早期母乳及母乳强化剂喂养对极低出生体重儿生长发育和营养状态的影响

目的 分析早期母乳及母乳强化剂喂养对极低出生体重儿(VLBWI)生长发育和营养状态的影响,为临床应用提供参考依据。方法 选取2016年1月—2019年5月重庆市开州区人民医院新生儿重症监护室收治的300例VLBWI为研究对象,根据喂养方式的不同分为母乳组、母乳及母乳强化剂组、早产儿配方奶组、母乳及早产儿配方奶组,比较四组VLBWI的生长发育、营养状况以及并发症发生情况。结果 生长指标的比较中,四组VLBWI平均体重增长率、平均身长周增长率、平均头围周增长率以及恢复至出生体重时间比较,差异均无统计学意义(F=0.083、1.217、1.225、1.512,P＞0.05);并发症的比较中,母乳及母乳强化剂组VLBWI喂养不耐受率及坏死性小肠结肠炎明显低于早产儿配方奶组、母乳及早产儿配方奶组(χ²=14.620、10.170、6.996、5.042,P＜0.05),在支气管肺发育不良、院内感染及视网膜病变方面,四组间比较差异无统计学意义(χ²=1.542、0.896、0.779,P＞0.05)。结论 采用早期母乳及母乳强化剂的喂养方式,不会影响极低出生体重儿的生长发育及营养状况,可以降低喂养不耐受、坏死性小肠结肠炎并发症的发生率,可在临床大力推广应用。     

Teaching mothers to express and store breast milk

Reasons for expressing milk vary from mother to mother. Those who breast feed may be more likely than other mothers to return to paid employment outside the home. To assist mothers to continue with exclusive breast feeding, health professionals should provide information antenatally about expressing milk. Mothers can start to express from birth and should be encouraged by health professionals to pump or express milk on a frequent basis--"the more the better"--as this will help to establish lactation and increase the milk supply. The use of pumps and the storage of breast milk are discussed.     

Infant feeding practices in a poor district of Santo Domingo

During August-December 1989, in the Dominican Republic, local health promoters interviewed 103 primary caretakers and took anthropometric measurements from 103 children aged 3 years and under during home visits in three poor neighborhoods of Los Alcarrizos (Alto de Chavon, Barrio Landia, and Pueblo Nuevo) to examine infant feeding practices. 95% of the mothers had started breast feeding. The median duration of breast feeding was 7.5 months. Almost 33% had quit breast feeding by 3 months. Perception of insufficient milk was the leading reason for early discontinuation of exclusive breast feeding. The local pharmacies in all three communities offered powdered milk. About 25% of mothers began using breast milk substitutes within the first week. A non-infant formula milk powder was the most commonly used breast milk substitute. 30% of mothers stored prepared milk for later feeds, as long as half a day. Only 13% of households had a refrigerator. The most frequently used first weaning foods were orange juice, lime juice, and beans. 76% of mothers had used or were currently using baby bottles. 95% of them reported washing the bottle in boiling water. The median age of introducing the baby bottle was 3 days. Only 44% of mother covered prepared food during storage. The most commonly eaten foods among children aged at least 1 year were milk, beans, rice, and citrus fruits. Yet the children did not eat all these foods daily. 18% of 1-2 year olds and 13% of 2-3 year olds did not eat meats and alternatives regularly. 7% of 1-2 year olds and 10% of 2-3 year olds did not eat fruits and vegetables regularly. 4% of 1-2 year olds and 3% of 2-3 year olds did not eat breads and cereals regularly. About 14% of all children were not consuming any milk at the time of the survey. These findings will be used to refine nutrition education programs in the district to make them more effective.     

Partial Hydrolyzed Protein as a Protein Source for Infant Feeding: Do or Don’t?

Exclusive breastfeeding until the age of six months is the recommended feeding method for all infants. However, this is not possible for every infant. Therefore, a second choice of feeding, as close as possible to the gold standard, is needed. For historical reasons, this has been cow’s-milk-based feeding. This paper discusses if this second-choice feeding method should contain intact protein or partially hydrolyzed proteins. The limited data available indicates that mother’s milk is relatively rich in bioactive peptides. Whether partially hydrolyzed protein might be a protein source closer to human milk protein content than intact cow’s milk needs further research. However, more research on protein and bioactive peptides in mother’s milk should be a priority for future scientific development in this field. Results of such research will also provide an answer to the question of which option would be the best second choice for infant feeding if sufficient breast milk is not available.     

