NICU住院早产儿母亲在母婴分离期的泌乳量及相关因素研究
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摘要
目的调查新生儿重症监护病房(neonatal intensive care unit,NICU)住院早产儿母亲在母婴分离期的泌乳量及乳汁分泌规律,分析相关因素。方法选取2016年2月—12月山东省某三级甲等综合医院122例NICU住院早产儿母亲为研究对象,采用现况调查法对早产儿母亲在患儿住院期间的泌乳量进行连续测定,并应用早产儿母亲泌乳相关因素综合问卷及爱丁堡产后抑郁量表(Edinburgh Postnatal Depression Scale,EPDS)对早产儿母亲进行调查;采用SAS 9.2统计软件对产后第1~7天与第8~14天泌乳量进行Pearson相关分析,通过多元线性回归分析筛选早产儿母亲产后早期泌乳量的相关因素。结果入选的住院早产儿母亲在产后14 d内的泌乳量呈上升趋势,第14天泌乳量为(535.43±265.97)ml,产后泌乳Ⅱ期启动时间为(68.23±26.42)h;第4天泌乳量与第14天泌乳量相关系数为0.707 0(P<0.01);妊娠高血压综合征、泌乳Ⅱ期启动时间、EPDS得分、早产儿出生胎龄、产妇年龄是NICU住院早产儿母亲母婴分离期泌乳量的主要影响因素。结论 NICU住院早产儿母亲产后早期泌乳量少,泌乳Ⅱ期启动时间晚、延迟率高;在临床护理工作中,应关注产龄较大、早产儿出生胎龄较小、合并妊娠高血压综合征、EPDS得分较高、泌乳Ⅱ期启动延迟的产妇,并给予及时、针对性干预措施,提高母婴分离期泌乳量和早产儿母乳喂养成功率。
Objective To explore the milk production and its regularity in mothers with preterm infants hospitalized in NICU during periods of mother-infant separation,and to analyze the associating factors. Methods Totally 122 mothers with preterm infants hospitalized in NICU were recruited from February to December,2017.Continuous measurements of daily breast milk production were performed. The maternal lactation related comprehensive questionnaire and Edinburgh Postnatal Depression Scale(EPDS) were used. The Pearson correlation analysis and multiple linear regression analysis were conducted using the Statistical Analysis Systems(version 9.2).Results The milk volumes for the first 14 days postpartum showed a trend of rising among mothers. The mean milk volume on day 14 postpartum was(535.43±256.97) ml. The mean initiation time of lactogenesis stage Ⅱ was(68.23±26.42) h. The correlation coefficient of lactation between day 4 and day 14 was 0.707 0(P<0.01). The multiple linear regression analysis revealed that the pregnancy induced hypertension syndrome,initiation time of lactogenesis stage Ⅱ,EPDS score,gestational age, maternal age were the influencing factors of milk volume for mothers during periods of mother-infant separation. Conclusion The milk volume of mothers with preterm infants was relatively lower compared with mothers with full-term infants during the early stage postpartum,and the onset of lactogenesis stage Ⅱ was later. In clinical nursing work,healthcare providers should pay special attention to mothers with older maternal age,smaller gestational age,pregnancy induced hypertension syndrome,higher EPDS score,and later initiation time of lactogenesis stageⅡ.
Objective To explore the milk production and its regularity in mothers with preterm infants hospitalized in NICU during periods of mother-infant separation,and to analyze the associating factors. Methods Totally 122 mothers with preterm infants hospitalized in NICU were recruited from February to December,2017.Continuous measurements of daily breast milk production were performed. The maternal lactation related comprehensive questionnaire and Edinburgh Postnatal Depression Scale(EPDS) were used. The Pearson correlation analysis and multiple linear regression analysis were conducted using the Statistical Analysis Systems(version 9.2).Results The milk volumes for the first 14 days postpartum showed a trend of rising among mothers. The mean milk volume on day 14 postpartum was(535.43±256.97) ml. The mean initiation time of lactogenesis stage Ⅱ was(68.23±26.42) h. The correlation coefficient of lactation between day 4 and day 14 was 0.707 0(P<0.01). The multiple linear regression analysis revealed that the pregnancy induced hypertension syndrome,initiation time of lactogenesis stage Ⅱ,EPDS score,gestational age, maternal age were the influencing factors of milk volume for mothers during periods of mother-infant separation. Conclusion The milk volume of mothers with preterm infants was relatively lower compared with mothers with full-term infants during the early stage postpartum,and the onset of lactogenesis stage Ⅱ was later. In clinical nursing work,healthcare providers should pay special attention to mothers with older maternal age,smaller gestational age,pregnancy induced hypertension syndrome,higher EPDS score,and later initiation time of lactogenesis stageⅡ.
