NICU母乳和配方乳喂养管理的现况调查

A survey on the management of breast milk and formula feeding in NICU

目的了解国内新生儿重症监护病房(neonatal intensive care unit,NICU)母乳和配方乳的管理现状及存在的问题。方法便利选取国内53所医院的NICU进行问卷调查,问卷共48个问题,内容包括母乳/配方乳管理支持系统、乳制品的来源与筛选、乳制品的管理、质量控制、喂养相关健康宣教和指导。结果 53所医院NICU的母乳喂养率为(62.1±31.5)%;母乳和配方乳管理支持系统不完善,66.0%的医院无吸乳室、81.1%不提供母乳采集设备、75.5%未完全开放探视、92.5%无母乳库、60.4%未开展家庭参与式护理;乳制品的来源的筛选方面,15.1%的NICU不接收母乳、42.2%不能随时接收母乳,母乳的筛选无统一标准,28.9%常规检测母乳巨细胞病毒,配方乳来源和种类各异;各NICU乳制品的管理存在不同程度的不规范,11.1%不具有冰箱保存母乳的条件、5.7%使用微波炉加热配方乳、4.4%巴氏消毒亲母母乳;质量控制措施不完善,分别有18.9%和6.7%的NICU对母乳和配方乳不登记、8.9%和3.8%无母乳喂养的病历记录和冰箱温度监测记录、17.0%由聘用护士以外的人员配奶;32.1%NICU宣教内容不全面,母乳喂养相关宣教不系统。结论各医院母乳和配方乳管理差异较大,且有相当一部分不够规范,应参照现有指南,加强NICU母乳和配方乳喂养管理,并制订适合我国国情的相关指南。

Objective To investigate the present situation and problems on the management of breast milk/formu- la in NICUs in China. Methods Neonatal intensive care units from 53 hospitals were recruited by convenience sampling. The questionnaire survey with 48 items,including breast milk/formula management supporting system, choices of dairy products,management of dairy products,quality control,and health education related feeding was conducted among these 53 NICUs. Results The results showed that among these 53 NICUs,66.0% were without breasffeeding room,81.1% didn＇t provide electric breast pumps,75.5% were not completely open to the parents, 92.5% were without human milk bank,60.4% did not carry out family integrated care. All of those implied that breast milk/formula management supporting system was not perfect.15.1% of the 53 NICUs did not receive breast milk from the parents,28.9% routinely tested cytomegalovirus in breast milk,42.2% did not receive breast milk at any time,formula varieties were different from one another,11.1% didn＇t possess the condition of storing breast milk,5.7% heated formula in the microwave,4.4% pasteurized breast milk of biological mothers. The management of dairy products in NICU,to some extent,were not standardized. About 18.9% and 6.7% of these NICUs were without any records of breast milk and formula respectively,8.9% and 3.8% were without any medical records of breast milk feeding and refrigerator temperature monitoring,17.0% employed other stuff to prepare the milk instead of nurses. The quality control measures were not perfect. The content of education was not comprehensive,and the breasffeeding related education was not systematic in 32.1% of the NICUs. Conclusion This survey described the status of the management of breast milk and formula and nursing routine among different NICUs in China,and pro- vided some evidence for developing and improving the relevant clinical guidelines.