EENC技术对自然分娩产妇泌乳启动及新生儿行为状态的影响

doi:10.3760/cma.j.cn441417-20240709-01033

摘要/Abstract

摘要：

目的　研究新生儿早期基本保健（EENC）技术对顺产产妇泌乳启动、母乳喂养及新生儿早期行为状态的影响。方法　采用前瞻性双盲试验，选取2023年1月至10月在西安市人民医院经阴道分娩的800对新生儿与初产妇作为研究对象，采用软件SPSS 24.0对所有入选者随机编码并分为两组，每组400对。观察组产妇年龄（27.4±5.1）岁，孕周（39.1±1.5）周；新生儿男267例，女133例，体重（3 268.2±363.7）g，1 min Apgar评分为（9.1±0.8）分，给予EENC技术。对照组产妇年龄（26.9±4.8）岁，孕周（39.0±1.9）周；新生儿男249例，女151例，体重（3 287.4±357.2）g，1 min Apgar评分为（9.2±0.8）分，给予传统新生儿保健。比较两组泌乳启动率、首次母乳喂养成功率、不良事件发生率、泌乳启动时间、首次母乳喂养测量工具（BAT）得分、动脉血氧饱和度（SaO₂）及新生儿神经行为测定量表（NBNA）评分。采用χ²检验、t检验进行统计分析。结果　观察组产妇泌乳启动时间、首次BAT得分、首次母乳喂养持续时间均优于对照组［（1.9±0.4）d比（2.3±0.5）d、（10.7±1.1）分比（10.3±1.0）分、（31.6±6.3）min比（25.9±7.7）min］，差异均有统计学意义（t=-12.494、5.381、11.459，均P<0.05）；泌乳启动率和首次母乳喂养成功率均高于对照组［95.8%（383/400）比89.8%（359/400）、93.5%（374/400）比89.0%（356/400）］，差异均有统计学意义（χ²=10.707、5.072，均P<0.05）。观察组产后24、48、72 h纯母乳喂养率均高于对照组（χ²=8.852、6.199、5.126，均P<0.05）。观察组新生儿出生后1、2、4 h体温均高于对照组，出生后24、48、72 h SaO₂水平均高于对照组，差异均有统计学意义（t=13.868、12.804、10.243、32.555、47.361、47.456，均P<0.05）。观察组新生儿1月龄时各维度NBNA评分均高于对照组（均P<0.05）。观察组新生儿住院时间、低体温和高胆红素血症发生率均低于对照组［（3.2±0.3）d比（3.4±0.5）d、0.8%（3/400）比2.8%（11/400）、1.0%（4/400）比4.3%（17/400）］，差异均有统计学意义（t=6.860，χ²=4.653、8.265，均P<0.05）。结论　EENC技术可加快顺产产妇泌乳启动，提高早期纯母乳喂养率，促使体温、SaO₂水平维持在平稳状态，对新生儿神经行为发育和降低不良事件发生率具有积极作用，值得临床推广。

关键词:

泌乳启动, 母乳喂养, 新生儿早期基本保健, 行为状态, 产妇

Abstract:

Objective　To study the effects of early essential newborn care (EENC) technique on the initiation of lactation, breastfeeding, and early behavioral status of newborns. Methods　A total of 800 pairs of newborns and primiparas who delivered vaginally in Xi'an People's Hospital from January 2023 to October 2023 were selected as the research objects and were randomly divided into two groups by SPSS 24.0 software, with 400 pairs in each group. In the control group, the maternal age was (27.4±5.1) years old, and the gestational age was (39.1±1.5) weeks; there were 267 boys and 133 girls, with a body weight of (3 268.2±363.7) g and a 1-minute Apgar score of (9.1±0.8) points. In the control group, the maternal age was (26.9±4.8) years old, and the gestational age was (39.0±1.9) weeks; there were 249 boys and 151 girls, with a body weight of (3 287.4±357.2) g and a 1-minute Apgar score of (9.2±0.8) points. The observation group was given EENC technique, and the control group was given traditional neonatal health care. The lactation initiation rate, first breastfeeding success rate, adverse event incidence, lactation initiation time, Bristol Breastfeeding Assessment Tool (BAT) score, arterial oxygen saturation (SaO₂), and Neonatal Behavioral Neurological Assessment (NBNA) score were compared between the two groups. χ² test and t test were used for statistical analysis. Results　The lactation initiation time, the first BAT score, and the duration of first breastfeeding in the observation group were all better than those in the control group [(1.9±0.4) d vs. (2.3±0.5) d, (10.7±1.1) points vs. (10.3±1.0) points, (31.6±6.3) min vs. (25.9±7.7) min], with statistically significant differences (t=-12.494, 5.381, and 11.459, all P<0.05). The lactation initiation rate and the success rate of first breastfeeding in the observation group were higher than those in the control group [95.8% (383/400) vs. 89.8% (359/400), 93.5% (374/400) vs. 89.0% (356/400)], with statistically significant differences (χ²=10.707 and 5.072, both P<0.05). The rates of exclusive breastfeeding at postpartum 24, 48, and 72 h in the observation group were higher than those in the control group (χ²=8.852, 6.199, and 5.126, all P<0.05). The body temperature of newborns in the observation group was higher than that in the control group at 1, 2, and 4 h after birth, and the SaO₂ level was higher than that in the control group at 24, 48, and 72 h after birth, with statistically significant differences (t=13.868, 12.804, 10.243, 32.555, 47.361, and 47.456, all P<0.05). The NBNA scores of newborns in the observation group were higher than those in the control group at 1 month of age (all P<0.05). The neonatal hospitalization time and incidences of hypothermia and hyperbilirubinemia in the observation group were lower than those in the control group [(3.2±0.3) d vs. (3.4±0.5) d, 0.8% (3/400) vs. 2.8% (11/400), 1.0% (4/400) vs. 4.3% (17/400)], with statistically significant differences (t=6.860, χ²=4.653 and 8.265, all P<0.05). Conclusion　EENC technique can accelerate the initiation of lactation in partopregnants, increase the rate of early exclusive breastfeeding, and maintain the levels of body temperature and SaO₂ in a stable state, which has positive effects on neonatal neurobehavioral development and reduce the incidence of adverse events, and is worthy of clinical promotion.

Key words:

Initiation of lactation, , Breastfeeding, , Early essential newborn care, , Behavior state, Parturients

吕海荣任毓张青唐乐暴蕾.

EENC技术对自然分娩产妇泌乳启动及新生儿行为状态的影响 [J]. 国际医药卫生导报, 2025, 31(1): 154-158.

Lyu Hairong, Ren Yu, Zhang Qing, Tang Le, Bao Lei.

Influences of EENC technique on the initiation of lactation in parturient women and the behavioral status of newborns [J]. International Medicine and Health Guidance News, 2025, 31(1): 154-158.