引文
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[24]Dosani A,Hemraj J,Premji SS,et al.Breastfeeding the late preterm infant:experiences of mothers and perceptions of public health nurses[J].Int Breastfeed J,2016,8(5):12-23.
[25]张广兰.脐血中胎盘催乳素测定及其催乳作用的临床研究[J].中国妇幼保健,2009,24(26):3744-3745.
[26]谭蓝,羊淑宇,黄春荣.营养对剖宫产术后产妇泌乳的影响研究[J].中国妇幼保健,2013,28(13):2170-2171.
[27]任大枫.早产相关因素的流行病学调查[D].南京:东南大学,2013.
[28]Chapman DJ.Maternal perception of the onset of lactation is a valid,public health indicator of lactogenesis stageⅡ[J].J Nutr,2000,130(12):2972-2980.
[29]Cregan MD,de Mello TR,Kershaw D,et al.Initiation of lactation in women after preterm delivery[J].Acta Obstet Gynecol Scand,2002,81(9):870-877.
[30]van Vo T,Hoa TKD.Postpartum depressive symptoms and associated factors in married women:a cross-sectional study in Danang City,Vietnam[J].Front Public Health,2017,5(4):93-100.
[31]张艳.信息支持对产后抑郁的单亲初产妇泌乳及子宫复旧的影响[J].中华现代护理杂志,2014,20(3):309-311.
[32]宋修丽,焦志安.产后抑郁对乳汁分泌的影响[J].现代妇产科进展,2011,20(4):327-328.
[33]Hill PD,Aldag JC,Demirtas H,et al.Association of serum prolactin and oxytocin with milk production in mothers of preterm and term infants[J].Biol Res Nurs,2009,10(4):340-349.
[34]Ellis L.Prolactin variants in term and preterm human milk:altered structural characteristics,biological activity and immunoreactivity[J].Endocr Regul,1993,27(4):181-192.
[35]王凤英,曹红卫,任玉香.对影响初乳分泌各种因素的分析[J].中华护理杂志,1998,33(12):5-7.
[36]李红华,周福顺.子痫15例临床分析[J].现代中西医结合杂志,2010,19(20):2521-2522.
[37]李成,于秀荣,吴玉梅,等.新生儿重症监护病房住院早产儿母亲产后抑郁相关因素的研究[J].中国实用护理杂志,2015,31(16):1221-1224.
[2]Meinzen-Derr J,Poindexter B,Wrage L,et al.Role of human milk in extremely low birth weight infants'risk of necrotizing enterocolitis or death[J].J Perinatol,2009,29(1):57-62.
[3]Bhatia J.Human milk and the premature infant[J].Ann Nutr Metab,2013,62(3):8-14.
[4]Fewtrell MS,Kennedy K,Ahluwalia JS,et al.Predictors of expressed breast milk volume in mothers expressing milk for their preterm infant[J].Arch Dis Child Fetal Neonatal Ed,2016,2(3):308-321.
[5]Héon M,Goulet C,Garofalo C,et al.An intervention to promote breast milk production in mothers of preterm infants[J].West J Nurs Res,2016,38(5):529-552.
[6]Fabiyi C,Rankin K,Norr K,et al.The association of low social support with breast milk expression in low-income motherpreterm infant dyads[J].J Hum Lact,2015,31(3):490-497.
[7]Healy DB,Brennan AM,O'Donovan R,et al.Structured promotion of breastmilk expression is associated with shortened hospitalisation for very preterm infants[J].Acta Paediatr,2016,105(6):252-256.
[8]世界卫生组织.母乳喂养咨询培训教程[M].北京:北京医科大学、中国协和医科大学联合出版社,1997:200-207.
[9]Matias SL,Dewey KG,Quesenberry CP.Maternal prepregnancy obesity and insulin treatment during pregnancy are independently associated with delayed lactogenesis in women with recent gestational diabetes mellitus[J].Am J Clin Nutr,2014,99(1):115-121.
[10]Murase M,Nommsen-Rivers L,Morrow AL,et al.Predictors of low milk volume among mothers who delivered preterm[J].JHum Lact,2014,30(4):425-435.
[11]Héon M,Goulet C,Garofalo C,et al.Acceptability and feasibility of a breast milk expression education and support intervention in mothers of preterm infants[J].Adv Neonatal Care,2014,14(4):9-19.
[12]Lee DT,Yip SK,Chiu HF,et al.Detecting postnatal depression in Chinese women validation of the Chinese version of the Edinburgh Postnatal Depression Scale[J].Br J Psychiatry,1998,172(5):433-437.
