NICU母乳喂养质量改进现状调查
Status Research of Breastfeeding Quality Im-provement in NICU
DOI: 10.12677/ACM.2022.126799, PDF,   
作者: 刘 兰：青海大学临床医学院，青海 西宁；吴亚臻*：青海大学附属医院新生儿科，青海 西宁
关键词: 母乳喂养；新生儿重症监护病房；质量改进；Breastfeeding； Neonatal Intensive Care Unit； Quality Improvement
摘要: 母乳是所有新生儿首选的营养形式。母乳喂养率已经作为爱婴医院及儿童专科医院、妇幼保健院新生儿科质量指标之一。然而我国的新生儿重症监护病房(Neonatal Intensive Care Unit, NICU)母乳喂养率低，母乳喂养实施情况不容乐观。如何提高NICU母乳喂养率一直是迫切需要解决的问题。本综述系统回顾国内外关于母乳喂养质量改进现状的研究，调查证实应用袋鼠式护理、口腔护理、家庭为中心的护理等质量改进(Quality Improvement, QI)措施，可显著提高母乳喂养率，降低住院新生儿多种并发症发生率等。本综述旨在通过回顾国内外母乳喂养QI的经验，总结母乳喂养QI措施，对建立我国母乳喂养规范的管理体系提供一定帮助。
Abstract: Breast milk is the preferred form of nutrition for all newborns. The breastfeeding rate has been taken as one of the quality indexes in neonatal departments of baby-friendly hospitals, children’s special hospitals and maternal and child health hospitals. However, the breastfeeding rate in Neo-natal Intensive Care Unit (NICU) in China is low, and the implementation of breastfeeding is not op-timistic. How to improve the breastfeeding rate in NICU has always been an urgent problem to be solved. This review systematically reviews the research on the improvement status of breastfeeding quality in China and abroad, and the survey confirms that the application of Quality Improvement (QI) measures such as kangaroo care, oral care and home-centered care can significantly increase the breastfeeding rate and reduce the incidence of various complications of hospitalized neonates. The purpose of this review was to provide some help for the establishment of standardized man-agement system of breastfeeding in China by reviewing the experience of breastfeeding QI in China and abroad and summarizing the measures for breastfeeding QI.
文章引用：刘兰, 吴亚臻. NICU母乳喂养质量改进现状调查[J]. 临床医学进展, 2022, 12(6): 5525-5532. https://doi.org/10.12677/ACM.2022.126799

参考文献

[1] Kim, L.Y., McGrath-Morrow, S.A. and Collaco, J.M. (2019) Impact of Breast Milk on Respiratory Outcomes in Infants with Bronchopulmonary Dysplasia. Pediatric Pulmonology, 54, 313-318. [Google Scholar] [CrossRef] [PubMed]
[2] 韩树萍. 母乳喂养对新生儿重症监护病房早产儿的益处[J]. 中国新生儿科杂志, 2015, 30(3): 161-163.
[3] Westerfield, K.L., Koenig, K. and Oh, R. (2018) Breastfeeding: Common Questions and Answers. Amer-ican Family Physician, 98, 368-373.
[4] 早产儿营养调查协作组. 新生儿重症监护病房中早产儿营养相关状况多中心调查974例报告[J]. 中华儿科杂志, 2009, 47(1):12-17.
[5] Shah, V., Warre, R. and Lee, S.K. (2013) Quality Improvement Initiatives in Neonatal Intensive Care Unit Networks: Achievements and Challenges. Academic Pediatrics, 13, S75-S83. [Google Scholar] [CrossRef] [PubMed]
[6] Ware, J.L., Schetzina, K.E., Morad, A., Barker, B., Scott, T.A. and Grubb, P.H. (2018) A Statewide Quality Improvement Collaborative to Increase Breastfeeding Rates in Tennessee. Breastfeeding Medicine, 13, 292-300. [Google Scholar] [CrossRef] [PubMed]
[7] 刘凤, 韩树萍, 余章斌, 陈小慧. 持续母乳喂养质量改进对极/超低出生体重儿的影响[J]. 中华围产医学杂志, 2019, 22(7): 451-456.
