BREASTFEEDING SERVICES FOR LBW INFANTS OUTCOMES AND COST

描述：(改编自申请者摘要)母乳提供 低出生体重(LBW&lt；2500克)婴儿的具体健康益处。 增加母乳喂养的频率和持续时间是一种 国家重点，只有35%的分娩LBW婴儿的母亲 母乳喂养，在这些人中，只有不到50%的人继续母乳喂养 婴儿住院出院。这些较低的母乳喂养率 LBW婴儿的母亲可以解释为这些妇女 体验许多母乳喂养的LBW婴儿所特有的问题。 尽管提供母乳喂养支持服务的模式已经 据介绍，这些服务面向健康足月婴儿的母亲。 不足以满足LBW母亲的独特需求 婴儿。只有一种以研究为基础的住院模式 为母亲和早产/高危婴儿提供母乳喂养支持服务 已经在文献中进行了描述；没有提供后处理的模型 为低出生体重婴儿的母亲提供的出院母乳喂养服务 描述。LBW婴儿的母亲需要一致的、全面的 母乳喂养服务由精通这两项技能的个人提供 低出生体重儿的护理和哺乳期的管理。围产期 高级执业护士(PAPN)是满足这一要求的理想专业人员 医疗保健需求。PAPN将提供母乳喂养服务(预科 和婴儿后排泄)是母亲和LBW婴儿特有的， 包括技能评估、技术援助、教育和 支持。这项随机临床试验的目的是比较 两组产妇结局、婴儿结局和护理费用 母乳喂养她们的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PAPN提供的母乳喂养服务的结构化方案。这个 研究将检验以下假设：一个结构化的计划 PAPN提供的母乳喂养服务与常规护理的比较 母乳喂养将导致：1)改善产妇结局：更多 频繁和更早地过渡到乳房；乳量增加； 延长母乳喂养的持续时间；更好地实现 母乳喂养目标；减少焦虑和抑郁，以及更大的 护理满意度；2)改善婴儿结局：减少急性护理 探视和再住院；改善精神和运动发育； 3)降低护理成本：降低每个受试者的总成本 降低了平均再住院费用。此外，这项研究将 检查两组之间的增长差异，预测 改善孕产妇/婴儿结局，并利用初级卫生行动网络进行干预。两者都有 两组将在婴儿出院后进行为期一年的跟踪。资料分析 将包括马诺瓦检验、卡方检验和t检验。数据将是重要的 消费者、研究人员、提供商、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.