母乳喂养不影响乙型肝炎病毒母婴传播阻断效果

目的：比较不同喂养方式对HBsAg阳性母亲的婴儿母婴传播阻断效果的影响。方法：HBsAg阳性母亲的婴儿常规接种乙型肝炎疫苗或接受乙型肝炎疫苗和乙型肝炎免疫球蛋白联合免疫并随访。62例婴儿单用乙型肝炎疫苗免疫，21例母乳喂养，41例人工喂养；168例婴儿联合免疫，33例母乳喂养，135例人工喂养。结果：单用疫苗时1、3、6、12月龄抗-HBs阳性率母乳喂养组分别为4.8％、42.9％、57.9％、80.9％，人工喂养组分别为12.2％、26.3％、60.5％、73.2％；联合免疫时1、4、7、12月龄抗-HBs阳性率母乳喂养组分别为72.7％、75.8％、77.4％、90.9％，人工喂状组为77.0％、72.9％、76.2％、90.4％。单用疫苗时，母乳喂养组1例、人工喂养组3例免疫失败；联合免疫时，母乳喂养组无一例免疫失败，人工喂养组4例免疫失败，母乳喂养和人工喂养比较，差异均无显著性。结论：母乳喂养不影响抗-HBs产生，不增加免疫失败。     

Interaction between feeding method and co-sleeping on maternal-newborn sleep

Background: Previous studies have demonstrated that breastfed newborns spend more time awake than bottle-fed newborns, breastfeeding mothers have more fragmented sleep than bottle-feeding mothers, and mother-newborn sleeping arrangements may affect the sleep/wake pattern of mother-newborn pairs.
Objective: To address the unsolved question of whether there is an interaction between type of feeding and sleeping arrangements that affects postpartum sleep during the 4th postpartum week.
Design: Correlational, two-way design using feeding method and location of newborn at night as independent variables, and sleep patterns as the dependent variables.
Setting: Patient's home during 4th week after giving birth.
Patients/Participants: First-time mothers and their newborns (n = 33).
Main Outcome Measures: Amount of total sleep, amount of night sleep, number of night awakenings, and number of sleep periods in 24 hours using a modified version of the self-report sleep instrument by Barnard and Eyres.
Results: Breastfed newborns had less total sleep per day than bottle-fed newborns, and breastfeeding mothers had more sleep periods in 24 hours than bottle-feeding mothers. Breastfeeding mothers slept more than bottle-feeding mothers when co-sleeping, but bottle-feeding mothers' sleep was unaffected by location of newborn. Average total sleep for 4-week-old newborns was about 14 hours daily.
Conclusions: More sleep was obtained when breastfeeding mothers slept with the newborn. Methods or devices that allow breastfeeding mothers and newborns to sleep next to each other in complete safety need to be developed.     

Factors associated with newborn in-hospital weight loss: comparisons by feeding method, demographics, and birthing procedures.

Full-term newborn normative weight loss and factors influencing this were determined through chart audits (n = 812) at 6 hospitals in Manitoba, Canada. The effects of parity, gestational age, birth weight, sex, length of stay, type of delivery (cesarean vs vaginal), epidural use, and type of infant feeding (exclusively breastfed, partially breastfed, exclusively formula-fed) on percentage weight loss in hospital were analyzed using multiple regression analysis. In-hospital weight loss was 5.09% +/- 2.89% (95% CI, 4.89-5.29), varying by feeding category: exclusively breastfed 5.49% +/- 2.60% (95% CI, 5.23-5.74), partially breastfed 5.52% +/- 3.02% (95% CI, 5.16-5.88), and formula-fed 2.43% +/- 2.12% (95% CI, 2.02-2.85). Factors significantly increasing the percentage weight loss included higher birth weight, female sex, epidural use, and longer hospital stay. Lower percentage weight loss was associated with greater gestational age and exclusive formula feeding. Parity and type of delivery were not significant. Controlling for demographic and delivery-related variables, exclusive formula feeding had the largest impact, with 3.1% less weight loss than exclusive breastfeeding.     

