Promotion of breastfeeding intervention trial (PROBIT) - A randomized trial in the Republic of Belarus
Promotion of breastfeeding intervention trial (PROBIT) - A randomized trial in the Republic of Belarus
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DOI：
10.1001/jama.285.4.413
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发表时间：
2001-01-24
影响因子：
120.7
通讯作者：
Helsing, E
中科院分区：
文献类型：
--
作者：
Kramer, MS;Chalmers, B;Helsing, E
目前母乳喂养有益于婴儿和儿童健康的证据完全基于观察性研究。这些研究中潜在的偏差来源导致了对工业化国家这些健康益处的程度的怀疑。目的评估母乳喂养促进对母乳喂养持续时间和排他性以及婴儿胃肠道和呼吸道感染和特应性湿疹的影响。设计促进母乳喂养干预试验（PROBIT），1996年6月至1997年12月进行的一项随机分组试验，随访1年。研究对象：白俄罗斯共和国31家妇产医院和综合医院。体重至少2500 g的足月单胎婴儿及其打算母乳喂养的健康母亲，16 491（96.7%）完成了整个12个月的随访。干预研究中心被随机分配接受以婴儿为模型的实验性干预（n=16）。世界卫生组织和联合国儿童基金会的友好医院倡议，该倡议强调卫生保健工作者协助启动和维持母乳喂养和哺乳以及产后母乳喂养支持，或继续常规婴儿喂养做法和政策的控制干预（n = 15）。出生后3个月和6个月时以母乳喂养为主和纯母乳喂养的患病率，出生后前12个月内发生1次或多次胃肠道感染、2次或多次呼吸道感染和特应性湿疹，干预组和对照组之间的比较。结果来自干预地点的婴儿比对照组婴儿更有可能在12个月时进行任何程度的母乳喂养（19.7%对11.4%;调整后的比值比[OR]，0.47; 95%置信区间[CI]，0.32-0.69），在3个月时更可能进行纯母乳喂养（43.3%对6.4%; P
Context Current evidence that breastfeeding is beneficial for infant and child health is based exclusively on observational studies. Potential sources of bias in such studies have led to doubts about the magnitude of these health benefits in industrialized countries.Objective To assess the effects of breastfeeding promotion on breastfeeding duration and exclusivity and gastrointestinal and respiratory infection and atopic eczema among infants.Design The Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial conducted June 1996-December 1997 with a 1-year follow-up.Setting Thirty-one maternity hospitals and polyclinics in the Republic of Belarus.Participants A total of 17046 mother-infant pairs consisting of full-term singleton infants weighing at least 2500 g and their healthy mothers who intended to breastfeed, 16 491 (96.7%) of which completed the entire 12 months of follow-up.Interventions Sites were randomly assigned to receive an experimental intervention (n=16) modeled on the Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children's Fund, which emphasizes health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support, or a control intervention (n = 15) of continuing usual infant feeding practices and policies.Main Outcome Measures Duration of any breastfeeding, prevalence of predominant and exclusive breastfeeding at 3 and 6 months of life and occurrence of 1 or more episodes of gastrointestinal tract infection, 2 or more episodes of respiratory tract infection, and atopic eczema during the first 12 months of life, compared between the intervention and control groups.Results Infants from the intervention sites were significantly more likely than control infants to be breastfed to any degree at 12 months (19.7% vs 11.4%; adjusted odds ratio [OR], 0.47; 95% confidence interval [CI], 0.32-0.69), were more likely to be exclusively breastfed at 3 months (43.3% vs 6.4%; P