哺乳知识ABC

如何调整喂奶时间与次数 新生儿吸乳能力弱,胃容量小,胃呈水平位,一次吸进的奶量很少,所以新生儿不需要规定喂奶时间与次数。应根据婴儿的需要哺乳,即以婴儿的饥饿啼哭为准。一般来说,1个月内的新生儿每天喂奶8次以上,满月后每天喂奶6～7次,到4个月时减为每天5～6次,且逐渐训练白天次数多于晚间次数。哺乳的时间每次应为15～20分钟,两乳依次喂哺。在哺乳之前婴儿稍有啼哭并无妨碍,且能帮助肺部扩张;但过于烦躁不安的婴儿应提前喂哺。 乳汁的排空 新生儿最渴望的是在母亲温暖的怀抱望,吃到母亲香甜的乳汁。饥饿的婴儿每隔     

产后5天母乳不足24例临床分析

目的 分析产后母乳不足的原因，以期找到解决母乳不足的办法。方法 通过随机抽查我院2005年6月～2005年11月实行母乳喂养并住院天数满产后5d的产妇200例，对其中乳量不足24例进行调查分析。结果 母乳不足占母乳喂养的12％：原因依次为：喂奶次数过少、婴儿吸吮姿势不正确、吸吮时间过短、不适当地加辅食、母亲乳房发育不良、母亲营养不良、母亲情绪低落和婴儿舌系带过短。结论 母乳不足与喂奶次数过少、婴儿吸吮姿势不正确有很大的关系，只要加强母乳喂养的宣传教育，多给予正确指导，母乳不足大部分是可以避免的。     

婴儿一日摄入母乳量的测定——24、48和72小时称奶量结果的相关分析

<正> 为研究婴儿营养,了解母乳喂养婴儿营养素摄入情况,需测出婴儿一日摄入的母乳量。目前常用的测量方法是称重法,即称量每次婴儿吃奶前后体重,两次结果之差表示为婴儿摄入的母乳量。此法的优点是简单可行,易于操作,缺点是给母亲喂奶带来麻烦,影响母亲哺乳。一般认为称量的时间长些则可能反映婴儿摄入奶量的实际情况,但限于人力,时间等因     

婴儿喂养形式与产后恢复月经分析

为研究哺乳与哺乳性闭经时间的关系,本文对541对二胎母婴自分娩后7天内至母亲恢复正常月经期间婴儿喂养及相关情况进行了随访研究。结果显示,喂奶次数和时间随产后时间变化不大。产后半年内,婴儿摄食90％以上为母乳,至婴儿一岁,母乳含量仍约70％。开始添加辅食的平均时间为产后153天。产后2周全母乳喂养率为73.4％,产后3月、6月分别约为60％和40％。产后一年半,仍有近80%的母亲部分母乳哺喂孩子。产后61,89,187和369天,母亲恢复月经累计概率分别为0.0150,0.0395,0.2345和0.6820。哺乳性闭经时间平均为282天。结果说明:全母乳喂养和以母乳为主的喂养时间较长和添加辅食较晚的母亲闭经时间较长。产后首次月经的出现是应采用避孕措施的信号。     

部分农村地区婴儿辅食添加状况调查

[目的] 了解目前农村婴儿辅食添加的状况及其影响因素。[方法] 选择内蒙古、四川、陕西三省，用分层整群抽样的方法抽取611名有4-12个月婴儿的母亲，于2001年8-10月对其进行辅食添加知识和行为的问卷调查。[结果] ①婴儿平均开始添加辅食的月龄为5．6个月左右；4个月时添加1种及以上辅食的占27．3％；6个月时6种辅食全部添加的为20．5％。⑦淀粉、水果、蔬菜、鸡蛋每天添加1次及以上的占65．0％以上，而鱼／肉和豆制品每天添加1次及以上的占39．4％和42．0％。③婴儿7个月时仍末添加辅食的主要原因是婴儿不吃、母亲认为没必要或认为对这个年龄的婴儿不适宜。④71．0％的母亲接受过辅食添加的教育。其中，主要途径为媒体者占46.5％，广告小册子占40．3％，家属、邻居和朋友占24．4％，而医务人员和保健人员占23．3％。⑤影响辅食添加的因素主要为家庭年人均收入、产后恢复工作、产后工作时间、产时及孕期母乳喂养健康教育、母亲喂养知识水平、辅食添加知识来源及婴儿是否在4个月以内开始喂奶制品等。[结论] 农村婴儿辅食添加时间晚、品种少、次数少，农村妇女辅食添加知识贫乏，应加强辅食添加知识的健康教育，宣传母乳及辅食的优点，减少母乳代用品的滥用。     