Incidence and correlates of breast milk feeding in hospitalized preterm infants

The majority of epidemiological studies of breast feeding have been conducted in healthy, fullterm infant samples. Little is known about the incidence and correlates of breast milk feeding in preterm infants, particularly in those born outside of metropolitan areas. Therefore, hospital medical charts of 151 consecutively admitted preterm infants (相似文献   

The convenience of breast feeding

Immediately after delivery when the baby is put to breast, the simplicity of breast feeding becomes apparent. There is no concern about the milk not agreeing with the baby, and if he is kept with his mother so she can feed him on demand, the baby will probably gain more weight than if he were on formula. The mother's milk is always right and is always there. Traveling is convenient if clothes are worn that make discreet nursing possible; a 2-piece outfit such as a blouse and a skirt works well. A rest room or a dressing room can also be used for nursing privacy. A diaper or little blanket thrown over the baby can be a casual cover-up if needed. The nursing mother has no bottles to carry around and no fears of running out of supplies. A study by Spock found that mothers of twins who were breast feeding were better organized than those who were bottle feeding. Although the breast feeding mother is tied down to being a mother of her baby, she grows in discovery of her importance to her baby. Weaning is a gradual process. As the baby nurses less, the mother's milk supply decreases. Even after a baby has been weaned, he might need an occasional nursing to assuage a trying experience like a bump or an illness.     

不同的奶方喂养对早产儿生长发育的研究

目的 探讨不同的奶方喂养对早产儿生长发育影响的研究。方法 选择本院新生儿科2011年1月-2015年12月247例800~1 500 g的早产儿,分为单纯生母母乳组78例(A组),生母母乳+母乳强化剂组75例(B组),无母乳愿意接受捐赠母乳者为捐赠母乳+母乳强化剂组49例(C组)和无母乳且不愿接受捐赠乳者予早产儿配方奶组45例(D组)。所有入选者均采取积极喂养措施,观察各组早产儿完全肠内喂养、体格生长发育、并发症发生情况、平均住院时间等项目。结果 头围、体重、身长等体格发育指标、喂养达100 Cal/(kg·d)时间、恢复出生体重的时间单纯生母母乳组较其他三组慢、静脉营养应用时间长,差异有统计学意义,其他三组之间差异无统计学意义;出院后1年内感染事件发生例次早产儿配方奶组较其他各组几率高,差异有统计学意义,其他三组之间差异无统计学意义;胆汁淤积发生率、住院时间、喂养不耐受、出院时宫外发育迟缓发生率等四组之间差异无统计学意义。结论 早产儿生母母乳加母乳强化剂为最佳奶方,其次为捐赠母乳加母乳强化剂,在两者均不能得到的情况下,早产儿配方奶也是为一种较好的奶方喂养方式。     

Breastfeeding: an appeal

Factors that hinder breast feeding include the lack of knowledge of health personnel about the uniqueness of breast milk and the ease with which they and mothers have accepted formula feeding. These factors prevailed in Europe and North America until the 1960s, and they prevail today in developing countries. It is crucial to persuade health workers of the merits of breast feeding in order to promote it. Baby milk formula was developed in 1919 to provide a substitute for infants afflicted by the lack of their mothers milk. The search for the perfect human milk formula continues, but formula feeding is an experiment whose long-term effects are unknown. Its putative benefits are convenience, creation of employment, decreased perinatal mortality in affluent societies, and increased weight gain of premature low-birth-weight babies. However, formula feeding encourages less frequent child-mother contact. Employment opportunities in the manufacture of formula milk are only generated in the developed countries. The decline in perinatal mortality in developed countries since the advent of bottle feeding has been attributable to better obstetric care and improved management of such conditions as respiratory distress syndrome in infants. Most of the weight gain associated with formula use is caused by water and solute retention, which may be harmful to immature kidneys. On the other hand, the indisputable benefits of breast feeding include 1) prevention of infant malnutrition in the poor and obesity in the affluent 2) reduction in infection owing to protective factors in breast milk 3) reduced exposure to foreign allergens leading to a lower incidence of atopic conditions 4) convenience 5) enhancing the emotional bond between mother and child; and 6) helping to regulate appetite and satiety. Developing countries need health workers who are committed to encouraging exclusive breast feeding for 4 months, followed by breast feeding with supplements for at least 12 months.     

