母乳哺餵狀況對新生兒出生數天內生理變化影響之探討

Impact of breast feeding practice on neonatal physiological variation in the first days

吳靜怡(Jing-Yi Wu)

指導教授 ： 蘇燦煮

國立臺灣大學/醫學院/護理學研究所/碩士(2008年)

https://doi.org/10.6342/NTU.2008.10629

摘要

母乳是新生兒最佳的營養來源，近十年來行政院衛生署積極進行母乳哺育推廣計畫，有愈來愈多的母親選擇哺餵母乳，因此如何讓母親於產後短暫的住院天數內能有效學習讓新生兒真正吃到母奶及判斷新生兒是否吃到足夠的奶水，以避免體重下降過多而導致合併症發生，是目前非常重要之課題，故本研究之目的是要瞭解新生兒於住院期間的母乳哺餵狀況及生理變化，並探討其關係與影響因素，以建構國內本土資料提供臨床醫護人員參考，且作為護理人員在教導母親哺餵母乳時之指標和依據。
本研究為量性研究設計，採緃貫式調查法（longitudinal survey），以立意取樣之方式，在台北市一所平均每年出生人數約為3000人的醫學中心進行資料收集，收案對象為健康足月的新生兒，收案時間自2008年1月15日至4月3日，收案人數為自然產新生兒105名及剖腹產新生兒80名，共185名。資料收集方式是依據新生兒及母親的基本屬性、新生兒住院期間的母乳哺餵狀況和生理變化之觀察與測量，並填寫量表和記錄表而得。研究工具為：「生理測量工具」，包括嬰兒用電子磅秤、經皮膽紅素測定器、離心機及膽紅素測定器；母乳哺餵狀況評估工具則使用「LATCH量表」，於新生兒出生後8小時內先評估一次，之後則每天評估一次至新生兒出院或轉出，同時以「泌乳量評估表」觀察記錄其母親的泌乳量；並以「新生兒狀況記錄表」來登錄新生兒每日的哺乳次數、時間、添加量及體重、大小便次數與性質和黃疸的變化。研究所得資料以SPSS 13.0版套裝軟體進行分析，採用之分析方法包括：次數分配、百分比、平均值、標準差、卡方檢定、t檢定、單因子變異數分析、皮爾森積差相關、複迴歸分析。
研究結果發現，住院期間完全哺餵母乳之新生兒共32人，佔17.3%；哺餵母乳及添加糖水者共58人，佔31.4%；哺餵母乳及添加配方奶者共95人，佔51.4%。 新生兒出生後第3天仍解胎便的共23人，佔12.4%，仍解結晶尿的共32人，佔17.3%。住院期間曾發生體重下降超過出生體重的7%而小於8%的新生兒共36人，佔19.5%，大多發生在出生後第2天；超過8%而小於10%的新生兒共79人，佔42.7%，亦大多發生在出生後第2天；超過10%的新生兒共29人，佔15.7%，主要發生在出生後第3天。住院期間曾因高膽紅素血症而接受照光治療的新生兒共34人，佔18.4%。
分析新生兒及母親基本屬性與新生兒住院期間之母乳哺餵狀況及生理變化的關係，發現與新生兒生產方式有顯著相關的為：哺餵型態、LATCH得分、泌乳量及體重變化；與母親年齡有顯著相關的為：哺餵型態、體重變化及是否接受照光治療；與新生兒哺餵型態有顯著相關的為：LATCH得分、泌乳量、非生理性體重喪失及是否接受照光治療。而新生兒非生理性體重喪失之相關因子包括：新生兒生產方式、哺餵型態及母親年齡，高膽紅素血症之相關因子包括：新生兒性別、哺餵型態及母親年齡。
依據研究結果建議，欲協助新生兒正確有效地含乳，且母親能順利成功地哺餵母乳，應從產前就開始提供完善的生產教育，教導母親做好生產及哺乳的準備，而產後新生兒科與產科應共同合作照顧新生兒及母親，醫護人員與家人及週遭環境的支持，能幫助母親持續的哺餵母乳，使新生兒獲得適當的營養，以減少非生理性體重喪失及高膽紅素血症的發生。

