早产儿母亲在患儿住院期间泌乳量不足的相关因素分析
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摘要
目的测定新生儿重症监护病房(NICU)早产儿母亲在患儿住院期间的泌乳量,分析其泌乳量不足的相关因素。方法采用现况调查方法,对2016年2-12月在该院NICU住院的早产儿母亲进行为期2周的每日泌乳量跟踪测定,采用早产产妇泌乳相关因素综合问卷及爱丁堡产后抑郁量表调查、分析其泌乳量不足的影响因素。结果 100例中53例(53%)在产后14 d泌乳量<500 ml,平均泌乳量为(341.08±89.70)ml。经多因素Logistic回归分析显示,产妇年龄、妊娠期高血压、泌乳Ⅱ期启动时间、EPDS分值是NICU住院早产儿母亲产后泌乳量不足的影响因素。结论 NICU住院早产儿母亲产后泌乳量水平较低,泌乳量不足发生率高;医护人员应针对影响泌乳的相关因素采取预见性干预措施,提高产妇泌乳量,降低泌乳量不足发生率,保障早产儿出院后母乳喂养的顺利实施。
Objective To measure breast milk volume of the mothers with premature infants in NICU,analyze the related factors of hypogalactia. Methods A cross-sectional study was performed,the daily breast milk volumes of mothers with premature infants in NICU of Affiliated Hospital of Binzhou Medical College from February to December in 2016 were measured for two weeks. A comprehensive questionnaire about lactation-related factors in the mothers with premature infants and Edinburgh Postnatal Depression Scale( EPDS) were used to survey and analyze the influencing factors of hypogalactia. Results Among 100 mothers,the breast milk volume of 53 mothers( 53%) was less than 500 ml at 14 days after delivery,the mean breast milk volume was( 341. 08 ±89. 70) ml. Multivariate logistic regression analysis showed that maternal age,hypertensive disorder complicating pregnancy,starting time of lactation stage Ⅱ,and EPDS score were influencing factors of hypogalactia among the mothers with premature infants in NICU. Conclusion The level of breast milk volume among the mothers with premature infants in NICU is low,the incidence rate of hypogalactia is high. The medical staff should take intervention measures targeting to the related influencing factors of lactation,improve breast milk volume,reduce the incidence rate of hypogalactia,and ensure smooth implementation of breastfeeding for preterm infants after leaving the hospital.
Objective To measure breast milk volume of the mothers with premature infants in NICU,analyze the related factors of hypogalactia. Methods A cross-sectional study was performed,the daily breast milk volumes of mothers with premature infants in NICU of Affiliated Hospital of Binzhou Medical College from February to December in 2016 were measured for two weeks. A comprehensive questionnaire about lactation-related factors in the mothers with premature infants and Edinburgh Postnatal Depression Scale( EPDS) were used to survey and analyze the influencing factors of hypogalactia. Results Among 100 mothers,the breast milk volume of 53 mothers( 53%) was less than 500 ml at 14 days after delivery,the mean breast milk volume was( 341. 08 ±89. 70) ml. Multivariate logistic regression analysis showed that maternal age,hypertensive disorder complicating pregnancy,starting time of lactation stage Ⅱ,and EPDS score were influencing factors of hypogalactia among the mothers with premature infants in NICU. Conclusion The level of breast milk volume among the mothers with premature infants in NICU is low,the incidence rate of hypogalactia is high. The medical staff should take intervention measures targeting to the related influencing factors of lactation,improve breast milk volume,reduce the incidence rate of hypogalactia,and ensure smooth implementation of breastfeeding for preterm infants after leaving the hospital.
引文
[1]Flaherman VL,Lee HC."Breastfeeding"by feeding expressed mother/s milk[J].Pediatr Clin North Am,2013,60(1):227-246.
[2]Boucher CA,Brazal PM,Graham-Certosini C,et al.Mothers'breastfeeding experiences in the NICU[J].Neonatal Netw,2011,30(1):21-28.
[3]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,1997,200-2007.
