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Clinical Application of Systematic Management of Human Milk Feeding in Hospitalized Preterm Infants
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摘要:
目的 探讨应用母乳喂养系统化管理对住院早产儿实施母乳喂养的效果。 方法 收集2011年1月至12月和2013年1月至12月在北京协和医院新生儿重症监护室住院且符合一定入选条件早产儿的临床资料。2011年实施早产儿母乳喂养的常规宣教及护理, 作为对照组。自2012年起实施母乳喂养系统化管理, 对工作人员实行全员培训, 对早产儿家属进行宣教干预, 健全母乳收集、运送、保存、配置、加热、喂养等一系列制度, 建立从早产儿入院到出院后母乳喂养的支持方案。2013年住院早产儿作为研究组。比较两组早产儿的母乳喂养情况、败血症发生率及住院天数。 结果 纳入研究的早产儿共116例, 其中男54例, 女62例; 研究组53例, 对照组63例。两组的性别、胎龄、出生体重、住院天数差异无统计学意义(P>0.05)。研究组首次母乳喂养日龄低于对照组[(3.98±2.45)d比(5.05±1.76)d, P=0.008], 7日内母乳喂养程度(42.98%比23.14%, P=0.001)、14日内母乳喂养程度(60.27%比40.95%, P=0.001)均高于对照组, 住院期间达纯母乳喂养的早产儿比例高于对照组(75.48%比34.92%, P=0.041), 新生儿败血症发生率低于对照组(15.1%比23.8%, P=0.012)。 结论 母乳喂养系统化管理是实现住院早产儿母乳喂养的有效方法。实施母乳喂养系统化管理可提高住院早产儿的母乳喂养率, 减少医院感染的发生。 Abstract:Objective To analyze the effect of systematic management of human milk feeding on the feeding of hospitalized preterm infants. Methods Preterm infants hospitalized at the neonatal intensive care unit of Peking Union Medical College Hospital from January to December 2011 and from January to December 2013 who met certain enrollment criteria were included and their clinical data were collected. The preterm infants in 2011 served as the control group, in which the parents were given routine education and infants given routine nursing. The systematic management of human milk feeding has been implemented since 2012, including staff training, special education of the family members of preterm infants, management of human milk collection, delivery, storage, preparation, warming, and feeding, establishing a comprehensive plan system supporting human milk feeding both during hospital stay and after discharge. The preterm infants in 2013 were as the study group. The 2 groups were compared in terms of human milk feeding state, incidence of sepsis, and length of hospital stay. Results One hundred and sixteen infants were enrolled, including 54 boys and 62 girls, 53 in the study group and 63 in the control group. There were no significant inter-group differences in gender, gestational age, birth weight, and length of hospital stay(P>0.05). Compared with the control group, the study group had an earlier initiation of human milk feeding [(3.98±2.45)d vs. (5.05±1.76)d, P=0.008], higher percentages of human milk feeding in the first 7 days (42.98% vs. 23.14%, P=0.001) and 14 days (60.27% vs. 40.95%, P=0.001), a higher proportion of exclusively human milk fed infants (75.48% vs. 34.92%, P=0.041), and a lower incidence of sepsis (15.1% vs. 23.8%, P=0.012). Conclusions The implementation of systematic management of human milk feeding could effectively facilitate human milk feeding of hospitalized preterm infants, raise the human milk feeding rate, and reduce the incidence of nosocomial infection. -
表 1 研究对象一般资料
组别 性别[例(%)] 胎龄[例(%)] 出生体重[例(%)] 平均体重
(g，x±s)住院天数
(d，x±s)男 女 ≤28周 28+1~30周 30+1~32周 32+1~34周 ＞34周 ＜1000 g 1000~1500 g 1501~2000 g ＞2000 g 对照组(n=63) 31(49.2) 32(50.8) 2(3.2) 9(14.3) 13(20.6) 25(39.7) 14(22.2) 3(4.8) 23(36.5) 26(41.3) 11(17.5) 1626.83±449.81 29.48±15.79 研究组(n=53) 23(43.4) 30(56.6) 7(13.2) 6(11.3) 13(22.4) 21(24.5) 6(39.6) 3(5.7) 17(32.1) 26(49.1) 7(13.2) 1577.92±373.44 29.87±16.83 t/χ2 1.224 2.341 -0.630 1.341 0.129 P 0.716 0.614 0.530 0.601 0.898 
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表 2 两组早产儿喂养程度比较
组别 首次母乳
喂养日龄
(d，x±s)7日内母乳喂养程度 14日内母乳喂养程度 住院期间达纯
母乳喂养的
早产儿比例
(%)总体程度
(%)母乳量达
50%~80%
[例(%)]母乳量达
＞80%
[例(%)]总体程度
(%)母乳量达
50%~80%
[例(%)]母乳量达
＞80%
[例(%)]对照组(n=63) 5.05±1.76 23.14 5(7.94) 2(3.17) 40.95 6(11.32) 20(31.75) 34.92 研究组(n=53) 3.98±2.45 42.98 13(24.53) 9(16.98) 60.27 16(30.19) 20(37.74) 75.48 t/χ2 -2.722 -3.318 4.354 2.476 3.363 3.627 2.693 0.260 P 0.008 0.001 0.043 0.002 0.001 0.017 0.037 0.041
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表 3 两组胎龄≤32周早产儿喂养程度比较(%)
组别 7日内母乳
喂养程度14日内母乳
喂养程度住院期间达纯母乳
喂养的早产儿比例对照组(n=24) 30.61 52.90 33.33 研究组(n=26) 49.26 65.19 69.23 χ2 -0.607 -0.943 1.726 P 0.039 0.026 0.002
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表 4 两组胎龄＞32周早产儿喂养程度比较(%)
组别 7日内母乳
喂养程度14日内母乳
喂养程度住院期间达纯母乳
喂养的早产儿比例对照组(n=39) 18.54 33.56 35.90 研究组(n=27) 36.93 55.54 81.48 χ2 3.100 2.990 -3.347 P 0.003 0.009 0.001
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表 5 研究组不同胎龄早产儿喂养程度比较
胎龄 首次母乳喂养
日龄(d, x±s)7日内母乳喂养
程度(%)14日内母乳喂养
程度(%)住院期间达纯母乳喂养的
早产儿比例(%)≤32周(n=26) 3.13±1.66 49.26 65.19 69.23 ＞32周(n=27) 4.63±2.77 36.93 55.54 81.48 t/χ2 -1.948 -1.327 -1.005 0.137 P 0.051 0.076 0.435 0.056
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