Effects of Dextrose Gel in Newborns at Risk for Neonatal Hypoglycemia in a Baby-Friendly Hospital

ObjectiveTo describe the effects of the introduction of dextrose gel to the neonatal hypoglycemia (NH) protocol on exclusive breastfeeding rates at discharge and NICU admission rates among clinically well newborns born at 35 weeks gestation or greater who were at risk for NH in a Baby-Friendly hospital.DesignQuasi-experimental, pre- and postintervention.SettingA suburban, Baby-Friendly hospital with approximately 2,000 births annually.ParticipantsClinically well newborns born at 35 weeks gestation or greater at risk for NH who were admitted to the mother–baby unit.MethodsWe compared 198 newborns at risk for NH born in the 6-month period before the introduction of dextrose gel (November 15, 2016, through May 14, 2017) versus 203 newborns born in the 6-month period after the introduction (May 15, 2017, through November 14, 2017). In the preintervention group, the NH protocol included blood glucose monitoring, prolonged skin-to-skin contact, feeding, and dextrose administered intravenously. In the postintervention group, oral dextrose gel was added to the NH protocol.ResultsWe found no differences in maternal or newborn characteristics between the pre- and postintervention groups. Dextrose gel was given to 50 newborns (approximately 25%) of 203 in the postintervention group. The proportion of newborns who were exclusively breastfed at discharge was similar between groups (56.6% of 198 vs. 59.1% of 203, p = .62), as were the NICU admission rates for hypoglycemia (2.5% of 198 vs. 1.5% of 203, p = .50).ConclusionsIn a suburban Baby-Friendly hospital, introduction of dextrose gel into the NH protocol had no significant effect on exclusive breastfeeding at discharge or NICU admission rates.     

Relationship of Early Bonding to Initial Infant Feeding Patterns in Bottle-fed Newborns

To determine the relationship between early bonding in the immediate post-delivery period and initial infant feeding patterns in bottle-fed newborns, data were gathered from the charts of 85 full-term normal infants. Of the infants, 57 had an early, extra bonding experience in the postpartum recovery room; 28 did not. In comparing the bond and no-bond groups for weight loss and formula intake, the t -test analyses showed a statistically significant effect of bonding that was beneficial to infant status.     

The effect of bather and location of first bath on maintaining thermal stability in newborns

OBJECTIVE: To compare thermal stability during the first bath of newborns bathed by maternal-child nurses in a newborn nursery with thermal stability of newborns bathed by parents at the maternal bedside. DESIGN: A randomized clinical controlled trial. SETTING: A tertiary care hospital in western Canada. PARTICIPANTS: Participants (N = 111) were full-term newborns born vaginally. INTERVENTIONS: The experimental treatment was the parent bathing the newborn under nursing supervision at the bedside in the first few hours of birth; the standard treatment was a nurse bathing the newborn in an admission nursery. MAIN OUTCOME MEASURES: The main outcome measure was newborn heat loss occurring from bathing as assessed by changes in aural temperatures, which were taken before, during, and following bathing. RESULTS: There was no difference in temperature change between newborns bathed by a nurse and those bathed by a parent (F = 0.595, df = 1, p = .442). A return to normal thermal ranges takes approximately an hour. CONCLUSION: Heat loss experienced by newborns during bathing is significant and is not associated with who bathes the newborn or where the bath takes place.     

Hidden morbidity with "successful" early discharge.

