NICU 母乳喂养挑战

母乳喂养 NICU 早产儿挑战性更为突出。脆弱抵抗力较差且患有医疗问题的婴儿往往无法直接母乳喂养,出生之后哺喂效率也不佳。在 NICU 环境中,母乳喂养是一项复杂的任务,需要密切关注妈妈和婴儿的需求。

早产儿的挑战

安全有效地经口哺喂不仅需要适当的吸吮、吞咽和呼吸,还需要协调这三种功能,以最大限度降低不良呼吸暂停、心动过缓、氧气不饱和和送气现象。

对于早产儿,影响其安全哺喂的因素有很多,包括张力减退(低肌肉张力)、神经系统和肠胃系统不成熟以及潜在的医疗并发症,例如胃食管反流和慢性呼吸道疾病。这些问题使得住院婴儿难以创建和维持母乳喂养所需真空,以及安全协调吞咽和呼吸。

唇裂和腭裂等先天缺陷会进一步限制婴儿母乳喂养的能力。

妈妈的挑战

早产会打断妈妈的乳房发育,她必须提前适应哺喂。早产儿,尤其是超低体重婴儿的妈妈会存在生理和心理问题,对成功进行母乳喂养产生负面影响。

当宝宝无法母乳喂养或无法有效吸出乳房母乳时,妈妈就需要帮助,以开始和保持充足母乳供应。

除乳房刺激不足外,母婴分离压力也会影响母乳喂养建立,增加并发症可能性。对于许多早产儿妈妈而言,这意味着她们开始必须依赖专业医护人员的帮助和专业吸乳器来吸乳喂养宝宝。如果泌乳不足,她们还需要临时依赖捐赠母乳。

妨碍母乳喂养的情况

NICU feeding

妈妈面临的其他挑战还包括:吸出的母乳需要在经过母乳强化才能哺喂,妈妈服用药物可能使母乳喂养不安全等情况。有时需要对母乳进行处理,如巴氏杀菌,可能进一步妨碍纯母乳喂养。在某些情况下,妈妈无法每天都去医院。

当婴儿无法直接哺乳时,主要目标是让这些婴儿吃到母乳,同时促进婴儿的经口喂养技巧发育,有助于尽早实现纯母乳喂养。

参考文献

McGuire, W., Henderson, G., & Fowlie, P.W. Feeding the preterm infant. BMJ 329, 1227–1230 (2004).

Barlow, S.M. Oral and respiratory control for preterm feeding. Curr Opin Otolaryngol Head Neck Surg 17, 179–186 (2009).

Bertoncelli, N. et al. Oral feeding competences of healthy preterm infants: A review. Int Pediatr 2012, (2012).

Meier, P. Bottle- and breast-feeding: Effects on transcutaneous oxygen pressure and temperature in preterm infants. Nurs Res 37, 36–41 (1998).

Lau, C., Smith, E.O., & Schanler, R.J. Coordination of suck-swallow and swallow respiration in preterm infants. Acta Paediatr 92, 721 (2003).

Delaney, A.L. & Arvedson, J.C. Development of swallowing and feeding: Prenatal through first year of life. Dev Disabil Res Rev 14, 105–117 (2008).

Mizuno, K., Ueda, A., Kani, K., & Kawamura, H. Feeding behaviour of infants with cleft lip and palate. Acta Paediatr 91, 1227–1232 (2002).

Reid, J., Reilly, S., & Kilpatrick, N. Sucking performance of babies with cleft conditions. Cleft Palate Craniofac J 44, 312–320 (2007).

Cregan, M., De Mello, T., Kershaw, D., McDougall, K., & Hartmann, P.E. Initiation of lactation in women after preterm delivery. Acta Obstet Gynecol Scand 81, 870–877 (2002).

Meier, P.P. & Engstrom, J.L. Evidencebased practices to promote exclusive feeding of human milk in very low-birthweight infants. NeoReviews 18, c467– c477 (2007).

Lau, C. Effects of stress on lactation. Pediatr Clin North Am 48, 221–234 (2001).

Chatterton, R.T., Jr. et al. Relation of plasma oxytocin and prolactin concentrations to milk production in mothers of preterm infants: Influence of stress. J Clin Endocrinol Metab 85, 3661–3668 (2000).

Dewey, K.G. Maternal and fetal stress are associated with impaired lactogenesis in humans. J Nutr 131, 3012S-3015S (2001).

Newton,M. & Newton,N. The let-down reflex in human lactation. J Pediatr 33, 698–704 (1948).

Schanler R.J., Lau, C., Hurst, N.M., & Smith, E.O. Randomized trial of donor human milk versus preterm formula as substitutes for mothers’ own milk in the feeding of extremely premature infants. Pediatrics 116, 400–406 (2005).

Schanler,R.J. The use of human milk for premature infants. Pediatr Clin North Am 48, 207–219 (2001).

Hale, T.W. Medications and Mothers’ Milk (Hale Publishing, Plano TX, 2014).

Hamprecht, K. et al. Cytomegalovirus (CMV) inactivation in breast milk: Reassessment of pasteurization and freeze-thawing. Pediatr Res 56, 529–535 (2004).

Meier, P.P., Engstrom, J.L., Patel, J.L., Jegier, B.J., & Bruns, N.E. Improving the use of human milk during and after the NICU stay. Clin Perinatol 37, 217–245 (2010).