Variation in the contents of nutrients of breast milk during one feeding

The concentrations of various nutrients in breast milk were studied in relation to the quantity of milk expressed from 1 breast on 1 occasion in 4 Swedish women. The contents of nutrients in breast milk showed considerable variation. Concentrations of fat, lactose, total nitrogen, nonprotein nitrogen, individual milk proteins (lactoferrin, alpha-lactalbumin, human serum albumin), and urea were measured. The results are graphed. Generally, the concentrations of fat and water-soluble nutrients of breast milk showed 2 distinct patterns during emptying of a breast. The fat content of fore milk was less than that of hind milk, the milk at the end of the feeding. Such water-soluble nutrients as lactose and protein did not vary during the feeding in this way. Although each of the 4 subjects showed the same pattern of rising concentration of fat with duration of the feeding, there was a definite range of fat concentrations among the women studied.     

母乳和牛奶中铜、铁、锌、锰、铬含量的比较

以原子吸收光谱法测定产后不同泌乳时期(1～90天)母乳及牛奶中铜、铁、锌、锰、铬的含量变化/结果表明,母乳中铜、铁、锌,锰的含量随泌乳期延长而下降,铬无显著变化。母乳中铜、铁、锌、铬的含量均较牛奶丰富。母乳喂养和牛奶喂养婴儿每日微量元素摄入量与其摄入推荐量相比较:母乳微量元素的营养价值较牛奶高。本研究为提倡母乳喂养,指导牛奶喂养者补充微量元素提供了科学依据。     

Metabolisable energy consumption in the exclusively breast-fed infant aged 3--6 months from the developed world: a systematic review

The present study aimed to evaluate evidence on metabolisable energy consumption and pattern of consumption with age in infants in the developed world who were exclusively breast-fed, at around the time of introducing complementary feeding. We carried out a systematic review aimed at answering three questions: how much milk is transferred from mother to infant?; does transfer increase with the age of the infant?; and what is the metabolisable energy content of breast milk? Thirty-three eligible studies of 1041 mother--infant pairs reported transfer at 3--4 months of age, the weighted mean transfer being 779 (SD 40) g/d. Six studies (99 pairs) measured transfer at 5 months, with a weighted mean transfer of 827 (SD 39) g/d. Five studies (72 pairs) measured milk transfer at 6 months, reporting a weighted mean transfer of 894 (SD 87) g/d. Nine longitudinal studies reported no significant increases in milk transfer after 2--4 months. Twenty-five studies on breast-milk energy content were based on 777 mother--infant pairs. The weighted mean metabolisable energy content was 2.6 (SD 0.2) kJ/g. Breast-milk metabolisable energy content is probably lower, and breast-milk transfer slightly higher, than is usually assumed. Longitudinal studies do not support the hypothesis that breast-milk transfer increases markedly with age. More research on energy intake in 5--6-month-old exclusively breast-fed infants is necessary, and information on the metabolisability of breast milk in mid-infancy is desirable. This evidence should inform future recommendations on infant feeding and help to identify research needs in infant energy balance.     

Patterns of variation in breast-feeding behaviors

This paper describes the range and patterning of variation in specific breast-feeding behaviors among a sample of 62 American mothers, as well as the relationship of the patterns to duration of exclusive breast feeding. Infant feeding data were collected using 24-hr records completed by mothers every 8 days through the first 6 months post partum. Behaviors examined were: number of daily feedings, minimum and maximum intervals between feedings, length of feedings and total daily nursing duration. Variation in magnitude of these behaviors ranged from three- to eight-fold. Principal components analysis found this variation patterned in two dimensions, relating to feeding frequency and length of time spent breast feeding. These dimensions accounted for approximately equal proportions of variance in the breast-feeding behaviors, totaling about 80% of all variance at 4 and 8 weeks. There was significant continuity of breast-feeding styles practiced by any one woman from 4 to 8 weeks. The feeding frequency dimension was strongly associated with duration of exclusive breast feeding. Three explanations--cultural, biological and biocultural--are proposed to account for this association. It is argued that the intracultural variation in breast-feeding styles in this sample may be sufficient to cause corresponding variation in breast milk production, in part accounting for variation in duration of exclusive breast feeding. Predictions of exclusive breast-feeding duration will be most accurate for women with a breast-feeding style of infrequent feedings, while predictions for women with a style of frequent feeding will be confounded by cultural factors which have an independent effect on breast-feeding supplementation.     

