基于倾向性评分匹配的泌乳Ⅱ期启动延迟与早产儿喂养和母亲母乳喂养心理的相关性

李玲燕; 厉建英; 黄子天; 项旦丹; 林小清

doi:10.16766/j.cnki.issn.1674-4152.003921

基于倾向性评分匹配的泌乳Ⅱ期启动延迟与早产儿喂养和母亲母乳喂养心理的相关性

doi: 10.16766/j.cnki.issn.1674-4152.003921

温州医科大学附属第二医院新生儿科，浙江温州 325000

基金项目:

浙江省卫生健康科技计划项目 2021KY800

详细信息

通讯作者:
李玲燕，E-mail：lilylily2857@163.com

中图分类号: R174
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出版历程
- 收稿日期: 2024-09-20
- 网络出版日期: 2025-05-14

Correlation of delayed onset of lactogenesis Ⅱ with feeding in preterm infants and maternal breastfeeding psychology based on propensity score matching

Neonatal Department, the 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探讨早产儿母亲泌乳Ⅱ期启动延迟(DOL Ⅱ)的发生率，及DOL Ⅱ与早产儿喂养和母亲母乳喂养心理的相关性，以期为早产儿母亲的管理提供一定的参考。方法使用方便抽样，于2022年1月—2023年6月在温州医科大学附属第二医院选择804例早产儿母亲为研究对象。倾向性评分后，DOL Ⅱ组与非DOL Ⅱ组各267例，比较2组早产儿院内喂养、母亲喂养态度、母乳喂养自我效能和持续时间的差异。结果早产儿母亲DOL Ⅱ发生率为36.3%(292/804)。DOL Ⅱ组早产儿胃管留置时间为(7.85±1.98)d，开始经口喂养时间为(6.65±1.53)d，出院时纯母乳喂养率为39.7%(106/267)，非DOL Ⅱ组分别为(7.19±1.67)d、(5.89±1.21)d和45.3%(121/267)，差异均有统计学意义(P < 0.05)。DOL Ⅱ组母亲日均泌乳量为(28.65±7.85)mL，婴儿喂养态度为(61.44±13.13)分，母乳喂养自我效能为(48.17±12.41)分，非DOL Ⅱ组分别为(30.75±7.94)mL、(68.43±14.52)分和(52.27±13.74)分，差异均有统计学意义(P < 0.05)。矫正月龄12月时母乳喂养率分别为22.8%(61/267)和36.3%(97/267)。2组母乳喂养持续时间比较差异有统计学意义(P < 0.05)。结论母亲发生DOL Ⅱ的早产儿开始经口喂养时间较晚，出院时母乳喂养率较低，母亲的婴儿喂养态度和母乳喂养自我效能水平较低，母乳喂养持续时间更短。
- 泌乳延迟 /
- 母乳喂养 /
- 母乳喂养态度 /
- 早产儿
Abstract: Objective To explore the incidence of delayed onset of lactogenesis Ⅱ (DOL Ⅱ) in premature mothers and its relationship with feeding status in preterm infants and breastfeeding psychology in mothers, and provide some reference for the management. Methods A total of 804 premature mothers were selected between January 2022 and June 2023 in the 2nd Affiliated Hospital of Wenzhou Medical University. After propensity score matching, there are 267 cases each in the DOL Ⅱ and non-DOL Ⅱ groups. The differences between the DOL Ⅱ and non-DOL Ⅱ groups in preterm hospital feeding, maternal feeding attitude, breastfeeding self-efficacy and breastfeeding duration were analyzed. Results The incidence of DOL Ⅱ in premature mothers was 36.3% (292/804). The duration of gastric tube, started oral feeding time and breastfeeding rates at discharge were (7.85±1.98) d, (6.65±1.53) d and 39.7% (106/267) respectively in DOL Ⅱ group, with (7.19±1.67) d, (5.89±1.21) d and 45.3% (121/267) in non-DOL Ⅱ group, which were all had significantly differences (P < 0.05). The average daily lactation, infant feeding attitude score and breastfeeding self-efficacy scale were (28.65±7.85) mL, (61.44±13.13) points and (48.17±12.41) points respectively in DOL Ⅱ group, with (30.75±7.94) mL, (68.43±14.52) points and (52.27±13.74) points in non-DOL Ⅱ group, which were all had significantly differences (P < 0.05). The breastfeeding rate was 22.8% (61/267) in DOL Ⅱ group and 36.3% (97/267) in non-DOL Ⅱ group in the corrected age of 12 months. The difference in breastfeeding duration time between the two groups was statistically significant (P < 0.05). Conclusion Preterm infants whose mothers have DOL Ⅱ have longer started oral feeding time, and lower breastfeeding rates at discharge. DOL Ⅱ mothers have lower infant feeding attitudes, breastfeeding self-efficacy and shorter breastfeeding duration.
- Delayed onset of lactogenesis /
- Breastfeeding /
- Infant feeding attitude /
- Preterm infants