院外坚持母乳喂养行为多因素分析

我们在广州市2所爱婴医院追踪调查221例4个月婴儿的母乳喂养情况,结暴发现:产妇出院后母乳喂养率呈逐月下降趋势。本文在单因素分析的基础上,采用多元回归分析的方法,筛选出影响母乳喂养持续行为的5个因素,根据标准偏回归系数绝对值大小,各影响因素强度依次为:母乳量,母乳喂养咨询门诊,母亲患病,家庭经济收入及对“母乳喂养完全能满足4个月婴儿全部营养而不必给婴儿添加任何辅食”的看法。     

母乳中生物活性成分胃生长素、脂联素、瘦素水平及喂养方式与母乳喂养婴儿超重的关系

目的探讨母乳中生物活性成分胃生长素、脂联素、瘦素水平及喂养方式与母乳喂养婴儿超重的关系,旨在为儿童肥胖的早期干预提供依据。方法选取2016年1月-2017年1月在德阳市人民医院门诊进行正常体检的3个月龄超重的婴儿120例作为超重组,另选取同期在该院进行正常体检的3个月龄内体质量正常的婴儿120例作为对照组,所有婴儿均为母乳喂养。收集两组产妇母乳,检测两组母乳中生物活性成分胃生长素、脂联素、瘦素水平,并发放喂养方式调查问卷,分析其与母乳喂养婴儿超重的关系。结果超重组出生后1个月、2个月、3个月母乳中胃生长素水平均明显高于对照组,差异有统计学意义(P0. 05)。两组母乳瘦素及脂联素水平比较,差异无统计学意义(P0. 05)。超重组出生后2个月、3个月喂奶次数明显高于对照组,差异有统计学意义(P0. 05);超重组出生后2个月、3个月喂奶间隔低于对照组,差异有统计学意义(P0. 05)。相关性分析结果显示,母乳胃生长素水平与喂奶次数呈正相关关系(r=0. 171,P0. 05),与喂奶间隔时间呈负相关关系(r=-0. 184,P0. 05)。结论婴儿食欲受母乳胃生长素水平影响,随其增高而增进,是婴儿出生后早期体质量增长过快的一个重要原因。     

影响母乳喂养因素探讨

目的：了解广州市母乳喂养的影响因素,方法：对广州市160名4－24个月婴幼儿进行母乳喂养的问卷调查。结果：纯母乳喂养率为50．63％,混合喂养率为43．75％,人工喂养率为5．62％,Logistic多变量分析影响母乳喂养的主要因素为母乳量不足,母亲产前对母乳喂养的信心不足及产假休息时间短（OR值分别为32．62,4．58和8．65,P值均＜0．05）,相关分析得母乳量与母亲产前对母乳喂养的信心足,产后首次吸吮前有奶胀感,产后开奶时间早和产后母婴同室时间早间存在存在正相关,产后首次吸吮前有奶胀感与母亲产前对母乳喂养的信心足,产后母婴同室时间早间存在正相关,产后开奶时间早与产后母婴同室时间早间存在正相关,结论：母乳量不足是影响母乳喂养的主要因素。     