连云港市4个月婴儿喂养现状

目的了解连云港市4个月婴儿纯母乳喂养情况及不能坚持纯母乳喂养的原因。方法选择在院出生的508名婴儿进行调查。结果4个月纯母乳喂养率为44.9%。结论影响纯母乳喂养的最重要因素为产后奶量不足,加强有关母乳喂养的知识教育可大大提高母乳喂养率。     

The influence of health education on breast feedingpractices in Benin City, Nigeria

Many mothers from developing countries including Nigeria are introducing their babies to artificial milk feeding early in life. This is probably due to the rapidly increasing female education whereby working mothers had to go back to work 6–8 weeks after delivery.In this study, only 31·4% of the mothers wholly breast fed their babies at confinement in spite of the health educational activities of breast feeding practices during antenatal clinic (A.N.C.) attendances. Breast feeding declined rapidly after discharge from hospital, and artificial milk feeding was well established at 6–8 weeks, post confinement, for socio—economic reasons.It is suggested that for these working mothers, bottle-feeding practices should be welldemonstrated to them so as to minimize the ill effects that ignorance and malutilization of the artificial milk may cause. For the non-working mothers, health educational activities on the advantages of breast feeding and breast milk should be continuous and continuing.     

Awareness about infant feeding practices among nursing personnel

The study examined knowledge of and attitudes toward breast and supplementary feeding of infants among 100 newly trained nurses in India. The nurses had recently completed three years of training in A-grade nursing skills. 100% of respondents agreed that breast feeding was the best option, and water was acceptable as the first feed. Feeding of infants was considered to be appropriate within the first 6 hours of birth and for 1-3 years. 60% preferred bottle feeding. 88% considered that the new-born should be kept with the mother rather than in the nursery. 66% knew that breast feeding was good for the mother's health. 68% preferred time-scheduled feeding. 90% desired milk diluted with water as a breast milk substitute. Respondents listed the following advantages of breast milk: nutritious (mentioned by 30% of respondents), good for the baby's health (20%), hygienic (20%), better for mother-child bonding (20%), time saving (18%), offering resistance against disease (18%), economical (11%), given at appropriate temperature (7%), easily digestible (6%), and easy to feed (2%). Respondents listed the following indications for bottle feeding: mother ill (mentioned by 40% of respondents), lactation failure (18%), cracked nipple (15%), other breast problems (11%), baby not sucking (8%), cleft lip/palate (6%), death of mother (6%), mother using oral contraceptives (4%). The study revealed a preference for 1/8 to 3/4 dilution of milk, because of milk's presumed heaviness. The practice of milk dilution is one of the important reasons for childhood malnutrition, and it demands urgent attention. There was a serious lack of knowledge about colostrum and techniques of feeding, burping, and weaning. Findings also confirmed the preference for bottle, cotton wicks, and fingers for providing milk substitutes. Continuing nursing education should provide better instruction on infant feeding practices.     

Effect of sucking characteristics on breast milk creamatocrit

One of the problems in the care of healthy children is that mothers often give infant formulae to their normally growing infants in the first 4 months of life because they believe that they are unable to satisfy them. However, the association of fat content in breast milk with the sucking pattern of the infant is not clearly known. In order to determine whether the fat concentration of human milk was associated with sucking characteristics of the infants, 80 healthy 2-month-old babies and their mothers were included in the study. Milk creamatocrit was assessed at the beginning, at the first, fifth and 10th minutes and at the end of breast feeding. The creamatocrit values increased as the time elapsed from the beginning of breast feeding. There was an inverse relationship between milk volume and creamatocrit at both the beginning and the end of breast feeding (P < 0.05). The mean milk volume was higher and the mean creamatocrit at the end of breast feeding was lower in the infants whose 2-month weight gain was higher than the 75th percentile (75P) compared with those whose 2-month weight gain was lower than the 25th percentile (25P) (for milk volume 105 +/- 36 mL vs. 76 +/- 30 mL, respectively, P < 0.05; and for creamatocrit value 11.4 +/- 4.0 vs. 14.3 +/- 3.8, respectively, P < 0.05). Milk volume is the most important factor affecting weight gain of exclusively breast-fed babies, and fat concentration of human milk is not a primary determining factor in individual differences in weight gain of the infants and appears to be secondary to factors such as number of feeds per day, duration of breast feeding and the volume of milk sucked.     

