母乳喂养质量改进项目对极低出生体重儿母乳喂养的促进作用

A quality improvement program to facilitate breastfeeding for very low birth weight infants

目的探讨母乳喂养质量改进项目对极低出生体重儿(very low birth weight infant,VLBWI)亲母母乳喂养以及早产儿相关并发症的影响。方法回顾性纳入母乳喂养质量改进项目实施前后,即2016年2月至2017年1月(实施前,对照组,84例)与2017年8月至2018年7月(实施后,干预组,75例)浙江省绍兴市妇幼保健院新生儿重症监护病房收治的VLBWI。比较亲母母乳喂养率及达全胃肠喂养时间等主要结局指标,以及经外周中心静脉置管留置时间、肠外营养使用时间、经外周中心静脉置管感染率、住院期间平均体重增长率,以及早产儿并发症发生率及死亡率等次要结局指标。采用两独立样本t检验、秩和检验及χ^2检验或Fisher精确概率法进行统计学分析。结果干预组亲母母乳喂养率较对照组升高[82.7%(62/75)与36.9%(31/84),χ^2=34.183],达全胃肠喂养时间缩短[M(P25~P75)为13(10~16)与17(14~23)d,Z=-4.542],差异均有统计学意义(P值均<0.001)。次要结局指标中,干预组经外周中心静脉置管留置时间和肠外营养使用时间明显缩短[M(P25~P75)分别为10(7~13)与14(11~20)d,12(9~15)与16(13~22)d,Z值分别为-4.902和-4.677,P值均<0.001],其余次要结局指标比较,差异均无统计学意义。结论母乳喂养质量改进项目可有效提高VLBWI亲母母乳喂养率,缩短达全胃肠喂养时间,可行性高,实践有效。

Objective To analyze the effectiveness of a quality improvement program for facilitating breastfeeding and improving clinical outcomes for very low birth weight infants (VLBWI). Methods VLBWI admitted to the Neonatal Intensive Care Unit of Shaoxing Women and Children's Hospital before the implementation of the quality improvement program from February 2016 to January 2017 were retrospectively selected as control group (n=84), while those admitted after the implementation from August 2017 to July 2018 were enrolled as intervention group (n=75). Primary outcomes included breastfeeding rates by biological mothers and duration of achieving full enteral feeding and the secondary outcomes included duration of peripherally inserted central venous catheters (PICC) and parenteral nutrition, PICC associated infections, average body weight growth rates during hospitalization, preterm-associated complications and mortality between the two groups were compared. Two independent sample t test, rank-sum test and Chi-square test or Fisher's exact test were used as statistical methods. Results Compared with the control group, the intervention group had significantly increased breastfeeding rate [82.7%(62/75) vs 36.9%(31/84),χ^2=34.183, P<0.001] and a shorter time to achieve full enteral feeding [M(P25-P75): 13(10-16) vs 17(14-23) d, Z=-4.542, P<0.001]. Moreover, the PICC indwelling time and parenteral nutrition duration were both significantly shortened after the implementation of quality improvement program [M(P25-P75): 10(7-13) vs 14(11-20) d, 12(9-15) vs 16(13-22) d, Z=-4.902 and -4.677;both P<0.001], but no statistical differences were found in any other secondary outcomes. Conclusions The quality improvement program is a feasible and practical approach to effectively improve breastfeeding rates in VLBWI and shorten the time required to achieve full enteral feeding.