[8] Randhawa, J.K., Kim, M.E., Polski, A., Reid, M.W., Mascarenhas, K., Brown, B., et al. (2021) The Effects of Breastfeeding on Retinoblastoma Development: Results from an International Multicenter Retinoblastoma Survey. Cancers, 13, Article No. 4773. [Google Scholar] [CrossRef] [PubMed]
[9] Muñoz-Esparza, N.C., Vásquez-Garibay, E.M., Guzmán-Mercado, E., Larrosa-Haro, A., Comas-Basté, O., Latorre-Moratalla, M.L., et al. (2022) Influence of the Type of Breastfeeding and Human Milk Polyamines on Infant Anthropometric Parameters. Frontiers in Nutrition, 8, Article ID: 815477. [Google Scholar] [CrossRef] [PubMed]
[10] Deoni, S., Dean, D., Joelson, S., O’Regan, J. and Schneider, N. (2018) Early Nutrition Influences Developmental Myelination and Cognition in Infants and Young Children. Neuroimage, 178, 649-659. [Google Scholar] [CrossRef] [PubMed]
[11] Rantalainen, V., Lahti, J., Henriksson, M., Kajantie, E., Mikkonen, M., Eriksson, J.G., et al. (2018) Association between Breastfeeding and Better Preserved Cognitive Ability in an Elderly Cohort of Finnish Men. Psychological Medicine, 48, 939-951. [Google Scholar] [CrossRef] 
[12] Niu, W., Xu, X., Zhang, H., Zhang, Y., Ni, S., Liu, T., et al. (2020) Breastfeeding Improves Dynamic Reorganization of Functional Connectivity in Preterm Infants: A Temporal Brain Network Study. Medical & Biological Engineering & Computing, 58, 2805-2819. [Google Scholar] [CrossRef] [PubMed]
[13] 中国医师协会新生儿科医师分会营养专业委员会, 中国医师协会儿童健康专业委员会母乳库学组, 《中华儿科杂志》编辑委员会. 新生儿重症监护病房推行早产儿母乳喂养的建议[J]. 中华儿科杂志, 2016, 54(1): 13-16.
[14] 江苏省NICU母乳喂养质量改进临床研究协作组. 极/超低出生体重儿住院期间人乳喂养情况多中心回顾性分析[J]. 中华新生儿科杂志, 2020, 35(3): 164-168.
[15] 李琳琳, 连冬梅, 孙静. NICU母乳和配方乳喂养管理的现况调查[J]. 中华护理杂志, 2018, 53(10): 1199-1205.
[16] 贺芳, 郭晓萍, 刘会. 早产儿母乳喂养多中心现状调查[J]. 中国保健营养, 2019, 29(10): 364-365.
[17] Shah, A. (2020) How to Move Beyond Quality Improvement Projects. BMJ, 370, Article No. m2319. [Google Scholar] [CrossRef] [PubMed]
[18] 张俊, 刘凤, 韩树萍. NICU母乳喂养质量改进进展[J]. 临床儿科杂志, 2016, 34(1): 74-77.
[19] 郑彩霞, 聂庭玉, 董水滢, 高艳娥. 回授法在初产妇母乳喂养宣教中的应用[J]. 中国妇幼健康研究, 2021, 32(11): 1696-1699.
[20] Parker, M.G., Melvin, P., Graham, D.A., Gupta, M., Burnham, L.A., Lopera, A.M., et al. (2019) Timing of First Milk Expression to Maximize Breastfeeding Continuation among Mothers of Very Low-Birth-Weight Infants. Obstetrics & Gynecology, 133, 1208-1215. [Google Scholar] [CrossRef] 
[21] Porta, R., Miralles, N., Paltrinieri, A., Ibáñez, B., Giménez, J., Roca, T., et al. (2021) A Breast Milk Pump at the Bedside: A Project to Increase Milk Production in Mothers of Very Low Birth Weight Infants. Breastfeeding Medicine, 16, 309-312. [Google Scholar] [CrossRef] [PubMed]
[22] Froh, E.B., Hallowell, S. and Spatz, D.L. (2015) The Use of Technologies to Support Human Milk & Breastfeeding. Journal of Pediatric Nursing, 30, 521-523. [Google Scholar] [CrossRef] [PubMed]
[23] 岳晓红, 赵翠霞, 芦惠, 薛辛东. 非营养性吸吮对早产儿营养及胃肠道转运时间的影响[J]. 中华儿科杂志, 2003, 41(2): 91-94.
[24] Nasuf, A.W.A., Ojha, S. and Dorling, J. (2018) Oropharyngeal Colostrum in Preventing Mortality and Morbidity in Preterm Infants. Cochrane Database of Systematic Reviews, No. 9, Article No. CD011921. [Google Scholar] [CrossRef] 
[25] 王佳琦, 徐静, 李蕊, 童笑梅. 初乳口咽哺喂对早产儿坏死性小肠结肠炎、晚发型败血症和死亡影响的系统评价[J]. 中华新生儿科杂志, 2021, 36(3): 78-79.
[26] 新生儿重症监护室母乳使用专家共识核心组, 曹云, 李正红, 韩树萍, 张谦慎, 李丽玲, 刘婵, 张崇凡, 中华医学会儿科学分会营养学组(筹). 新生儿重症监护室母乳使用专家共识[J]. 中国循证儿科杂志, 2021, 16(3): 171-178.
