Breastfeeding the Late Preterm Infant: A Grounded Theory Study

描述(由申请人提供)：晚产早产儿(孕34-37周)是美国增长最快、规模最大的早产儿群体。尽管外表相似，但晚产早产儿缺乏足月早产儿的发育成熟度，这使他们容易受到独特的、通常未被认识到的医疗脆弱性和随之而来的高发病率。一 从这些数据中浮现出惊人的矛盾之处在于，接受母乳喂养的晚期早产儿往往比那些没有母乳喂养的早产儿出现发育迟缓、黄疸和脱水的比率要高得多，这一发现在很大程度上归因于母乳摄入量不足。因此，尽管母乳喂养提供了许多无可辩驳的长期和短期健康益处，特别是对早产婴儿，但很难建议将母乳喂养作为最佳喂养方法，并鼓励在早产儿中更广泛地采用母乳喂养。虽然早产晚期母乳喂养并发症通常被追溯到与婴儿有关的问题，但母乳喂养是一项涉及婴儿和母亲的复杂、对等的活动。因此，了解导致母乳喂养成功和母乳喂养失败的过程变得至关重要，这些过程是由于早产晚期人口中母乳摄入不足造成的。因此，这项定性的、扎根的理论研究的主要目的是描述和解释早产晚期母婴之间母乳喂养的开始和继续的过程。次要目标是，1)将母乳喂养放在哺育晚早产儿的更广泛的背景下；2)确定影响晚早产母亲决定开始和继续母乳喂养的因素。主要基于Strauss和Corbin提出的扎根理论技术，本研究将利用产后连续半结构化访谈、观察性实地笔记和二次数据收集方法(例如，自我录音、视频回顾/反思)，对大约10-18名早产儿母亲进行实质性理论的发展。将采用理论抽样、记忆和利用恒定比较法的系统编码。这项建议满足了NINR的两个目标：1)确定和改善早产的长期后果，包括近期婴儿的并发症；2)确定对决策的影响，导致行为变化，促进健康，预防疾病和残疾。这项研究的结果有望为未来缩小或消除早产晚期人群母乳喂养健康差距的研究工作提供基础。此外，这项研究将有助于目前关于晚早产儿，特别是这一群体中母乳喂养的知识基础的不发达。

DESCRIPTION (provided by applicant): Late preterm infants (34-37 weeks gestation) account for the fastest growing, largest cohort of preterm births in the U.S. Despite comparable outward appearances, late preterm infants lack the developmental maturity of their term counterparts, predisposing them to unique, often unrecognized medical vulnerabilities and a concomitant high incidence of morbidity. One striking paradox emergent from these data is that late preterm infants who are breastfed tend to present with diagnoses of failure to thrive, jaundice, and dehydration at much higher rates than those who are not breastfed, a finding largely attributed to insufficient breast milk intake. Consequently, it is difficult to recommend breastfeeding as the optimal method of feeding and encourage its more widespread uptake among the late preterm population, despite the many, irrefutable long- and short-term health benefits that breastfeeding provides, particularly for infants born prematurely. While late preterm breastfeeding complications are often traced to infant-related issues, breastfeeding is a complex, reciprocal activity involving both infant and mother. It has become crucial, therefore, to understand the processes leading to both breastfeeding success and breastfeeding failure stemming from insufficient breast milk intake within the late preterm population. Accordingly, the primary aim of this qualitative, grounded theory study is to describe and explain the process of breastfeeding initiation and continuation among late preterm mother-infant dyads. Secondary aims are, 1) to place breastfeeding within the broader context of mothering a late preterm infant; and 2) to identify factors influencing the late preterm mother's decision to initiate and continue breastfeeding. Based mainly on the grounded theory techniques proposed by Strauss & Corbin, the study will utilize serial postpartum semi-structured interviews, observational field-notes, and secondary data collection methods (e.g., self-audio recordings, video review/reflection) for an estimated 10-18 mothers of late preterm infants in the development of a substantive theory. Theoretical sampling, memoing, and systematic coding utilizing the constant comparative method will be employed. This proposal satisfies two NINR objectives: 1) to identify and ameliorate the long-term consequences of prematurity, including complications of near-term infants; and 2) identify influences on decision-making that result in behavioral changes that promote health and prevent disease and disability. Results from this study are expected to provide a foundation for future research efforts seeking to narrow or eliminate breastfeeding health disparities for the late preterm populace. Additionally, this study will contribute to the currently underdeveloped knowledgebase surrounding late prematurity in general, and breastfeeding within this group, in particular.