OBJECTIVE: This study was conducted to determine if early postnatal discharge (EDC; < or =48 hours) in well newborns had an effect on the rate of hospital readmission within the first week after hospital discharge when compared to infants who remained >48 hours after birth (later discharge, LDC). STUDY DESIGN: This was a retrospective medical chart review. Charts of infants born between January 1994 and December 1998, discharged as "well newborns" and treated subsequently at a primary children's hospital within 7 days of neonatal discharge, were reviewed. Infants were categorized by length of neonatal hospital stay, level of medical intervention (emergency department treatment or hospital admission), and final diagnosis. RESULTS: There was a significant increase in hospital readmission rate for LDC infants when compared to EDC infants. When considering jaundice alone as an admitting diagnosis, EDC infants were admitted at a higher rate than LDC infants and with higher serum bilirubin concentrations. Readmitted, jaundiced infants had been almost always breast-fed. CONCLUSION: Overall, EDC of well newborns appears to be a safe and reasonable practice. However, the risk for severe jaundice is an unresolved issue that requires a discharge strategy and early follow-up to prevent serious morbidity.     

A Randomized Controlled Trial of the Effect of Intrapartum Intravenous Fluid Management on Breastfed Newborn Weight Loss

ObjectiveTo determine the effect of conservative versus usual intrapartum intravenous (IV) fluid management for low‐risk women receiving epidural analgesia on weight loss in breastfed newborns.DesignA randomized controlled trial.SettingA tertiary perinatal center in a large urban setting.SampleWomen experiencing uncomplicated pregnancies who planned to have epidural analgesia and to breastfeed.MethodsHealthy pregnant women were randomized to receive an IV epidural preload volume of <500 mLs continuing at an hourly rate of 75–100 mL/h (conservative care) or an epidural preload volume of ≥500 mLs and an hourly rate >125 mL/h (usual care). The primary study outcome was breastfed newborn weight loss >7% prior to hospital discharge. Secondary study outcomes included breastfeeding exclusivity, referral to outpatient breastfeeding clinic support, and delayed discharge. Other outcomes were admission to the neonatal intensive care unit and cord blood pH <7.25.ResultsTwo hundred women participated (100 in the conservative care and 100 in the usual care groups). Forty‐eight of 100 infants in the usual care group and 44 of the 100 infants in the conservative care group lost >7% of their birth weight prior to discharge, p < 0.52 RR 0.92 [0.68–1.24].ConclusionA policy of restricted IV fluids did not affect newborn weight loss. Women and their care providers should be reassured that the volumes of IV fluid <2500 mLs are unlikely to have a clinically meaningful effect on breastfed newborn weight loss >7%. Exploratory analyses suggest that breastfed newborn weight loss increases when intrapartum volumes infused are >2500 mLs. Care providers are encouraged to consider volumes of IV fluid infused intrapartum as a factor that may have contributed to early newborn weight loss in the first 48 h of life.     

Determination of newborn feeding in maternity hospital care. Part I: Factors associated with breast feeding initiation]

The data on 11,750 newborns collected in 427 hospitals during the survey of maternity words practices in 1995 were used to analyse the factors related to breastfeeding initiation while in hospital. The statistical analyses were done using percentage of newborn breastfed as well as odds ratio (OR) and population attributable risk in percent (PAR%) of artificial feeding. The identified factors of artificial feeding were: newborn birth weight < 2500 g (OR = 28.2; PAR = 52%), complications in neonatal period (OR = 10.3; PAR = 64%), caesarean section (OR = 4.3; PAR = 32.2%), mother and newborn separation longer than 1h/24h (OR = 13%; PAR = 87.2%), lack of skin-to-skin contact after birth (OR = 8.5; PAR = 60.9%).     

Specialized care for twin gestations: improving newborn outcomes and reducing costs

OBJECTIVE: To compare newborn outcomes and costs of hospital stays for twins born to mothers receiving care in a specialized twin clinic with a research-based care protocol and one consistent caregiver versus twins whose mothers received standard prenatal care. DESIGN AND SETTING: A retrospective, historical cohort study conducted in a high-risk obstetric clinic in central Texas. PATIENTS: Thirty women pregnant with twins received specialized care. The comparison group consisted of 41 women pregnant with twins who received standard care. INTERVENTIONS: An advanced practice nurse provided prenatal care, which included weekly clinic visits, home visits, and 24-hour availability for phone support. OUTCOME MEASURES: Gestational age at birth, birth weight, length of stay in the neonatal intensive-care unit (NICU), and hospital charges for the newborns. RESULTS: No newborns of less than 30 weeks gestation were born to women in the specialized care group, the mean birth weight was 249 g (SD +/- 77) higher, days in the NICU were reduced from a mean of 17 to 7, and hospital charges were $30,000 less per infant. CONCLUSIONS: Newborn outcomes were improved and length of stay and hospital charges were significantly reduced for newborns whose mothers had received care in the specialized twin clinic.     

