Yenidoğan yoğun bakım ünitesine yatış emzirme sürecini nasıl etkiliyor?

Amaç: Bu çalışmada yenidoğan yoğun bakım ünitesine yatışın ve hastanede uygulanan biberon sayısının emzirme sürecini nasıl etkilediğini araştırmak istedik. Gereç ve Yöntem: Yenidoğan yoğun bakım ünitesine (YYBÜ) yatırılan ve oral beslenebilen bebeklerin dosyaları retrospektif olarak tarandı. Yenidoğan bebeklerin hastanede kalış süreleri, yatış öncesi, yatış sürecindeki ve taburculuk sonrasındaki beslenme şekilleri incelendi. Bulgular: Çalışmaya YYBÜ’ye yatırılmış ve şifa ile taburcu olmuş 111 bebek alındı. Yatış öncesinde 81 bebek (%73) emzirilerek sadece anne sütü ile, 30 bebek (%27) ise emzirilmeye ek olarak mama ile beslenmekteydi. Yoğun bakımda yatış boyunca bebeklerin ancak %27,92’sinin sadece anne sütü ile beslenebildiği, %72,97’sine anne sütüne ek mama verilmek zorunda kalındığı gözlendi. Taburculuk sonrası 72 bebek (%64,86) sadece anne sütü ile, 39 bebek (%35,13) ise anne sütü ve mama ile beslenmekteydi. Taburculuk sonrasında sadece anne sütü alan bebekler ile karışık beslenen bebekler arasında yatış sürecinde bebeklere uygulanan biberon sayısı (p=0,32) ve emzirme sayısı (p=0,86) açısından anlamlı bir fark yoktu. Sonuç: YYBÜ’ne yatış anne sütü yetersizliği nedeniyle sadece anne sütü ile beslenme oranını azaltıyor ancak bu kötüleşmede biberon uygulamasının rolü olduğu söylenemez. Sağlıklı yenidoğanlarda da zamanla sadece anne sütü ile beslenme oranının azaldığı göz önünde bulundurulduğunda bu kötüleşmenin hastaneye yatıştan kaynaklandığının net olarak söylenebilmesi için hastaneye yatan ve yatmayan bebeklerin izlendiği geniş çaplı prospektif çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Emzirme, anne sütü, yenidoğan yoğun bakım, formül mama

How hospitalization in the neonatal intensive care unit affects the breastfeeding process?

Purpose: In this study, we aimed to investigate how hospitalization and number of bottles applied in the hospital affect the breastfeeding process.Materials and methods: Pre-hospitalization, hospitalization and post-discharge feeding patterns of the babies who were admitted to the neonatal intensive care unit (NICU) were scanned retrospectively.Results: 111 infants who were hospitalized in the neonatal intensive care (NICU) and discharged with healing were included in the study. Prior to hospitalization, 81 babies (73%) were breastfed, and 30 babies (27%) were fed with formula in addition to breastfeeding. It was observed that only 27.92% of the babies could only be fed with breast milk during their stay in the NICU, and 72.97% had to be given additional formula to breast milk. After discharge, 72 infants (64.86%) were fed exclusively breastfeeding and 39 infants (35.13%) were fed with breast milk and formula. There was no significant difference in terms of the number of bottles (p=0.32) and breastfeeding (p = 0.86) applied to the infants during hospitalization between infants who were breastfed and mixed-fed infants.Conclusion: Admission to the NICU decreases the rate of exclusively breastfeeding because of insufficient breast milk, but it cannot be said that bottle application plays a role in this deterioration. Considering the fact that exclusively breastfeeding rate decreases in healthy newborns over time, large prospective studies with hospitalized and non-hospitalized infants are needed to clearly state that this deterioration is due to hospitalization.

Keywords:

Breastfeeding, breastmilk, NICU, formula,

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1. Butte NF, Lopez-Alarcon MG, Garza C. Nutrient adequacy of exclusive breastfeeding for the term infant during the first six months of life. https://apps.who.int/iris/handle/10665/42519. Accessed May 29, 2019.
2. Lamberti LM, Walker CLF, Noiman A, Victora C, Black RE. Breastfeeding and the risk for diarrhea morbidity and mortality. BMC Public Health. 2011;11:S15. doi: 10.1186/1471-2458-11-S3-S15.
3. Victora CG, Bahl R, Barros AJ, et al. Breastfeeding in the 21 st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016;387:475-490. DOI:10.1002/jcla.1860030210.
4. Batrick M, Reinhold A. The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics 2010;125:1048-1056 doi: 10.1542/peds.2009-1616.
5. Cattaneo A, Ronfani L, Burmaz T, Quintero-Romero S, Macaluso A, Di Mario S. Infant feeding and cost of health care: a cohort study. Acta Paediatr 2006;95:540-546. DOI:10.1080/08035250500447936.
6. Yokoyama Y, Ueda T, Irahara M, Aono T. Releases of oxytocin and prolactin during breast massage and suckling in puerperal women. Eur J Obstet Gynecol Reprod Biol 1994;53:17-20. DOI:10.1016/0028-2243(94)90131-7.
7. Blomquist HK, Jonsbo F, Serenius F, Persson LA. Supplementary feeding in the maternity ward shortens the duration of breastfeeding. Acta Paediatr 1994;83:1122-1126. DOI:10.1111/j.1651-2227.1994.tb18263.x
8. Holmes AV, Auinger P, Howard CR. Combination feeding of breast milk and formula: evidence for shorter breast-feeding duration from the National Health and Nutrition Examination Survey. J Pediatr 2011;159:186-191. doi: 10.1016/j.jpeds.2011.02.006.
9. Lee H, Kurtin P, Wight N, et al. A quality improvement project to increase breast milk use in very low weight infants. Pediatrics 2012;130:1679-e1687. doi: 10.1542/peds.2012-0547.
10. Meier P, Engstrom J, Patel A, Jegier BJ, Bruns NE. Improving the use of human milk during and after the NICU stay. Clin Perinatol 2010;37:217-245. doi: 10.1016/j.clp.2010.01.013.
11. Davanso R, Monasta L, Ronfani L, Brovedani P, Demarini S. Breastfeeding at NICU discharge: a multicenter Italian study. J Hum lact 2013;29:374-380. doi: 10.1177/0890334412451055.
12. NICU by the numbers-Vermont Oxford Network. States with supportive breastfeeding policies have higher rates of discharge home on any human milk among surviving VLBW infants. https://public.vtoxford.org Accessed September, 2019.
13. Marmet C, Shell E. Training neonates to suck correctly. MCN Am.J. Matern.Child Nurs 1984;9:401-407. DOI:10.1097/00005721-198411000-00009.
14. Mc Bride MC, Danner SC. Sucking disorders in neurologically impaired infants: Assessment and facilitation of breastfeeding. Clin.Perinatol 1987;14:109-130.
15. Rigotti RR, de Oliveira MI, Boccolini CS. Association between the use of a baby’s bottle and pacifier and the absence of breastfeeding in the second six months of life. Cien Saude Colet 2015;20:1235-1244. doi: 10.1590/1413-81232015204.00782014.
16. Neifert M, Lawrence R, Seacat J. Nipple confusion: toward a formal definition. J Pediatr 1995;126: S125-129.
17.Cronenwett L, Stukel T, Kearney M, et al. Single daily bottle use in the early weeks postpartum and breastfeeding outcomes. Pediatrics 1992;90:760-766.
18. Feinstein JM, Berkelhamer JE, Gruszka ME, Wong CA, Carey AE. Factors related to early termination of breastfeeding in an urban population. Pediatrics 1986;78:210-215.
19. Castrucci BC, Hoover KL, Lim S, Maus KC. A comparison of breastfeeding rates in an urban birth cohort among women delivering infants at hospitals that employ and do not employ lactation consultants. J Public Health Manag Pract 2006;12:578-585.
20. Merewood A, Chamberlain LB, Cook JT, Philipp BL, Malone K, Bauchner H. The effect of peer counselors on breastfeeding rates in the neonatal intensive care unit: results of a randomized controlled trial. Arch Pediatr Adolesc Med 2006;160:681-685.
21. Oza-Frank R, Bhatia A, Smith C. Impact of Peer Counselors on Breastfeeding Outcomes in a Nondelivery NICU Setting. Advancess in Neonatal Care 2014;14:E1-8 doi: 10.1097/ANC.0000000000000101.
22. Hacettepe Üniversitesi Nüfus Etüdleri Enstitüsü (2019). 2018 Türkiye Nüfus ve Sağlık Araştırması. Hacettepe Üniversitesi Nüfus Etüdleri Enstitüsü, T.C. Cumhurbaşkanlığı Strateji ve Bütçe Başkanlığı ve TÜBİTAK, Ankara, Türkiye.
23. Ahluwalia IB, Morrow B, Hsia J. Why do women stop breastfeeding? Findings from the pregnancy risk assessment and monitoring system. Pediatrics 2005;116:1408-1412.
24. Bai Y. Middlestadt SE, Peng CY, Fly AD. Predictors of continuation of exclusive breastfeeding for the first six months of life. J Hum Lact 2010;26:26-34. doi: 10.1177/0890334409350168.
25. Donath SM, Amir LH. Relationship between prenatal infant feeding intention and initiation and duration of breastfeeding: a cohort study. Acta Paediatr 2003;92:352-356.
26. Taylor JS, Risica PM, Cabral HJ. Why primiparous mothers do not breastfeed in the United States: a national survey. Acta Paediatr 2003;92:1308-1313.
27. Colaizy TT, Morriss FH. Positive effect of NICU admission on breastfeeding of preterm US infants in 2000 to 2003. J Perinatol 2008;28:505-510. doi: 10.1038/jp.2008.32.