Retrospective Investigation And Analysis Of Breastfeeding In Very Low And Extremely Low Birth Weight Infants

Objective:This study aims to analyze the effect of breastfeeding on the clinical outcomes of VLBWI and ELBWI by investigating the related data of breastfeeding during hospitalization,to provide data for the continuous improvement of breastfeeding quality in NICU.Methods:Retrospective analysis was used.VLBWI and ELBWI hospitalized in NICU of Northwest Women and Children's Hospital from April 1,2018 to March 31,2019 were selected as subjects to record in detail the perinatal period,breastfeeding status,duration of parenteral nutrition,bodyweight growth rate and nutritional index well as the incidence of NEC and BPD,delayed infection and other related complications,hospitalization days,hospitalization expenses and so,the status of breastfeeding and its impact on the clinical outcomes of infants were analyzed.Results:1.General data:234 infants were included,the ratio of male to female was 1.02,the gestational age was mainly 28?33⁺⁶ weeks,accounting for 84.7%,and the birth weight was mainly VLBW,accounting for 91.2%,SGA accounted for 33.8%,and 97.0%of all infants get better and discharged from hospital.2.Breastfeeding rate and breastfeeding volume:the exclusive breastfeeding rate increased significantly from the second week after hospitalization.60.3%of the infants were exclusively breastfed before discharge,and the exclusive breastfeeding rate reached79.1?94.1%for infants who were hospitalized for 6 to 8 weeks.Those who ate a lot of breast milk accounted for 50.9%,accounting for 77.3%and 65.2% of very premature infants and ELBWI,respectively.The smaller the gestational age,the higher the average proportion of breast milk,P<0.001,the difference was statistically significant.3.Enteral and parenteral nutrition:the median time to start enteral feeding was 1?1-2?days,and the median time to start breastfeeding was 5?3-7?days.The smaller the gestational age,the later the milk opening time,the difference was statistically significant?P=0.002?.There was no significant difference in milk opening time among different weight groups?P=0.116?.89.7%of the infants began enteral feeding within 3 days after birth,and the breast milk opening rate was only 6.4%.The breast milk opening rates of very premature infants and ELBWI were 22.7%and 17.4%,respectively.40.7%of the infants used HMF,the median age of first use of parenteral nutrition was 27?20-37.3?days,the median duration of the first use of parenteral nutrition was 24?18-33?are 30infants who stopped intravenous nutrition within 14 days or for 12.8%of all infants.Compared with those with smaller gestational age and body weight,the intake of large amounts of breast milk was helpful to shorten the duration of parenteral nutrition of middle and late preterm and infants whose birth weight below 1250g?P<0.05?.But there was no significant difference in the group with an average proportion of breast milk less than 80%.4.Weight gains and nutritional index:there was no significant difference in weight growth rate among infants who ate different amounts of breast milk.Compared with infants who were mainly breastfed without HMF,the addition of HMF contributed to weight gains and reduced the incidence of NEC.The P values were 0.046 and 0.036,respectively.The addition of HMF was more active in infants with SGA,and the growth rate of body weight in infants with SGA was faster than that in infants with AGA?P<0.001?,but there was no significant difference in HMF intolerance.There was no significant difference in the levels of albumin and hemoglobin among infants with different amounts of breast milk.5.Effect on complications:studies have shown that breast milk has a significant protective effect on NEC.The incidence of NEC was 6.7%in the group with a large amount of breast milk and 17.4%in the group with an average proportion of less than 80%.Stratified analysis showed that in infants less than 32 weeks,the group with a large amount of breast milk reduced the incidence of NEC from 21.5%to 7.1%.Among infants less than 1250g,the incidence decreased from 23.3%to 6.9%,and the P value ratio was0.005 and 0.039,respectively.Among the infants with more than 1250g,the late-onset infection rate in the high-dose breast milk group was 1.6%,while in the group with an average breast milk proportion of less than 80%,it was 19.4%,and the difference was statistically significant.In the whole and stratified study,different amounts of breast milk intake had no significant effect on the occurrence of BPD.6.The median length of stay and cost of hospitalization was 46?36-59?days,the average corrected gestational age at discharge was 38.6?37.1-40.0?weeks,and the median cost of hospitalization was 60736?42901-79597?yuan.Among the whole infants,there was no significant difference in daily hospitalization costs among different breast milk intake groups.stratified analysis showed that in middle and late preterm infants,the hospitalization costs of a large amount of breast milk group was lower than in other groups,and the difference was statistically significant?P=0.006?.Conclusion:1.The center opened milk actively and had a high rate of breastfeeding,but the speed of adding milk and the strategy of adding HMF were conservative.2.Breast milk has a significant protective effect on NEC.In the group with birth weight?1250g,the intake of a large amount of breast milk can significantly reduce late-onset infection.Breastfeeding has no obvious advantages in the incidence of BPD,duration of parenteral nutrition,weight gain,nutritional index,length of hospital stay and average daily cost.3.The addition of HMF can help gain weight,reduce the duration of intravenous nutrition and hospitalization costs,and reduce the incidence of NEC.