母乳胃生长素、脂联素、瘦素水平与婴儿超重的关系

目的探讨母乳胃生长素、脂联素、瘦素水平及喂养方式与母乳喂养婴儿超重的关系。方法选取门诊正常查体3个月龄以内超重婴儿96例为超重组,正常体质量婴儿100例为对照组,均为母乳喂养;收集1个月、2个月、3个月母乳,检测母乳激素水平,发放喂养行为调查问卷。结果生后1个月、2个月、3个月超重组母乳胃生长素水平分别为279.26 ng/L、442.79 ng/L、498.75 ng/L均高于对照组218.44 ng/L、380.38 ng/L、458.27 ng/L,1、2个月时母乳胃生长素两组差异有统计学意义(P<0.05);两组母乳瘦素及脂联素水平比较差异均无统计学意义(P>0.05)。生后2个月及3个月喂奶次数超重组为(8.97±1.03)次/d及(9.10±1.45)次/d较对照组(8.11±1.39)次/d及(7.22±1.07)次/d多,喂奶间隔时间超重组(166.19±32.82)min及(162.60±28.47)min较对照组(182.89±32.89)min及(203.61±28.72)min少,差异有统计学意义(P<0.05)。母乳胃生长素水平与喂奶次数呈正相关(r=0.172,P=0.016),与喂奶间隔时间呈负相关(r=-0.186,P=0.001)。结论母乳胃生长素水平增高可增进食欲是婴儿生后早期体质量增长过快的原因之一。     

2013年中国母亲感知无母乳状况及危险因素

目的 探讨2013年中国母亲产后感知无母乳的发生状况及影响因素。方法 数据来源于2013年中国居民营养与健康状况监测中2岁以下儿童和母亲的调查数据,采用多阶段分层整群抽样方法,抽取中国30个省(直辖市、自治区)的55个监测点的12091名母亲。将感知无母乳定义为由于母亲自我报告无母乳且未进行母乳喂养。通过结构化问卷收集母乳喂养信息、母亲母乳喂养知识和一般特征。采用单因素分析和Logistic回归分析与感知无母乳相关的因素。结果 纳入母亲中感知无母乳组419例(3.5%)。多因素Logistic回归结果显示,母亲年龄(OR=1.04,95%CI 1.02～1.06)、产后大出血(OR=2.03,95%CI 1.30～3.16)、认为母乳喂养应该持续到孩子12月龄以上(OR=0.27,95%CI 0.17～0.45)、不清楚如何喂母乳(OR=3.31,95%CI 2.31～4.74)是产后感知无母乳的主要影响因素。结论 年龄、产后大出血、母乳喂养知识水平是中国母亲产后感知无母乳的主要危险因素,且母乳喂养知识水平为可改变因素。     

Breast milk and lipid intake distributions for assessing cumulative exposure and risk

Breast milk consumption is the primary route of infant exposure to certain lipophilic toxicants that have accumulated over decades in maternal adipose tissue, as well as to less persistent toxicants from maternal exposure during lactation. Such infant exposures occur at a time of rapid growth and development when susceptibility to certain toxicants can be greatest. Breast milk and lipid intake rates are presented for the 0-6 and 0-12 month age periods for infants fed according to the American Academy of Pediatrics' current recommendations (exclusive breast-feeding for 0-6 months and continued breast-feeding to 12 months). Intake rates are normalized to infant bodyweight to account for the covariance of consumption and bodyweight. Frequency distributions describe the population variability in intake. For age 0-12 months, daily average milk intake is 100.7 +/- 22.7 g/kg day (mean +/- SD), with a 95th percentile of 153.5 g/kg day. Breast milk intake distributions are also developed for infants exclusively breast-fed (no significant calories from non-breast milk sources) over their first year, and for the entire (nursing and non-nursing) infant population. For short-term exposures, intake can be derived from the regression equation presented here. Lipid intake estimated assuming a 4% lipid content (current risk assessment practice) is compared and found comparable to that derived from measured lipid content. The national trend of increased breast-feeding found in surveys further supports including the breast milk pathway in risk assessment.     