關鍵字

母乳哺餵狀況 ； 生理變化 ； 非生理性體重喪失 ； 高膽紅素血症

並列摘要

Breast milk is the best nutrition for newborn. Over the past 10 years, the Department of Health has expanded breast feeding program aggressively. Therefore, more mothers choose to breast feed their babies. Since postpartum mothers can only learn the knowledge and skills regarding breast feeding in a couple days in the hospital after given birth to their babies, how to help these mothers learn effectively has become an important issue. So we can avoid complications resulted from excessive weight loss due to mothers’ insufficient knowledge and skills regarding breast feeding. The purpose of this study was to understand the relationship between newborns’ breast feeding practice in the hospital, their physiological variation, and other related factors. Findings will not only provide a clinical data base for future references but also provide data and guidelines for clinical nurses while helping mothers learn breast feeding.
This is a longitudinal survey design study. Using purposive sampling, 185 healthy full-term newborns, including 105 normal spontaneous delivery and 80 cesarean section from a medical center in Taipei which have an average of 3000 newborns per year were included for study. Data were collected from 2008 January 15 to April 3. Information regarding the mothers’ and the newborns’ basic attributes, breast feeding practice, and the physiological variation in the hospital were collected using various types of physiological measurement tools and 3 scales. The previous includes the use of electronic baby weight machine, transcutaneous bilirubinometer, hematocrit centrifuge, and bilirubinometer. The later includes a breastfeeding assessment tools named "LATCH Scoring System", Lactation Assessment Form, and Neonatal Conditions Record Sheet. At the same time, using the "Lactation Assessment Form," observed mother's lactation capacity, and the "Neonatal Conditions Record Sheet" to record newborn’s daily breast feeding frequency and the amount of time, the number and nature of urine and bowel movements, body weight and jaundice changes. Data were analyzed using SPSS 13.0 version. Descriptive analysis, chi-square, t-test, ANOVA, Pearson's correlation, Multiple regression analysis were used.
The results showed that during the hospitalization, the number of newborns fully breastfeed was 32 (17.3%); breastfeed but added glucose water was 58 (31.4 %); breastfeed but added formula was 95 (51.4 %). The number of newborns still having meconium on the 3rd day after birth was 23 (12.4%), still having crystal urine is 32 (17.3%). While in the hospital, the number of newborns’ weight loss more than 7% and less than 8% of the birth weight was 36 (19.5 %), most happened in the first two days after birth; more than 8% less than 10 % was 79 (42.7 %), most happened in the first two days after birth also; more than 10 % was 29 (15.7 %), most happened in the first three days after birth. During the hospital, the number of newborns received hyperbilirubinemia and accepted phototherapy treatment was 34 (18.4%).
The correlation analysis showed that mode of delivery was significantly related to feeding patterns, LATCH score, lactation capacity, and weight changes; mother’s age were significantly related to feeding patterns, weight changes and whether or not to accept phototherapy treatment; neonatal feeding patterns were significantly related to LATCH points, lactation capacity, neonatal non-physiological weight loss, and whether or not to accept phototherapy treatment; neonatal non-physiological weight loss were significantly related to mother’s age, mode of delivery, and feeding patterns; neonatal hyperbilirubinemia were significantly related to mother’s age, newborn’s sex, and feeding patterns.
Based on the research findings, in order to assist newborns suck breast milk effectively and help mothers breast feeding successfully, prenatal delivery education including knowledge related to breast feeding is strongly recommended. Furthermore, newborn Pediatric and Obstetric care should work together for newborns and mothers, because good support from family and healthcare workers can help mothers continue breastfeeding, so that newborns receive appropriate nutrition to reduce occurrence of non-physiological weight loss and hyperbilirubinemia.

Key words: breast feeding practice, physiological variation, non-physiological weight loss, hyperbilirubinemia.

並列關鍵字

breast feeding practice ； physiological variation ； non-physiological weight loss ； hyperbilirubinemia

參考文獻

丁素珠、陳春菊（2005）・照顧一位高齡初產婦產後初期之護理經驗・高雄護理雜誌，22（1），37-49。

吳鳳英、鄧素文、謝麗華（1994）・探討產婦產後初期對自己及新生兒之關注及所感受的護理照顧・護理研究，2（1），78-88。

林麗華、周汎澔（2006）・運用羅氏適應模式於一位高齡初產婦剖腹產後之護理經驗・高雄護理雜誌，23（1），83-96。

陳慧主、雷玉華、周承珍（2004）・協助一位剖腹產產婦住院期間哺餵母乳的護理經驗・長庚護理，15（1），99-108。

黃郁惠、陳惠紋、黃美智（1999）・建立經皮測黃疸器在嬰兒室之使用指標・慈濟醫學，11（4），359-363。