[13]Meltzer-Brody S.New insights into perinatal depression:pathogenesis and treatment during pregnancy and postpartum[J].Dialogues Clin Neurosci,2011,13(1):89-100.
[14]Segre LS,O'Hara MW,Arndt S.Screening and counseling for postpartum depression by nurses:the women's views[J].MCNAm J Matern Child Nurs,2010,35(5):280-285.
[15]Nommsen-Rivers LA,Chantry CJ,Peerson JM,et al.Delayed onset of lactogenesis among first-time mothers is related to maternal obesity and factors associated with ineffective breastfeeding[J].Am J Clin Nutr,2010,92(3):574-584.
[16]Neville MC,Keller R,Seacat J,et al.Studies in human lactation:milk volumes in lactating women during the onset of lactation and full lactation[J].Am J Clin Nutr,1988,48(6):1375-1386.
[17]Hurst NM,Meier PP,Engstrom JL.Mothers performing in-home measurement of milk intake during breastfeeding of their preterm infants:maternal reactions and feeding outcomes[J].JHum Lact,2004,20(2):178-187.
[18]Omarsdottir S,Adling A,Bonamy AK,et al.Predictors of sustained maternal milk feeds in extremely preterm infants[J].JPerinatol,2015,35(5):367-372.
[19]Matias SL,Nommsen-Rivers LA,Creed-Kanashiro H.Risk factors for early lactation problems among Peruvian primiparous mothers[J].Matern Child Nutr,2010,6(2):120-133.
[20]Neville MC.Physiology and endocrine changes underlying human lactogenesisⅡ[J].J Nutr,2001,131(11):3005-3008.
[21]Parker LA,Sullivan S,Krueger C.Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stageⅡamong mothers of very low-birth-weight infants[J].Breastfeed Med,2015,10(2):84-91.
[22]Henderson JJ,Hartmann PE,Newnham JP.Effect of preterm birth and antenatal corticosteroid treatment on lactogenesisⅡin women[J].Pediatrics,2008,121(1):92-100.
[23]Hill PD.Milk volume on day 4 and income predictive of lactation adequacy at 6 weeks of mothers of nonnursing preterm infants[J].J Perinat Neonatal Nurs,2005,19(3):273-282.
[24]Dosani A,Hemraj J,Premji SS,et al.Breastfeeding the late preterm infant:experiences of mothers and perceptions of public health nurses[J].Int Breastfeed J,2016,8(5):12-23.
[25]张广兰.脐血中胎盘催乳素测定及其催乳作用的临床研究[J].中国妇幼保健,2009,24(26):3744-3745.
[26]谭蓝,羊淑宇,黄春荣.营养对剖宫产术后产妇泌乳的影响研究[J].中国妇幼保健,2013,28(13):2170-2171.
[27]任大枫.早产相关因素的流行病学调查[D].南京:东南大学,2013.
[28]Chapman DJ.Maternal perception of the onset of lactation is a valid,public health indicator of lactogenesis stageⅡ[J].J Nutr,2000,130(12):2972-2980.
[29]Cregan MD,de Mello TR,Kershaw D,et al.Initiation of lactation in women after preterm delivery[J].Acta Obstet Gynecol Scand,2002,81(9):870-877.
[30]van Vo T,Hoa TKD.Postpartum depressive symptoms and associated factors in married women:a cross-sectional study in Danang City,Vietnam[J].Front Public Health,2017,5(4):93-100.
[31]张艳.信息支持对产后抑郁的单亲初产妇泌乳及子宫复旧的影响[J].中华现代护理杂志,2014,20(3):309-311.
[32]宋修丽,焦志安.产后抑郁对乳汁分泌的影响[J].现代妇产科进展,2011,20(4):327-328.
[33]Hill PD,Aldag JC,Demirtas H,et al.Association of serum prolactin and oxytocin with milk production in mothers of preterm and term infants[J].Biol Res Nurs,2009,10(4):340-349.
[34]Ellis L.Prolactin variants in term and preterm human milk:altered structural characteristics,biological activity and immunoreactivity[J].Endocr Regul,1993,27(4):181-192.
[35]王凤英,曹红卫,任玉香.对影响初乳分泌各种因素的分析[J].中华护理杂志,1998,33(12):5-7.
[36]李红华,周福顺.子痫15例临床分析[J].现代中西医结合杂志,2010,19(20):2521-2522.
[37]李成,于秀荣,吴玉梅,等.新生儿重症监护病房住院早产儿母亲产后抑郁相关因素的研究[J].中国实用护理杂志,2015,31(16):1221-1224.