33%）,足月LBW儿为4例（1.67%）。采用回顾性分析法,分析LBW儿住院期间母乳喂养情况,以及LBW儿住院来源、电话追踪随访次数、母亲职业与喂养方式的关系。本研究遵循的程序符合四川大学华西第二医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象监护人的知情同意,并与之签署临床研究知情同意书。结果 240例LBW儿中,纯母乳喂养为7例（2.9%）,混合喂养为30例（12.5%）,人工喂养为203例（84.6%）。236例早产LBW儿的纯母乳喂养率（2.5%）低于足月产LBW儿（25.0%）,并且差异有统计学意义（χ2=25.6,P〈0.01）。在本院住院分娩的孕妇所分娩的高危新生儿的纯母乳喂养率高于外院转入者（3.2%vs 0）,并且差异有统计学意义（χ2=18.1,P〈0.01）。电话追踪随访次数与纯母乳喂养方式存在正相关关系（r=0.481）,电话追踪随访次数≥3次者的纯母乳喂养率明显高于1次者,并且差异有统计学意义（χ2=73.37,P=0.000）。母亲职业为干部（职员）的母乳喂养率低于无业者（农民）（1.72%vs 3.3%）,并且差异有统计学意义（χ2=34.7,P〈0.001）。结论完善新生儿科医师对高危产妇围生期会诊制度、加强产前母乳喂养宣教、完善NICU探视与追踪随访制度,是提高NICU中LBW儿母乳喂养率的有效措施。

Objective To discuss the breast-feeding status of low birth weight （LBW） infants in neonatal intensive care unit （NICU）, so as to discover the current problems and find out countermeasures. Methods A total of 240 LBW infants （236 premature infants and 4 term infants） who were admitted in NICU of West China Second University Hospital from June 2013 to January 2014 were included into this study. Their age averaged from newborn to 3 days, and their birth weights averaged from 730 g to 2 400 g. The breast-feeding situation of LBW infants, as well as the relationship between patients sources, follow up duration, mother＇s occupations and feeding modes were retrospectively analyzed. The study protocol was approved by the Ethical Review Board of Investigation of West China Second University Hospital, Sichuan University. Informed consent was obtained from all participatesf patients. Results Of 240 cases of LBW infants, breast-feeding was 7 cases （2.9%）, mixed feeding was 30 cases （12. 5%）, and artificial feeding was 203 cases （84.6 % ）. The rate of breast-feeding for premature LBW infants was significantly lower than that of term LBW infants （2.5% vs 25.0%）, with significant difference （X^2=25.6,P〈0.01）. The rate of breast-feeding for those who delivered at our hospital was higher than that of those who transferred from other hospital（3.2% vs 0） with significant difference （X^2= 18.1 ,P〈0.01）. And significant difference could he found between motherr s different occupations （ X^2=34. 7, P〈 0. 001）. Conclusions Effective countermeasures to improve the breast-feeding rate of LBW infants in NICU may include completing the prenatal consultation system of the neonatologists, enhancing the publicity and health education about the benefits of breast-feeding, helping the mothers of the preterm LBW infants to insisted on breast-feeding, and constantly improving the NICU visit and follow-up system.