Systematic Review of Expected Weight Changes After Birth for Full-Term,Breastfed Newborns

ObjectiveTo summarize the findings of recent studies on neonatal weight changes that occur in the early weeks of life among full-term, breastfed newborns.Data SourcesUsing the keywords breastfeeding, newborn, infant, weight, weight loss, and growth, we searched PubMed, Cumulative Index of Nursing and Allied Health Literature, Cochrane Library, and MEDLINE for primary studies and secondary analyses. We also reviewed the reference lists of retrieved articles.Study SelectionQuantitative studies published in the English language from 2015 through 2019 that focused on newborn weight changes. From a total of 827 records initially screened, we included 11 studies in this analysis.Data ExtractionTwo authors independently reviewed the selected articles with the use of the Johns Hopkins Nursing Evidence-Based Practice Synthesis and Recommendations Tool. To determine evidence levels and quality ratings, we evaluated the consistency and generalizability of study results, sample sizes, study designs, adequacy of controls, and definitive nature of the conclusions.Data SynthesisBy 2 days after birth, mean weight loss among neonates was 6% to 7% of birth weight, and by Day 3, mean weight loss was usually 7% to 8%. The nadir of lost birth weight occurred on Days 2, 3, or 4 after birth. At times, breastfed newborns lost 10% or more of their birth weight. By 10 to 14 days, most newborns regained their birth weight. Rates of exclusive breastfeeding decreased when newborns lost greater amounts of weight. Compared with past studies, more sample groups in this review included exclusively breastfed newborns and weight assessments beyond birth hospitalization.ConclusionWeight loss is commonly 7% to 8% of birth weight or greater by the third day after birth among healthy, full-term, breastfed newborns.     

In‐Hospital Formula Supplementation of Breastfed Babies: A Population‐Based Survey

Abstract: Background: In‐hospital formula supplementation of breastfed newborns is commonplace despite its negative association with breastfeeding duration. Although several studies have described the use of formula supplementation, few have explored the factors that may be associated with its use. The aim of this study was to explore factors associated with in‐hospital formula supplementation using data from a large Australian population‐based survey. Methods: All women who gave birth in September and October 2007 in two Australian states were mailed questionnaires 6 months after the birth. Women were asked how they fed their baby while in hospital after the birth. Multivariable logistic regression was used to explore specified a priori factors associated with in‐hospital formula supplementation. Results: Of 4,085 women who initiated breastfeeding, 23 percent reported their babies receiving formula supplementation. Breastfed babies had greater odds of receiving formula supplementation if their mother was primiparous (adj. OR = 2.16; 95% CI: 1.76–2.66); born overseas and of non‐English‐speaking background (adj. OR = 2.03; 95% CI: 1.56–2.64); had a body mass index more than 30 (adj. OR = 2.27; 95% CI: 1.76–2.95); had an emergency cesarean section (adj. OR = 1.72; 95% CI: 1.3–2.28); or the baby was admitted to a special care nursery (adj. OR = 2.72; 95% CI: 2.19–3.4); had a birthweight less than 2,500 g (adj. OR = 2.02; 95% CI: 1.3–3.15) or was born in a hospital not accredited with Baby‐Friendly Hospital Initiative (BFHI) (adj. OR = 1.53; 95% CI: 1.2–1.94). Conclusions: The number of factors associated with in‐hospital formula supplementation suggests that this practice is complex. Some results, however, point to an opportunity for intervention, with the BFHI appearing to be an effective strategy for supporting exclusive breastfeeding. (BIRTH 38:4 December 2011)     

Pacing as a treatment technique for transitional sucking patterns.