[27] Waddington, C., van Veenendaal, N.R., O’Brien, K. and International Steering Committee for Family In-tegrated Care (2021) Family Integrated Care: Supporting Parents as Primary Caregivers in the Neonatal Intensive Care Unit. Pediatric Investigation, 5, 148-154. [Google Scholar] [CrossRef] [PubMed]
[28] O’Brien, K., Robson, K., Bracht, M., Cruz, M., Lui, K., Alvaro, R., et al. (2018) Effectiveness of Family Integrated Care in Neonatal Intensive Care Units on Infant and Parent Outcomes: A Multicentre, Multinational, Cluster-Randomised Controlled Trial. The Lancet Child & Adolescent Health, 2, 245-254. [Google Scholar] [CrossRef] 
[29] WHO Immediate KMC Study Group (2021) Immediate “Kangaroo Mother Care” and Survival of Infants with Low Birth Weight. New England Journal of Medicine, 384, 2028-2038. [Google Scholar] [CrossRef] 
[30] 陈红雨. NICU极低出生体重早产儿袋鼠式照护与母乳喂养的关联分析[J]. 中国妇幼健康研究, 2021, 32(2): 196-199.
[31] Sánchez, L.M., Martin, S.C. and Gómez-de-Orgaz, C.S. (2021) Human Milk Bank and Personalized Nutrition in the NICU: A Narrative Review. Euro-pean Journal of Pediatrics, 180, 1327-1333. [Google Scholar] [CrossRef] [PubMed]
[32] Daili, C., Kunkun, Z. and Guangjun, Y. (2020) Cost Analysis of Operating a Human Milk Bank in China. Journal of Human Lactation, 36, 264-272. [Google Scholar] [CrossRef] [PubMed]
[33] Cormontagne, D., Rigourd, V. and Vidic, J. (2021) Bacillus ce-reus Induces Severe Infections in Preterm Neonates: Implication at the Hospital and Human Milk Bank Level. Toxins, 13, Article No. 123. [Google Scholar] [CrossRef] [PubMed]
[34] Feldman-Winter, L., Ustianov, J., Anastasio, J., Butts-Dion, S., Heinrich, P., Merewood, A., et al. (2017) Best Fed Beginnings: A Nationwide Quality Improvement Initiative to Increase Breastfeeding. Pediatrics, 140, Article ID: e20163121. [Google Scholar] [CrossRef] [PubMed]
[35] Kaur, R., Kant, S., Goel, A.D., Bhatia, H. and Murry, L. (2021) A Quality Improvement Intervention to Improve Early Initiation of Breastfeeding among Newborns Delivered at a Secondary Level Hospital in Northern India. Medical Journal Armed Forces India, 77, 230-236. [Google Scholar] [CrossRef] [PubMed]
[36] Patyal, N., Sheoran, P., Sarin, J., Singh, J., Jesika, K., Kumar, J., et al. (2021) A Quality Improvement Initiative: Improving First-hour Breastfeeding Initi-ation Rate among Healthy Newborns. Pediatric Quality and Safety, 6, Article No. e433. [Google Scholar] [CrossRef] [PubMed]
[37] Muhammed, S., Shaw, S.C., Rawat, A., Joy, D.V., Sood, A., Venkatnarayan, K., et al. (2020) Improving Exclusive Breast Feeding in the First 24 h of Life Using Plan-Do-Study-Act Cycle in a Tertiary Care Hospital. Medical Journal Armed Forces India, 76, 325-332. [Google Scholar] [CrossRef] [PubMed]
[38] Wang, Y., Zhao, T., Zhang, Y., Li, S. and Cong, X. (2021) Posi-tive Effects of Kangaroo Mother Care on Long-Term Breastfeeding Rates, Growth, and Neurodevelopment in Preterm Infants. Breastfeeding Medicine, 16, 282-291. [Google Scholar] [CrossRef] [PubMed]
[39] Mundhra, N., Desai, S. and Nanavati, R. (2021) A Quality Improve-ment Initiative Study to Improve Breastfeeding Rates in Kangaroo Mother Care Position. Breastfeeding Medicine, 16, 313-317. [Google Scholar] [CrossRef] [PubMed]
[40] 陈娟, 倪萍萍. 母乳喂养质量改进项目对低出生体重儿母乳喂养的促进作用[J]. 系统医学, 2021, 6(2): 183-185.
[41] 郭玉珍, 赵晓燕, 邱宇灵. 母乳喂养质量改进项目对提高早产儿新鲜母乳及母乳喂养率的临床效果[J]. 中国医药科学, 2021, 11(14): 92-95+130.
[42] 陈长春, 周勤, 王敏, 梅英姿, 姜善雨. 母乳喂养质量改进对极/超低出生体重儿的影响[J]. 中国儿童保健杂志, 2021, 29(8): 906-909.

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