The Research On The Influencing Factors Of Breastfeeding Within 12 Months And The Effects Of Feeding Milks On Neurodevelopment Among The Preterm Infants Of Corrected 3-12 Months

Part I:Analysis of the factors affecting breastfeeding within 12 months of preterm birth infantsObjective To investigate exclusive breastfeeding(Exclusive breatfeeding,EBF)within 12months after birth,analyzing the impact of maternal age,education,occupation,delivery mode,parity,number of births,Gestational age(GA),Birth weight(BW),hospital days,Neonatal respiratory distress syndrome(NRDS),Patent ductus arteriosus(PDA)、Necrotizing enterocolitis(NEC),Mild-moderate intraventricular hemorrhage(IVH),anemia during hospitalization,Bronchopulmonary dysplasia(BPD)on EBF.To provide the basis theoretical for improving the rate of exclusive breastfeeding.Methods Selected 455 preterm infants in our clinical system from January 1st,2012 to December 31st,2020.To investigate their postnatal feeding through outpatient follow-up data,questionnaires,and telephone visit.Divided into exclusive breastfeeding groups and non-exclusive breastfeeding groups according to their postnatal feeding milk.To investigate the situation of breastfeeding within 3,6,12months and the difference influencing factors in preterm infants was carried out usingχ~2test.The influencing factors of exclusive breastfeeding rate in preterm infants within 3,6 and 12 months after birthed was carried out using univariate and multivariate logistic regression.Result1.Infants whithin 3 months after birth,96 exclusive breastfeeding cases and 359non-exclusive breastfeeding,exclusive breastfeeding rate were 21.09%,and the non-exclusive breastfeeding rate was 78.91%.Infant whithin 6 months after birth,89exclusive breastfeeding cases and 366 non-exclusive breastfeeding,exclusive breastfeeding rate were 19.56%,and the non-exclusive breastfeeding rate was80.44%.Infant whithin 12 months after birth,32 exclusive breastfeeding cases and423 non-exclusive breastfeeding,exclusive breastfeeding rate were 7.00%,and the non-exclusive breastfeeding rate was 93.00%.There was no significant difference in exclusive breastfeeding rates for 3、6 months of age(χ~2=0.33,p=0.56~).2.Analysis the affecting factors of exclusive breastfeeding at 3 months after birth using theχ~2test showed significant differences in gestational age(χ~2=9.10,p=0.01),birth weight(χ~2=15.22,p<0.01),hospital days(χ~2=5.62,p=0.01),anemia during hospitalization(χ~2=4.67,p=0.03)and year of follow-up(χ~2=8.99,p=0.01)between the two groups.There was significant differences in number of births(χ~2=8.19,p<0.01),gestational age(χ~2=8.22,p=0.01),birth weight(χ~2=8.91,p=0.01),and year of follow-up(χ~2=10.33,p<0.01)at 6 months between the two groups.There was significant differences in maternal education(χ~2=7.01,p=0.03),number of births(χ~2=10.24,p=0.001),gender(χ~2=3.98,p=0.04),gestational age(χ~2=8.29,p=0.01),IVH incidence(χ~2=8.06,p<0.01)at 12months between the two groups.3.Maternity(OR=1.90,95%CI=1.11～3.25),gestationalage(OR=1.58,95%CI=1.15～2.17),hospital days(OR=1.74,95%CI=1.09～2.76),anemia during hospitalization(OR=0.60,95%CI=0.38～0.95),and follow-up years(OR=1.57,95%CI=1.16～2.12)were the influence factors of exclusive breastfeeding at 3 months after birth.4.Number of births(OR=0.53,95%CI=0.30～0.92),follow-up years(OR=1.57,95%CI=1.16～2.14)were the factors influencing of exclusive breastfeeding at 6months after birth.5.Maternal age(OR=0.52,95%CI=0.29～0.93),maternal education(OR=2.48,95%CI=1.36～4.51),parity(OR=2.90,95%CI=1.17～7.17),IVH(OR=3.72,95%CI=1.54～8.95)were factors influencing exclusive breastfeeding at 12months after birth.6.The proportion of breastfeeding rate in different years after 12 months was15.71%in 2013-2016,25.56%in 2017-2020.Comparison of breastfeeding rate at 12months in 2013-2020 showed significant differences between years(χ~2=4.39,p=0.03).Conclusion The exclusive breastfeeding rate of preterm infants within 1 year after birth is seriously low,the factors influencing exclusive breastfeeding were different in different months.Gestational age,hospital days,anemia affect the rate of early exclusive breastfeeding,and IVH,maternal age and educational background affect the rate of later stage exclusive breastfeeding.Maternity and Number of births affect exclusive breastfeeding rates in early and later stages of infants.Part 2: The effects of feeding milks on neurodevelopment among the preterm infants of corrected 3-12 monthsObjective To analyze the effects of different feeding milk at 12 months after birth on neurodevelopment at corrected 3-12 months,so as to provide a basis for scientific feeding and reasonable catch-up growth of preterm infants.Method Among the 455 study subjects,124 preterm infants completed three neurological assessments within 12 months of planned correction,and the feeding milks were divided into exclusive breastfeeding group(n=33),mixed feeding group(n=54)and artificial feeding group(n=37).Neurobehavioral developmental outcomes and physical indicators were assessed at 40 weeks of corrected gestational age,3-6 months,and 7-12 months,respectively.Data were analyzed using SPSS 26.0statistical software with significant differences at p <0.05.Result1.There was no significant difference in weight,length and head circumference at gestational age and corrected age,and no significant difference in weight,length,Extrauterine Growth Restriction(EUGR)at 40 weeks and 10 months(p> 0.05).2.In the three groups of children the Neonatal Behavioral Neurological Assessment test at corrected 40 weeks of gestational age,the total score and abnormal rate were not significant(p> 0.05).3.There was no significant difference in the Thick and large movement area,fine movement area,,adaptive area,language and social areas(p> 0.05),and no significant difference in developmental retardation rate(p> 0.05).4.The total score of developmental assessment(F=5.61,p<0.01)was significant different among the three groups of preterm infants,including Thick and large movement area(F=4.60,p=0.01),fine movement area(F=6.56,p<0.01),and adaptation area(F=6.61,p<0.01),and no significant difference in language and social scores(p>0.05).The retardation rate was significant different in total score of developmental assessment(F=6.58,p=0.03)、 fine movement area(χ~2=8.41,p=0.01),adaptive area(χ~2=10.95,p<0.01),There was no significant difference in ck and large movement area,language and social area(p> 0.05).The pairwise comparisons between the three groups at 7 and 12 months,The total score,Thick and large movement area,fine movement area and adaptation area were better than the mixed feeding and formula groups(p <0.05),three was no significant difference between the mixed fed and formula groups in language and social area(p>0.05).Conclusion Early feeding milk is closely related to the neurobehavioral development of3-12 months,breastfeeding influence neurobehavioral development in the middle and later stages of infants.