参考文献

[1] 何惠言,胡丽玲,邓丽娟. 品管圈活动在提高产后1 h母乳喂养自我效能中的应用效果[J]. 国际医药卫生导报,2020,26(16):2449-2452. DOI:10.3760/cma.j.issn.1007-1245.2020.16.037.
[2] Obara H, Sobel H. Quality maternal and newborn care to ensure a healthy start for every newborn in the World Health Organization Western Pacific Region[J]. BJOG, 2014,121 Suppl 4:154-159. DOI: 10.1111/1471-0528.12943.
[3] 徐韬. 新生儿早期基本保健:终结可预防新生儿死亡的优先干预措施[J]. 中华预防医学杂志,2020,54(5):498-502. DOI:10.3760/cma.j.cn1112150-20190614-00477.
[4] 莫小慧,罗琳雪. 新生儿早期基本保健技术应用的研究现状[J]. 广西医学,2021,43(9):1133-1136. DOI:10.11675/j.issn.0253-4304.2021.09.22.
[5] Singhala K, Mills AC, Wong-Anuchit C. Bristol breastfeeding assessment tool-Thai version: translation, validity, and reliability[J]. J Hum Lact, 2022,38(2):227-235.DOI: 10.1177/08903344221079348.
[6] 张晓丽,刘彦超,夏磊,等. NBNA评分联合磁共振弥散张量成像在早产儿脑白质发育评价中的作用及相关性分析[J]. 中国当代儿科杂志,2021,23(9):916-921. DOI:10.7499/j.issn.1008-8830.2106005.
[7] Neves PAR, Vaz JS, Ricardo LIC,et al. Disparities in early initiation of breast feeding and prelacteal feeding: a study of low- and middle-income countries[J]. Paediatr Perinat Epidemiol, 2022 ,36(5):741-749.DOI: 10.1111/ppe.12871.
[8] McAllister J, Wexelblatt S, Ward L. Controversies and conundrums in newborn feeding[J]. Clin Perinatol, 2023,50(3):729-742. DOI: 10.1016/j.clp.2023.04.003.
[9] 中华预防医学会儿童保健分会. 新生儿保健专科建设专家共识[J]. 中国妇幼健康研究,2023,34(2):1-5. DOI:10.3969/j.issn.1673-5293.2023.02.001.
[10] 张亚南,李亚丽. 孕期营养与体质量管理在孕产妇保健中的效果及对新生儿妊娠结局的影响[J]. 国际医药卫生导报,2023,29(8):1175-1179. DOI:10.3760/cma.j.issn.1007- 1245.2023.08.033.
[11] 孙菲,刘敏,胡珊珊,等. 产妇泌乳建立影响因素及干预的研究进展[J]. 中国护理管理,2023,23(6):946-950. DOI:10.3969/j.issn.1672-1756.2023.06.028.
[12] Huang C, Hu L, Wang Y,et al. Effectiveness of early essential newborn care on breastfeeding and maternal outcomes: a nonrandomized controlled study[J]. BMC Pregnancy Childbirth, 2022,22(1):707. DOI: 10.1186/s12884-022-05037-8.
[13] Li Z, Mannava P, Murray JCS,et al. Association between early essential newborn care and breastfeeding outcomes in eight countries in Asia and the Pacific: a cross-sectional observational -study[J]. BMJ Glob Health, 2020,5(8):e002581.DOI: 10.1136/bmjgh-2020-002581.
[14] 梁英福,黄芳,梁春燕. 新生儿早期基本保健技术应用研究进展[J]. 中国临床新医学,2022,15(9):883-886. DOI:10.3969/j.issn.1674-3806.2022.09.23.
[15] 刘军,程欢,翟立红,等. 不同皮肤接触时间对剖宫产新生儿早期母乳喂养行为的影响[J]. 护理学杂志,2023,38(3):36-39. DOI:10.3870/j.issn.1001-4152.2023.03.036.
[16] Wang X, Zhang X, Sobel HL,et al. Early essential newborn care for cesarean section newborns in China: study protocol for a multi-centered randomized controlled trial[J]. Trials, 2022,23(1):696. DOI: 10.1186/s13063-022- 06615-z.
[17] Wang C, Lin Y, Zhang H,et al. Effectiveness of early essential newborn care implementation in four counties of western China[J]. BMC Health Serv Res, 2022,22(1):1185.DOI: 10.1186/s12913-022-08570-6.
[18] 李夏芸,张琳,巫琳漫,等. 新生儿早期基本保健技术促进母乳喂养的干预研究[J]. 中国妇幼卫生杂志,2020,11(5):10-15. DOI:10.19757/j.cnki.issn1674-7763.2020.05.003.
[19] Kolnik SE, Billimoria ZC. A guide to feeding term and preterm newborns[J]. Pediatr Ann, 2020,49(2):e71-e76. DOI: 10.3928/19382359-20200123-01.
[20] Miao Y, Zhao S, Liu W,et al. Prevalence and risk factors of delayed onset lactogenesis II in China: a systematic review and meta-analysis[J]. J Matern Fetal Neonatal Med, 2023,36(1):2214833.DOI: 10.1080/14767058.2023. 2214833.
[21] Zhu J, Xie Y, Wang B,et al. Epidemiological investigation on the current practice of umbilical cord clamping in China[J]. Am J Perinatol, 2022 ,39(9):1015-1019.DOI: 10.1055/s-0040-1721494.
[22] 孙彩霞,王晓燕,李胜玲,等. 新生儿早期基本保健对早产儿6个月内生长发育的影响[J]. 护理实践与研究,2022,19(16):2407-2411. DOI:10.3969/j.issn.1672-9676.2022. 16.007.
[23] 魏小燕,何婧. 袋鼠式护理对新生儿神经行为、体格发育及母乳喂养的影响[J]. 实用医院临床杂志,2020,17(3):192-195. DOI:10.3969/j.issn.1672-6170.2020.03.056.
[24] Wang Y, Zhao T, Zhang Y,et al. Positive effects of kangaroo mother care on long-term breastfeeding rates, growth, and neurodevelopment in preterm infants[J]. Breastfeed Med, 2021 ,16(4):282-291.DOI: 10.1089/bfm.2020.0358.
[25] Garg BD, Bansal A, Kabra NS. Role of kangaroo mother care in the management of neonatal hyperbilirubinemia in both term and preterm neonates: a systematic review[J]. J Perinat Educ, 2020,29(3):123-133. DOI: 10.1891/J-PE-D-18-00043.
[26] 袁玲,周临,袁莉,等. 新生儿早期基本保健对初产妇泌乳启动时间新生儿体温和体质量变化及并发症发生率的影响[J]. 中国妇幼保健,2022,37(16):2973-2976. DOI:10.19829/j.zgfybj.issn.1001-4411.2022.16.019.