Breastfeeding Promotion Effect Evaluation For Early Essential Newborn Care (EENC)

ObjectiveTo know the current status of implementation of early neonatal care measures in the study area;to evaluate the role of Early Essential Newborn Care(EENC)in the promotion of breastfeeding in term infants of natural delivery.MethodsIn this study,eight Maternal and Child Health Hospital(MCH)in Mianyang City and Deyang City of Sichuan Province were selected as research sites.Two municipal agencies and six county-level institutions were randomly divided into intervention and control groups.The intervention group performed EENC interventions.The control group routinely completed neonatal care and compared the differences in breastfeeding between the two groups.The number of maternal and infant samples in each group was 253 pairs,including 102 pairs of municipal maternity and child care hospitals and 51 pairs of maternal and child health clinics at county level.Data collection was divided into two phases,baseline data collection and post-intervention data collection.The same questionnaires were used at each stage,including maternity and childbirth record forms,maternal interview forms,and child follow-up record forms.The data included maternal basic information,maternal birth information,and newborn care services at birth,maternal and child skin-to-skin contact,newborn first breastfeeding,pre-discharge feeding,1 month feeding and so on.By establishing a Difference in Difference model,the net effect of index changes in the intervention group and the control group was calculated,and the effect of EENC on breastfeeding was evaluated.Results1.Status of implementation of early neonatal care:55.8%of the newborns can be contacted by the skin immediately after delivery.The skin-to-skin contact(SSC)initiation time is 9.7 minutes after birth and the median duration of skin contact between mothers and babies is 12.2min.The contact more than 60 minutes accounts for 3.3%.In the delivery room,30.8%of newborns before maternal separation were unable to establish breastfeeding successfully,and 25.2%of newborns had to be separated from their mothers due to routine physical examinations to terminate skin contact.Among pre-discharge feeding methods,54.9%of newborns were exclusively breastfed,42.7%were mixed and 2.4%were artificial.2.Effect of EENC intervention on breastfeeding for the first time:After intervention with EENC,the net effect of skin contact time in the intervention group was 45.5min higher than that of the control group,and the net effect of the increase in the duration of the first breast feeding was 16.4min.The probability of immediate skin contact in newborns of the intervention group was 7.836 times that of the control group,and the contact time of the mother and child "≥90 min" was 58.929 times that of the control group,and the probability of the first breastfeeding before maternal separation was 5.337 times that of the control group(P<0.05).3.Effect of EENC technology on breastfeeding before discharge:After intervention group was trained by EENC,the exclusive breastfeeding rate before discharge from baseline was increased from 62.1%to 74.3%,the mixed feeding rate was reduced from 35.5%to 23.4%,and the artificial feeding rate was from 2.4 to 2.3%.4.Effect of EENC technology on breastfeeding infants at 1 month:There was no statistically significant difference between EENC and 1-month-old feeding way in intervention and control groups(P=0.238).5.Relationship between early skin contact and breastfeeding:The first breastfeeding start time was positively correlated with the maternal and child skin contact initiation time(P<0.001)。The skin contact initiation time was extended by 1 minute,and the time for the first breastfeeding initiation was extended.0.9 minutes.The longer the maternal-infant skin contact time,the longer the corresponding time for the first breastfeeding,and the partial regression coefficient was 0.267(P<0.001).Conclusion1.There are certain differences between the newborn health care measures in the study area and the "baby-sucking,early-contact,and early-breaking milk" management in the baby-friendly hospital management.More effective training and intervention are needed to improve the existing neonatal care operation procedures.2.The early basic health care technology for newborns has a significant effect on maternal and child skin contact;it can effectively help the newborn to complete breastfeeding for the first time and achieve early milking.3.Early neonatal basic health care technology can increase the pre-hospitalization rate of breastfeeding;however,the effect of promoting exclusive breastfeeding for infants aged 1 month and over needs further analysis.