Effect of breast milk lead on infant blood lead levels at 1 month of age

Nursing infants may be exposed to lead from breast milk, but relatively few data exist with which to evaluate and quantify this relationship. This route of exposure constitutes a potential infant hazard from mothers with current ongoing exposure to lead as well as from mothers who have been exposed previously due to the redistribution of cumulative maternal bone lead stores. We studied the relationship between maternal breast milk lead and infant blood lead levels among 255 mother-infant pairs exclusively or partially breast-feeding through 1 month of age in Mexico City. A rigorous, well-validated technique was used to collect, prepare, and analyze the samples of breast milk to minimize the potential for environmental contamination and maximize the percent recovery of lead. Umbilical cord and maternal blood lead were measured at delivery; 1 month after delivery (+/- 5 days) maternal blood, bone, and breast milk and infant blood lead levels were obtained. Levels of lead at 1 month postpartum were, for breast milk, 0.3-8.0 microg/L (mean +/- SD, 1.5 +/- 1.2); maternal blood lead, 2.9-29.9 microg/dL (mean +/- SD, 9.4 +/- 4.5); and infant blood lead, 1.0-23.1 microg/dL (mean +/- SD, 5.5 +/- 3.0). Infant blood lead at 1 month postpartum was significantly correlated with umbilical cord (Spearman correlation coefficient rS = 0.40, p < 0.0001) and maternal (rS= 0.42, p < 0.0001) blood lead at delivery and with maternal blood (rS= 0.67, p < 0.0001), patella rS = 0.19, p = 0.004), and breast milk (rS = 0.32, p < 0.0001) lead at 1 month postpartum. Adjusting for cord blood lead, infant weight change, and reported breast-feeding status, a difference of approximately 2 microg/L (ppb; from the midpoint of the lowest quartile to the midpoint of the highest quartile) breast milk lead was associated with a 0.82 microg/dL increase in blood lead for breast-feeding infants at 1 month of age. Breast milk lead accounted for 12% of the variance of infant blood lead levels, whereas maternal blood lead accounted for 30%. Although these levels of lead in breast milk were low, they clearly have a strong influence on infant blood lead levels over and above the influence of maternal blood lead. Additional information on the lead content of dietary alternatives and interactions with other nutritional factors should be considered. However, because human milk is the best and most complete nutritional source for young infants, breast-feeding should be encouraged because the absolute values of the effects are small within this range of lead concentrations.     

Nutritional aspects of human lactation

This paper reviews the literature on the incidence and duration of breast-feeding in various countries, the volume and composition of breast milk, the health and nutrition of breast-fed babies as judged by growth and morbidity, maternal nutritional requirements during lactation, and the effect of prolonged lactation on maternal health. It appears that lactation can be as well sustained by impoverished as by affluent mothers, and that even in communities where malnutrition is common the average growth of infants is satisfactory up to the age of about 3 months on a diet of breast milk alone. Breast milk appears to have specific anti-infective properties, but prolonged breast-feeding will not prevent infections among older infants reared in a poor environment. The authors believe that breast-feeding is the best form of nutrition for the young infant and deplore its decline in modern industrial societies. The recommendations of various FAO/WHO Expert Groups on nutritional intakes during lactation are summarized. The need for an increased daily energy intake of 4.2 MJ (1 000 kcal) is questioned, and an increase of 2.5 MJ (600 kcal) is suggested. Data on the effect of prolonged lactation on the health of the mother are scanty; body weight appears to be maintained even among poorly nourished mothers. The authors stress the need for well-planned and technically adequate studies of the material and psychological factors involved in breast feeding.     

