BREASTFEEDING SERVICES FOR LBW INFANTS OUTCOMES AND COST

描述：（改编自申请人摘要）人乳提供 对低出生体重（LBW <2500 g）婴儿的特殊健康益处。 虽然增加母乳喂养的频率和持续时间是一个 国家优先事项，只有35%的分娩低出生体重婴儿的母亲 母乳喂养，其中，不到50%的人在超过 婴儿出院这些较低的母乳喂养率， LBW婴儿的母亲可以解释为， 母乳喂养的LBW婴儿会遇到许多独特的问题。 虽然提供母乳喂养支持服务的模式已经 如前所述，这些服务面向健康足月婴儿的母亲， 不足以满足低出生体重母亲的特殊需要 婴儿。只有一种基于研究的模式， 为母亲及早产儿/高危婴儿提供母乳喂哺支援服务 在文献中已经描述过;没有提供后- 为体重不足婴儿的母亲提供的出院母乳喂哺服务， 介绍了LBW婴儿的母亲需要一致的，全面的 母乳喂养服务由熟练掌握这两方面技能的个人提供 低出生体重婴儿的护理和哺乳管理。围产儿 高级实践护士（PAPN）是满足这一要求的理想专业人员。 保健需要。该计划将提供母乳喂养服务（产前）。 和婴儿出院后），这是专门针对母亲和低出生体重婴儿， 包括技能评估、技术援助、教育， 支持.这项随机临床试验的目的是比较 两组之间的孕产妇结局、婴儿结局和护理费用 母乳喂养LBW婴儿的妇女;对照组接受 常规母乳喂养护理和干预组接受 由PAPNs提供的母乳喂养服务的结构化方案。的 研究将测试以下假设：一个结构化的程序， 与常规护理相比， 母乳喂养将导致：1）改善产妇的结果：更多 频繁和早期过渡到乳房;增加乳汁量; 增加母乳喂养的时间; 母乳喂养目标;减少焦虑和抑郁， 对护理的满意度; 2）改善婴儿结局：减少急性护理 访问和再住院;以及改善精神和运动发育; 3)降低护理成本：降低每例受试者的总成本， 平均再住院费用降低。此外，该研究将 研究两组之间的生长差异， 改善母婴结局和PAPN使用的干预措施。两 婴儿出院后，将对各组进行为期1年的随访。数据分析 将包括MANOVA，卡方和t检验。数据将是重要的， 消费者、研究人员、供应商、保险公司和政策制定者。

DESCRIPTION: (Adapted from applicant abstract) Human milk affords specific health benefits for low birth weight (LBW < 2500g) infants. While increasing the frequency and duration of breastfeeding is a national priority, only 35% of mothers who deliver LBW infants initiate breastfeeding and of these, less than 50% sustain breastfeeding beyond infant hospital discharge. These lower breastfeeding rates among mothers of LBW infants can be explained by the fact that these women experience numerous problems that are unique to breastfed LBW infants. Although models for providing breastfeeding support services have been described, these services are geared to mothers of healthy term infants and are inadequate for meeting the unique needs of mothers of LBW infants. Only one research-based model for providing in-hospital breastfeeding support services for mothers and preterm/high risk infants has been described in the literature; no models for providing post- discharge breastfeeding services for mothers of LBW infants have been described. Mothers of LBW infants need consistent, comprehensive breastfeeding services provided by individuals who are skilled in both the care of LBW infants and management of lactation. The Perinatal Advanced Practice Nurse (PAPN) is the ideal professional to meet this health care need. The PAPN would provide breastfeeding services (pre- and post-infant discharge) that are specific to mothers and LBW infants, including skilled assessment, technical assistance, education, and support. The purpose of this randomized clinical trial is to compare maternal outcomes, infant outcomes and cost of care between two groups of women who breastfeed their LBW infants; a control group receiving routine breastfeeding care and an intervention group receiving a structured program of breastfeeding services provided by PAPNs. The study will test the following hypotheses: A structured program of breastfeeding services provided by PAPNs compared to routine care for breastfeeding will result in: 1) Improved maternal outcomes: more frequent and earlier transition to breast; increased milk volume; increased duration of breastfeeding; and greater attainment of breastfeeding goals; decreased anxiety and depression and greater satisfaction with care; 2) Improved infant outcomes: fewer acute care visits and rehospitalizations; and improved mental and motor development; 3) Decreased cost of care: decreased total costs per subject and decreased average rehospitalization cost. Additionally, the study will examine differences in growth between the two groups, predictors of improved maternal/infant outcomes and interventions used by PAPNs. Both groups will be followed for 1 year post infant discharge. Data analysis will include MANOVA, chi-square and t-tests. Data will be important to consumers, researchers, providers, insurers, and policy makers.