Infant feeding in the neonatal unit
Infant feeding in the neonatal unit
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DOI：
10.1111/j.1740-8709.2009.00210.x
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发表时间：
2010-10-01
影响因子：
3.4
通讯作者：
Niven, Catherine
中科院分区：
文献类型：
--
作者：
McInnes, Rhona J.;Shepherd, Ashley J.;Niven, Catherine
住进新生儿病房(NNU)的婴儿往往因为健康不佳或早产而不能用母乳或奶瓶喂养。这些婴儿需要营养支持，直到他们可以开始口服喂养。这些婴儿提倡母乳喂养，并经常鼓励母亲表达母乳，通过肠道管喂养。然而，由于出院，母乳喂养率往往很低。口腔喂养需要仔细的管理，尽管实践可能会因临床需要而有所不同，但有些可能会被单位规范所告知。在这种环境下，有效的母乳喂养支持的证据有限，对常规喂养决定的影响的探索也很少。这项研究旨在探索喂养决定，并考虑这些决定可能如何影响结果。访谈了参与喂养决策的两个大型城市国家营养中心的工作人员，并使用理论框架对数据进行了分析。喂养决定主要是由单位工作人员做出的，父母的参与有限。随后的管理各不相同，差异与工作人员的经验和信念、单位规范、父母的期望和单位内的物质限制有关。工作人员公开支持母乳喂养，但监测和量化牛奶摄入量的需要可能会破坏母乳喂养。此外，在母亲不在的时候喂养母乳喂养的婴儿是有争议的，并引发了争论。有必要制定明确的指导方针，增加父母对喂养决定的参与。该系统内的常规做法可能会阻碍母亲开始并坚持母乳喂养。需要改变单位文化，以完全支持父母的喂养选择。
Infants admitted to a neonatal unit (NNU) are frequently unable to feed by breast or bottle because of ill health or prematurity. These infants require nutritional support until they can start oral feeding. Breastfeeding is advocated for these infants, and mothers are frequently encouraged to express breast milk to be fed via the enteral tube. However, by discharge, breastfeeding rates tend to be low. Oral feeding requires careful management, and although practices may vary because of clinical need, some may be informed by unit norms. There is limited evidence for effective breastfeeding support in this environment and little exploration of the effect of routine feeding decisions. This study aimed to explore feeding decisions and considered how these might affect outcomes. The staff in the two large urban NNUs who participated in the feeding decisions were interviewed and the data were analysed using a theoretical framework. Feeding decisions were made mainly by the unit staff, with limited parental involvement. Subsequent management varied, with differences being related to staff experience and beliefs, unit norms, parent's expectations and physical constraints within the unit. The staff were overtly supportive of breastfeeding, but the need to monitor and quantify milk intake may undermine breastfeeding. Furthermore, feeding breastfed infants during the mothers' absence was controversial and provoked debate. There is a need for clear guidelines and increased parental involvement in feeding decisions. Routine practices within the system may discourage mothers from initiating and persisting with breastfeeding. A change in unit culture is required to fully support the parent's feeding choices.