OBJECTIVE: To ascertain whether the implementation of a paced feeding protocol in a sample of preterm infants with respiratory diagnoses will result in the development of more efficient sucking patterns, increased weight gain, decreased incidence of bradycardia during feeding, and shorter length of hospital stay. METHOD: A total of 36 premature infants were enrolled into a nonrandomized clinical trial conducted in a neonatal intensive care unit (NICU). The first 18 infants were traditionally bottle-fed. Following this cohort's discharge from NICU, nursing staff completed continuing education on implementing a paced feeding protocol and the next 18 infants were delivered paced feedings. RESULTS: The two cohorts were equivalent at the initiation of oral feedings on gestational age, birth weight, 1 and 5 minute Apgar scores, weight, and postconceptual age. The paced infants demonstrated statistically and clinically significant decreases in bradycardic incidences during feeding and gains in development of more efficient sucking patterns at discharge. Discharge and average weekly weight gain did not differ between the two groups. CONCLUSIONS: The incorporation of pacing into NICU care practices appears to be beneficial for preterm infants with respiratory disease.     

Improved outcomes of feeding low birth weight infants with predominantly raw human milk versus donor banked milk and formula

Objectives: To investigate the benefits of treating low birth weight infants predominantly with mother’s own raw milk and early initiation of breastfeeding (raw human milk/breast-fed infants), in comparison to feeding only with donor banked milk (until the third week of life) and afterwards a preterm formula until hospital discharge (donor banked/formula-fed infants).

Methods: One hundred and ninety-two predominantly raw human milk-fed infants (70% of raw and 30% of donor milk) were matched to 192 donor/formula-fed ones (on 1:1 ratio). Aggressive nutrition policy and targeted fortification of human milk were implemented in both groups.

Results: The two groups show similar demographic and perinatal characteristics. Predominantly raw milk-fed infants regained earlier their birth weight, suffered less episodes of feeding intolerance and presented a higher body length and head circumference at discharge (p?<?0.001). Those treated mainly with their mothers’ milk were able to initiate breastfeeding almost 2 weeks earlier compared to those fed with donor milk who achieved to be bottle-fed later on post-conceptual age (p?<?0.001). Infants being breastfed until the 8th month of life conducted less visits for a viral infection to a pediatrician compared to those in the other group (p?<?0.001).

Conclusions: Feeding predominantly with mother’s raw milk seems to result in optimal neonatal outcomes.     

Neonatal outcome of infants born after in vitro fertilization at National Taiwan University Hospital.

BACKGROUND AND PURPOSE: This study compared the neonatal outcome between infants born after in vitro fertilization (IVF) and after natural conception at National Taiwan University Hospital. METHODS: All medical records of women who underwent IVF and gave birth at our hospital from January 1995 to December 1996 were reviewed. The charts of their offspring were also reviewed. We compared the neonatal outcome of infants born after IVF with that of infants born after natural conception. Neonatal outcome was evaluated based on preterm birth, very low birth weight (VLBW), perinatal morbidity, and neonatal mortality. RESULTS: A total of 75 women underwent IVF and gave birth to a total of 100 live newborns and two fetuses with intrauterine death during the 2-year study period. Among these newborns, the prevalence of preterm birth was 28%, of perinatal morbidity was 17%, and of neonatal mortality was 3%, which were significantly higher than those among the 7,736 neonates born after natural conception. However, the rate of VLBW was similar between the two groups. The rate of preterm birth for twin pregnancies were higher than that for singleton pregnancies in both groups. CONCLUSION: This study showed that infants born after IVF had a higher risk of preterm birth and higher perinatal morbidity and neonatal mortality.     

Is routine hospitalization needed in antenatal care of twin pregnancy?