Breast milk intake is not reduced more by the introduction of energy dense complementary food than by typical infant porridge

The effect of different energy densities of complementary foods on breast milk consumption is not well understood. In this study, we tested the hypothesis that provision of fortified spread (FS), a micronutrient fortified, energy-dense (22 kJ/g), ready-to-use food, to Malawian infants would not decrease their breast milk intake more than a traditional corn + soy blended flour (CSB). Forty-four healthy 6-mo-old infant and mother pairs were enrolled in a prospective, parallel group, investigator-blinded, randomized controlled complementary feeding trial. Infants were randomized to receive 25 g/d of FS, 50 g/d of FS, or 72 g/d of CSB. The primary outcome was the difference in breast milk intake after 1 mo of complementary feeding as measured by the dose-to-mother deuterium oxide dilution technique. Outcomes were compared using repeated measures ANOVA. A total of 41 mother-infant pairs completed the study. At enrollment, 88% of the infants had received corn porridge. At baseline, the infants consumed 129 +/- 18 g.kg body wt(-1) x d(-1) (mean +/- SD) of breast milk. After 1 mo of complementary feeding with 25 g/d FS, 50 g/d FS, or 72 g/d CSB, their breast milk consumption was 115 +/- 18 g.kg body wt(-1) x d(-1), a significant reduction; however, the effects of the complementary foods did not differ from one another (F-value model = 4.33, P = 0.0008 for effect of time and P = 0.69 for effect of type of food). The results suggest that complementary feeding of Malawian infants with FS has the same effect on their breast milk intake as complementary feeding with traditional CSB porridge.     

产后母乳不足的原因及护理对策

目的了解导致母乳不足的相关因素,探讨有效促进乳汁分泌的护理措施。方法选择在2010年1～6月分娩实行母乳喂养的产妇720例,其中乳汁不足219例占30．4％。对219例产妇进行母乳不足的原因分析,并针对原因采取相应的护理措施。结果导致乳汁分泌不足主要原因为：母亲喂奶次数少、吸吮时间短（48．4％）、过早添加辅食（44．3％）等因素。通过对每个产妇进行针对性的指导、实施综合性护理措施,219例产妇中204例（93．2％）乳汁分泌明显增多。结论针对乳汁分泌不足的原因,采取综合性护理措施,能使乳汁分泌充足,成功母乳喂养。     

Is breast feeding the solution to the infant nutrition problem in underdeveloped countries?

One hundred and thirty-three children from birth to 1 year of age were studied to investigate the value of breast milk as a solution to the infant nutrition problem. Fifteen per cent of the children were being fed exclusively breast milk, 44 (44.4%) were fed breast milk plus cow's milk and 40.6% were fed only cow's milk. Thirty-three per cent of the breast fed children, 44.4% of those on mixed feeding and 47% of those on cow's milk alone, were malnourished.     

Expressing yourself: A feminist analysis of talk around expressing breast milk

Recent feminist analyses, particularly from those working within a poststructuralist framework, have highlighted a number of historically located and contradictory socio-cultural constructions and practices which women are faced with when negotiating infant feeding, especially breastfeeding, within contemporary western contexts. However, there has been little explicit analysis of the practice of expressing breast milk. The aim of this article is to explore the embodied practice of expressing breast milk. This is done by analysing, from a feminist poststructuralist perspective, discourse surrounding expressing breast milk in sixteen first time mothers' accounts of early infant feeding. Participants were recruited from a hospital in the South Midlands of England. The data are drawn from the first phase of a larger longitudinal study, during which mothers kept an audio diary about their breastfeeding experiences for seven days following discharge from hospital, and then took part in a follow-up interview. Key themes identified are expressing breast milk as (i) a way of managing pain whilst still feeding breast milk; (ii) a solution to the inefficiencies of the maternal body; (iii) enhancing or disrupting the ‘bonding process’; (iv) a way of managing feeding in public; and (v) a way to negotiate some independence and manage the demands of breastfeeding. Links between these and broader historical and socio-cultural constructions and practices are discussed. This analysis expands current feminist theorising around how women actively create the ‘good maternal body’. As constructed by the participants, expressing breast milk appears to be largely a way of aligning subjectivity with cultural ideologies of motherhood. Moreover, breastfeeding discourses and practices available to mothers are not limitless and processes of power restrict the possibilities for women in relation to infant feeding.