[4]Neville MC,Morton J.Lactogenesis the transition from pregnancy to lactation[J].Pediatr Clin North Am,2001,48(1):35-52.
[5]Murase M,Nommsen-Rivers L,Morrow AL,et al.Predictors of low milk volume among mothers who delivered preterm[J].J Hum Lactat,2014,30(4):425-435.
[6]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.
[7]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].Advn Neonatal Care,2014,14(4):E9-E19.
[8]Hill PD,Aldag JC,Chatterton RT,et al.Comparison of milk output between mothers of preterm and term infants:the first 6 weeks after birth[J].J Hum Lact,2005,21(1):22-30.
[9]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.
[10]Larkin T,Kiehn T,Murphy PK.Examining the use and outcomes of a new hospital-grade breast pump in exclusively pumping NICU mothers[J].Adv Neonatal Care,2013,13(1):75-82.
[11]Dowling DA,Blatz MA,Graham G.Mothers'experiences expressing breast milk for their preterm infants.Does NICU design make a difference?[J].Adv Neonatal Care,2012,12(6):377-384.
[12]Morton J,Hall JY,Wong RJ,et al.Combining hand techniques with electric pumping increases milk production in mothers of preterm infants[J].J Perinatol,2009,29(11):757-764.
[13]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.
[14]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.
[15]冷辉,王义芝.心理干预对产妇产后抑郁、睡眠情况及泌乳的影响[J].中国实用护理杂志,2012,28(8):73-74
[16]Chatterton RT,Hill PD,Aldag JC,et al.Relation of plasma oxytocin and prolactin concentrations to milk production in mothers of preterm infants:influence of stress[J].J Clin Endocrinol Metab,2000,85(10):3661-3668.
[17]徐艳敏,李术平,张倩.营养护理对产妇泌乳的影响分析[J].中国食物与营养,2014,20(6):87-89.
[18]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.
[2]Boucher CA,Brazal PM,Graham-Certosini C,et al.Mothers'breastfeeding experiences in the NICU[J].Neonatal Netw,2011,30(1):21-28.
[3]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,1997,200-2007.
[4]Neville MC,Morton J.Lactogenesis the transition from pregnancy to lactation[J].Pediatr Clin North Am,2001,48(1):35-52.
[5]Murase M,Nommsen-Rivers L,Morrow AL,et al.Predictors of low milk volume among mothers who delivered preterm[J].J Hum Lactat,2014,30(4):425-435.
[6]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.
[7]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].Advn Neonatal Care,2014,14(4):E9-E19.
[8]Hill PD,Aldag JC,Chatterton RT,et al.Comparison of milk output between mothers of preterm and term infants:the first 6 weeks after birth[J].J Hum Lact,2005,21(1):22-30.
[9]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.
[10]Larkin T,Kiehn T,Murphy PK.Examining the use and outcomes of a new hospital-grade breast pump in exclusively pumping NICU mothers[J].Adv Neonatal Care,2013,13(1):75-82.
[11]Dowling DA,Blatz MA,Graham G.Mothers'experiences expressing breast milk for their preterm infants.Does NICU design make a difference?[J].Adv Neonatal Care,2012,12(6):377-384.
[12]Morton J,Hall JY,Wong RJ,et al.Combining hand techniques with electric pumping increases milk production in mothers of preterm infants[J].J Perinatol,2009,29(11):757-764.
[13]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.
[14]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.
[15]冷辉,王义芝.心理干预对产妇产后抑郁、睡眠情况及泌乳的影响[J].中国实用护理杂志,2012,28(8):73-74
[16]Chatterton RT,Hill PD,Aldag JC,et al.Relation of plasma oxytocin and prolactin concentrations to milk production in mothers of preterm infants:influence of stress[J].J Clin Endocrinol Metab,2000,85(10):3661-3668.
[17]徐艳敏,李术平,张倩.营养护理对产妇泌乳的影响分析[J].中国食物与营养,2014,20(6):87-89.
[18]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.