A prospective study was carried out to evaluate the significance and efficacy of routine hospital bed rest in prevention of premature birth and pregnancy complications compared to specialized antenatal care at the outpatient clinic of 73 twin pregnancies. The twin pregnancies were screened in health centers by means of symphysis-fundus measurement, and the diagnosis was confirmed by ultrasound examination at the outpatient clinic. On the average the ultrasonic diagnosis was performed during the 23rd gestational week; at this visit the women were divided into two groups with similar follow-up to the end of the 29th gestational week. At this stage one of the groups was hospitalized unless there had been indications for earlier admission. In the hospital group, the mean for gestational week at delivery was 36.7 (+/- 2.4) and in the outpatient group 37.4 (+/- 1.8) respectively (N.S.). There was no difference in the rate of pregnancy complications between the groups too. No statistical differences in the perinatal mortality (7.1% and 1.1% respectively) or birthweights of the newborns were found, either. Present results do not support the idea of using routine hospital bed rest. It could not be proved to have positive effects on the gestational age, birth weight and perinatal mortality of the newborns, nor to the pregnancy complications. In our opinion early diagnosis of twin pregnancy is of decisive importance and specialized ambulatory follow-up could be employed instead of routine bed rest in antenatal care of twin pregnancy.     

Systematic Review of Newborn Feeding Method and Outcomes Related to Neonatal Abstinence Syndrome

ObjectiveTo critically appraise and synthesize existing studies on the relationship between newborn feeding method and neonatal outcomes related to neonatal abstinence syndrome (NAS).Data SourcesA systematic search of the literature on newborn feeding method in newborns with NAS was conducted with the use of the electronic databases PubMed, CINAHL, Nursing and Allied Health, PyschINFO, Evidence Based Medicine, Web of Science, and MEDLINE (Embase).Study SelectionStudies were eligible for inclusion if the following criteria were met: the authors reported original data on outcomes related to newborn feeding and NAS, the research followed any type of quantitative design that included comparison of breastfed and formula-fed newborns with NAS, and the articles were published in English in peer-reviewed journals from 1990 to February 2018.Data ExtractionTwo authors independently extracted the data from the full-text articles and entered them into a data extraction template developed for the systematic review. The data were synthesized narratively because of the diversity in assessment of newborn feeding methods and outcome measures.Data SynthesisWe identified eight studies in which newborn feeding method and outcomes related to NAS were evaluated in newborns exposed to opioids. The synthesis indicated that for newborns exposed to methadone, breastfeeding was associated with decreased incidence and duration of pharmacologic treatment, shorter hospital length of stay, and decreased severity of NAS. The association between newborn feeding method and NAS among newborns exposed to buprenorphine was unclear.ConclusionBreastfeeding may be effective to mitigate negative outcomes related to NAS among newborns exposed to methadone in utero. Women who are stable on opioid substitution treatment should be provided with appropriate education and support to breastfeed. However, to effectively promote breastfeeding among these mothers, evidence-based strategies are required, and barriers to breastfeeding need to be addressed.     

Breast feeding and early postnatal weight gain in Potsdam

Nutrition and weight gain during the first trimenon of life of 400 babies (200 boys and 200 girls) born in 1975-1977 or 1979-1980 were compared with those of 600 babies (300 boys and 300 girls) born in 1982-1984. The following results were obtained: 1. In 1975-1977 only 10.8%, but in 1979-1980 23.1% and 1982-1984 33.6% of the babies have been breast-fed for more than 6 weeks. 2. In 1975-1977 16% of the babies showed a weight gain of more than 3.0 kg during the first trimenon of life, whereas in 1979-1980 only 8.5% and 1982-1984 only 2.2% displayed such a high weight gain. The average weight gain during the first trimenon was 2.75 +/- 0.55 kg in 1975-1977 and 2.30 +/- 0.61 kg in 1979-1980 and 2.43 +/- 0.35 kg in 1982-1984. 3. The percentage of babies with a weight gain of more than 3 kg during the first trimenon of life was significantly lower in those who were predominantly breast-fed than in those who where predominantly bottle-fed during this period (4.7% versus 9.7%). Hence breast feeding appears to be the best preventive therapy of an early developmental obesity.