广东江门地区3月龄婴儿血铅与乳母血铅及乳铅等因素的相关性研究

目的:了解广东省江门地区3月龄婴儿血铅与乳母血铅、乳铅等的相关关系,寻找影响婴儿血铅水平的高危因素。方法:采用横断面描述性人群调查方法,对2005年1~4月在广东省江门市新会区妇幼保健院出生的纯母乳或者混合喂养的新生儿在3月龄时分别进行婴儿血铅、乳母血铅与乳铅的测定,并结合其出生时脐带血铅水平,综合评价婴儿血铅的相关影响因素。结果:婴儿3月龄时血铅水平(49.53±23.6μg/L)与其对应的脐血铅水平(49.70±23.77μg/L)比较无显著性差异(P>0.05);但是两者均明显低于婴儿3月龄时乳母血铅水平(59.24±28.71μg/L)而高于此时的乳铅水平(26.77±13.70μg/L)(P均<0.05);而乳铅水平也明显低于同时采集的乳母血铅水平(P<0.05)。Spearman偏相关分析显示,婴儿3月龄血铅水平与出生时脐带血铅水平(Spearman偏相关系数rs=0.39,P<0.01)、乳母血铅水平(rs=0.42,P<0.01)以及乳铅水平(rs=0.31,P<0.01)均存在显著的正相关关系。多元回归分析显示,在校正了居住地点、铅接触史、性别等因素的影响后,母乳血铅每变化1μg/L,可相应引起婴儿血铅约14μg/L的变化。结论:乳母血铅及乳铅可明显影响3月龄婴儿血铅水平;乳铅的定量测定和分析,对儿童早期铅暴露的防治具有重要意义。     

社区产褥期妇女采用通络催乳套路疗法的研究

目的探讨通络催乳套路疗法在社区产褥期对产妇和婴儿的临床效果。方法采用系统抽样法选取社区产褥期妇女200例,随机分为治疗组和对照组,每组各100例。治疗组在对照组基础上采用通络套路疗法,比较两组产妇的乳汁充盈时间、哺乳次数、哺乳方式、产妇情况和婴儿情况。结果产妇的喂养方式、产妇恶露排尽时间、每天哺乳次数和产妇睡眠时间、婴儿黄疸消退时间和婴儿每次睡眠时间的差异有统计学意义(P0.05);婴儿在产后42天、42～60天和≥60天生病次数的差异无统计学意义(P0.05)。结论通络套路疗法能够促进产妇乳汁分泌、催乳成功和保证乳房充盈度,但对婴儿生病次数无影响。这种深入家庭的中医保健治疗方法值得在社区推广。     

Beliefs and practices in infant feeding among the Wagogo of Chigongwe (Dodoma rural district), Tanzania. I. Breastfeeding

Fieldwork conducted in 1989-91 among the Wagogo, a semipastoral people in central Tanzania, documented the cultural and social contexts of infant nutrition. 120 breast-feeding mothers were observed extensively and 291 mothers of 322 children attending a health center were interviewed. In this setting, repeated pregnancy and lactation are natural conditions for all adult women. Breast milk is perceived as an essential source of nutrition, energy, vigor, and strength. Lactation failure does not occur in this society. All infants nurse within a few hours of delivery and receive colostrum. The infant remains with the mother night and day, even when she is working in the fields. Breast feeding is on demand, generally in response to crying, and lasts for 2-3 years. Any changes in the quality of breast milk are viewed as associated with maternal disease or witchcraft due to jealousy. "Bad" milk is believed to cause diarrhea and withheld from the infant. In many cases, milk in one breast is perceived as bad and that breast is no longer used for feeding. Sexual intercourse is prohibited during lactation, and women who become pregnant before weaning are shamed. The progressive weakening of the child associated with the cessation of breast feeding at the time of a new pregnancy is viewed as a consequence of the breach of sexual taboos ant not recognized as malnutrition.     

