论文部分内容阅读
目的:探讨极低出生体重儿(very low birth weight infant，VLBWI)和超低出生体重儿(extremely low birth weight infant，ELBWI)住院期间人乳喂养情况。方法:采用多中心回顾性病例队列研究，病例来源于2018年江苏省NICU母乳喂养质量改进临床研究协作组中的19家单位，选择胎龄≤35周且生后24 h内入院的VLBWI/ELBWI临床资料。人乳喂养包括亲母母乳喂养和(或)捐赠母乳喂养，人乳喂养率为住院期间接受过亲母母乳和(或)捐赠母乳喂养的比例。结果:(1)共收治VLBWI/ELBWI 1 359例，占早产儿总数的9.5%(1 359/14 346)。符合纳入标准的1 132例VLBWI/ELBWI中VLBWI 986例(87.1%)，男580例(51.2%)，胎龄(29.8±2.0)周，出生体重1 257(1 100，1 390) g，多胎280例(24.7%)。(2)19家单位中仅有1家VLBWI/ELBWI在住院期间均有人乳喂养，有6家单位无纯人乳喂养，其余12家单位均为人乳喂养、人乳喂养＋配方奶喂养和配方奶喂养3种喂养方式；19家单位VLBWI/ELBWI住院期间平均人乳喂养率为73.8%，1家单位达100%，最低19.4%，其中15家在50%以上，2家单位在40%以下。(3)19家单位住院期间人乳喂养量占比中位数为70.6%，最高100%；日均人乳喂养量中位数为46.3 ml/(kg·d)，最高118.0 ml/(kg·d)，4家单位日均人乳喂养量中位数为0 ml/(kg·d)。(4)19家单位VLBWI/ELBWI生后0～7 d人乳喂养占比在50%以下，随着日龄的增长逐渐增加，0～28 d为75.0%。日均人乳喂养量也呈上升趋势，生后0～7 d<5 ml/(kg·d)，0～28 d为12.7 ml/(kg·d)。(5)住院期间的人乳喂养量占比和日均人乳喂养量成线性相关。结论:2018年江苏省NICU母乳喂养质量改进临床研究协作组19家单位VLBWI/ELBWI人乳喂养率、人乳喂养量占比、日均人乳喂养量存在很大差距，需加强VLBWI/ELBWI住院期间人乳喂养质量改进工作，提高人乳喂养率。“,”Objective:To study the breastfeeding status of very low birth weight (VLBW) infants and extremely low birth weight (ELBW) infants during hospitalization.Method:Among the 19 hospitals of the Jiangsu Multicenter Study Collaborative Group for Breastmilk Feeding in Neonatal Intensive Care Units in 2018, a multi-center retrospective cohort study was performed in VLBW and ELBW infants with gestational age ≤35 weeks admitted to the hospital within 24 hours after birth. Breastfeeding meant feeding the babies breast milk of their mothers and/or donators. The proportion of those who have received breast milk of mothers and/or donators during hospitalization among all VLBW/ELBW infants was calculated as the breastfeeding rate. The proportion of breastfeeding milk in all the infants intake was calculated as the breastfeeding%.Result:(1) A total of 1 359 cases of VLBW/ELBW infants were admitted[VLBW: 986 cases (87.1%)], accounting for 9.5% (1 359/14 346) of all the premature infants. Among the 1 132 eligible preterms, 580 (51.2%) cases were male, the average gestational age was (29.8±2.0) weeks, the average birth weight was 1 257 (1 100, 1 390) g, and 280 (24.7%) cases were multiple births. (2) Only 1 hospital performed breastfeeding for every preterm infant during hospitalization. 6 hospitals did not have any case fully breastfed. Preterms in the other 12 hospitals were fed using breast milk and/or formula milk. The average breastfeeding rate was 73.8% among 19 hospitals, with 1 hospital reaching 100%, and the lowest rate was 19.4%. 15 hospitals were above 50% and 2 units were below 40%. (3) The median breastfeeding% during hospitalization in 19 hospitals was 70.6%, with the highest 100%. The median daily breastfeeding amount is 46.3 ml/(kg·d), with the highest 118.0 ml/(kg·d). However, the median daily breastfeeding amount of 4 hospitals is 0 ml/(kg·d ). (4) Breastfeeding rate was less than 50% within the first week after birth in 19 hospitals, and the rate increased as time went, reaching 75% at 28-day. The average daily breastfeeding volume also increased from less than 5 ml/(kg·d) in the initial 7 days to 12.7 ml/(kg·d) at the 28-day after birth. (5) The breastfeeding% during hospitalization was linearly related to the average daily breastfeeding volume.Conclusion:Great differences existed among breastfeeding rate, breastfeeding% and the average daily breastfeeding volume in 19 hospitals. Its greatly needed to improve breastfeeding quality in VLBW/ELBW infants during hospitalization and to improve the breastfeeding rate.