促进极低出生体重婴儿母乳喂养的质量改进计划

Q4 Medicine

中华围产医学杂志 Pub Date : 2019-09-16 DOI:10.3760/CMA.J.ISSN.1007-9408.2019.09.007

Hong-Fei Zhu

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引用次数: 0

摘要

目的分析质量改进计划对极低出生体重儿（VLBWI）母乳喂养和改善临床效果的有效性。方法回顾性选择2016年2月至2017年1月质量改进计划实施前入住绍兴市妇幼医院新生儿重症监护室的VLBWI为对照组（n=84），2017年8月至2018年7月实施后入住的VLBWI为干预组（n=75）。主要结果包括生母的母乳喂养率和实现全肠内喂养的持续时间，次要结果包括外周插入中心静脉导管（PICC）和肠外营养的持续时间、PICC相关感染、住院期间的平均体重增长率、，比较两组患者的早产相关并发症和死亡率。采用两个独立样本t检验、秩和检验和卡方检验或Fisher精确检验作为统计方法。结果与对照组相比，干预组母乳喂养率显著提高[82.7%（62/75）vs 36.9%（31/84），χ2=34.183，P<0.001]，全肠内喂养时间缩短[M（P25-P75）:13（10-16）vs 17（14-23）d，Z=-4.542，P<0.001]，实施质量改进计划后，PICC留置时间和肠外营养持续时间均显著缩短[M（P25-P75）:10（7-13）vs 14（11-20）d，12（9-15）vs 16（13-22）d，Z=-4.902和-4.677；均P<0.001]，但其他次要结果均无统计学差异。结论质量改进计划是一种切实可行的方法，可以有效提高VLBWI的母乳喂养率，缩短全肠内喂养所需的时间。关键词：母乳喂养；婴儿，出生体重很低；质量改进

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A quality improvement program to facilitate breastfeeding for very low birth weight infants

Objective To analyze the effectiveness of a quality improvement program for facilitating breastfeeding and improving clinical outcomes for very low birth weight infants (VLBWI). Methods VLBWI admitted to the Neonatal Intensive Care Unit of Shaoxing Women and Children's Hospital before the implementation of the quality improvement program from February 2016 to January 2017 were retrospectively selected as control group (n=84), while those admitted after the implementation from August 2017 to July 2018 were enrolled as intervention group (n=75). Primary outcomes included breastfeeding rates by biological mothers and duration of achieving full enteral feeding and the secondary outcomes included duration of peripherally inserted central venous catheters (PICC) and parenteral nutrition, PICC associated infections, average body weight growth rates during hospitalization, preterm-associated complications and mortality between the two groups were compared. Two independent sample t test, rank-sum test and Chi-square test or Fisher's exact test were used as statistical methods. Results Compared with the control group, the intervention group had significantly increased breastfeeding rate [82.7% (62/75) vs 36.9% (31/84), χ2=34.183, P<0.001] and a shorter time to achieve full enteral feeding [M(P25-P75): 13(10-16) vs 17(14-23) d, Z=-4.542, P<0.001]. Moreover, the PICC indwelling time and parenteral nutrition duration were both significantly shortened after the implementation of quality improvement program [M(P25-P75): 10(7-13) vs 14(11-20) d, 12(9-15) vs 16(13-22) d, Z=-4.902 and -4.677; both P<0.001], but no statistical differences were found in any other secondary outcomes. Conclusions The quality improvement program is a feasible and practical approach to effectively improve breastfeeding rates in VLBWI and shorten the time required to achieve full enteral feeding. Key words: Breast feeding; Infant, very low birth weight; Quality improvement

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来源期刊

中华围产医学杂志 Medicine-Obstetrics and Gynecology

CiteScore

0.70

自引率

0.00%

发文量

4446

期刊介绍： Chinese Journal of Perinatal Medicine was founded in May 1998. It is one of the journals of the Chinese Medical Association, which is supervised by the China Association for Science and Technology, sponsored by the Chinese Medical Association, and hosted by Peking University First Hospital. Perinatal medicine is a new discipline jointly studied by obstetrics and neonatology. The purpose of this journal is to "prenatal and postnatal care, improve the quality of the newborn population, and ensure the safety and health of mothers and infants". It reflects the new theories, new technologies, and new progress in perinatal medicine in related disciplines such as basic, clinical and preventive medicine, genetics, and sociology. It aims to provide a window and platform for academic exchanges, information transmission, and understanding of the development trends of domestic and foreign perinatal medicine for the majority of perinatal medicine workers in my country.