Multiple micronutrients in pregnancy and lactation: an overview

This overview of multiple micronutrients during pregnancy and lactation emphasizes 2 relatively neglected issues. The first is that maternal micronutrient status in the periconceptional period, and throughout pregnancy and lactation, should be viewed as a continuum; too often these 3 stages are treated and discussed separately from both a scientific and a public health perspective. Iron and vitamin B-12 are included as examples to stress how status at conception affects maternal, fetal, and infant status and health until the child is weaned. The second issue is that while most attention has been focused on a few micronutrients, for example iron and folate as discussed elsewhere in this Supplement, multiple micronutrient deficiencies occur simultaneously when diets are poor. Some of these deserve more attention as causes of poor pregnancy outcome, including other B vitamin deficiencies that result in homocysteinemia, antioxidants, vitamin D, and iodine. In lactation, maternal status or intake of the B vitamins (except folate), vitamin A, selenium and iodine strongly affect the amount of these nutrients secreted in breast milk. This can result in the infant consuming substantially less than the recommended amounts and further depleting stores that were low at birth. While the optimal mode of meeting recommended micronutrient intakes is an adequate diet, in some situations supplementation is also important. Unfortunately, information is lacking on the optimal formulation of micronutrient supplements for pregnant women, and the need to continue these supplements during lactation is not recognized in many situations where maternal and infant health could benefit.     

Studies in human lactation: milk volumes in lactating women during the onset of lactation and full lactation

After validation of test-weighing procedures milk volumes produced by 13 multiparous Caucasian women were followed longitudinally through the first year of lactation. All practiced exclusive breast-feeding for at least 5 mo. Milk transfer to the infant was low on days 1 and 2 and increased rapidly to 498 +/- 129 g/d (means +/- SD) on day 5 and then more slowly to 753 +/- 89 g/d during months 3-5. There was a characteristic milk volume for each mother-infant pair that was significantly related neither to milk yield on days 4-6 nor to birth weight. It was, however, strongly related to infant weight at 1 mo, suggesting that infant and/or maternal factors coming into play during the first month of life are strong determinants of subsequent milk transfer to the infant.     

Nutritional transition during infancy in East Java, Indonesia: 1. A longitudinal study of feeding pattern, breast milk intake and the consumption of additional foods

Infant feeding pattern was studied longitudinally from birth to 52 weeks among all infants born in the period September 1982-December 1984 in three villages in Madura, East Java (n = 687). Genuine demand breast-feeding was practised but it is the custom to force-feed infants from as early as the third day after birth until about 16 weeks. In a sub-sample the intake of breast milk and additional foods were measured, longitudinally in 76 infants and cross-sectionally in 77 infants. Breast milk intake ranged from 745 g per 24 h in the first month to 640 g per 24 h in the 12th month. Force-feeding did not have a negative influence on breast milk intake. The main constraint in infant feeding is the low intake of additional foods, which remained at 180 kcal and 3 g protein per day from the age of 16 weeks onwards.     

Does ethnicity predict lactation? A study of four ethnic communities

Human lactation is influenced by a variety of interrelated factors. The purpose of the study was to see whether the racial/ethnic factor is predictive of the onset of lactation and of the volume of breast milk. We planned a prospective study enrolling 269 women who were classified into four ethnic groups: Group 1 Arabs, Group 2 Africans, Group 3 Eastern Europeans, Group 4 Italians. Data regarding the women's habits, medical history and pregnancy were collected. After delivery we recorded the onset of lactogenesis and volume of milk output up until the fifth post-delivery day. A Cox model was fitted in order to assess the independent role that ethnicity has on the time to lactation; a general linear model was used to relate ethnicity to the overall amount of milk produced. Mean age was 27 years and was similar in all groups; half of the women were primiparae. All babies were exclusively breast-fed. Median time to lactation was 36 hours (20-36) and the median daily amount of milk produced was 173.5 ml (119-215). The earliest onset of lactation and the highest milk output was registered among Arab and Eastern European women. On Cox regression analysis ethnicity appeared to be an independent predictor of earlier lactogenesis: breast milk output occurred significantly earlier in the immigrant population than it did in the Italian population. No difference was observed among the immigrants. The multiple regression model showed that ethnicity independently predicts the overall amount of milk production: the Immigrant population produced a significantly higher milk output than the Italian population. No differences were observed within the immigrant groups. Ethnicity has been shown to be associated with the characteristics of breast-feeding. Further research is needed to understand the underlying mechanism.