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图 1 DOL Ⅱ组和非DOL Ⅱ组的母乳喂养持续时间曲线

Figure 1. Duration of breastfeeding curves for the DOL Ⅱ and non-DOL Ⅱ groups

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表 1 匹配前后2组早产儿及母亲一般资料比较[例(%)]

Table 1. Comparison of general data of preterm infants and their mothers between the two groups before and after matching [cases (%)]

项目	匹配前(n=804)		χ²值	P值	匹配后(n=534)		χ²值	P值
项目	DOL Ⅱ组(n=292)	非DOL Ⅱ组(n=512)	χ²值	P值	DOL Ⅱ组(n=267)	非DOL Ⅱ组(n=267)	χ²值	P值
年龄(岁)
＜35	196(67.1)	390(76.2)	7.704	0.006	186(69.7)	196(73.4)	0.920	0.338
≥35	96(32.9)	122(23.8)			81(30.3)	71(26.6)
文化程度
大专及以下	189(64.7)	341(66.6)	0.291	0.589	171(64.0)	175(65.5)	0.131	0.717
本科及以上	103(35.3)	171(33.4)			96(36.0)	92(34.5)
家庭月收入(元)
≤10 000	97(33.2)	148(28.9)	1.679	0.432	88(32.9)	78(29.2)	0.877	0.645
10 001~20 000	162(55.5)	305(59.6)			150(56.2)	158(59.2)
≥20 001	33(11.3)	59(11.5)			29(10.9)	31(11.6)
母乳喂养培训经历
有	191(65.4)	375(73.2)	5.472	0.019	176(65.9)	189(70.8)	1.463	0.226
无	101(34.6)	137(26.8)			91(34.1)	78(29.2)
产次
1	185(63.4)	287(56.1)	4.089	0.043	167(62.5)	151(56.6)	1.990	0.158
≥2	107(36.6)	225(43.9)			100(37.5)	116(43.4)
母乳喂养史
有	91(31.2)	186(36.3)	2.196	0.138	84(31.5)	96(36.0)	1.207	0.272
无	201(68.8)	326(63.7)			183(68.5)	171(64.0)
分娩方式
自然分娩	179(61.3)	373(72.9)	11.528	0.001	167(62.5)	184(68.9)	2.403	0.121
剖宫产	113(38.7)	139(27.1)			100(37.5)	83(31.1)
孕前体重指数
＜18.5	22(7.5)	32(6.3)	2.628	0.269	17(6.4)	14(5.3)	0.310	0.856
18.5~＜24	214(73.3)	401(78.3)			201(75.3)	203(76.0)
≥24	56(19.2)	79(15.4)			49(18.3)	50(18.7)
妊娠合并症
有	31(10.6)	49(9.6)	0.227	0.634	26(9.7)	25(9.4)	0.022	0.883
无	261(89.4)	463(90.4)			241(90.3)	242(90.6)
早产儿资料
性别
男	161(55.1)	287(56.1)	0.063	0.801	147(55.1)	149(55.8)	0.030	0.862
女	131(44.9)	225(43.9)			120(44.9)	118(44.2)
出生胎龄(周)
28~33⁺⁶	107(36.6)	143(27.9)	6.590	0.011	93(34.8)	81(30.3)	1.228	0.268
≥34	185(63.4)	369(72.1)			174(65.2)	186(69.7)
出生体重(g)
＜1 500	91(31.2)	122(23.8)	5.139	0.023	80(30.0)	69(25.8)	1.126	0.289
≥1 500	201(68.8)	390(76.2)			187(70.0)	198(74.2)
Apgar评分
≥8分	178(61.0)	329(64.3)	0.869	0.351	164(61.4)	171(64.0)	0.393	0.531
≤7分	114(39.0)	183(35.7)			103(38.6)	96(36.0)

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表 2 DOL Ⅱ组与非DOL Ⅱ组母亲的早产儿院内喂养状况比较

Table 2. Comparison of hospital feeding status among preterm infants in DOL Ⅱ group and non-DOL Ⅱ group

组别	例数	胃管留置时间(x±s，d)	开始经口喂养时间(x±s，d)	全经口喂养时间(x±s，d)	出院母乳喂养状况[例(%)]
组别	例数	胃管留置时间(x±s，d)	开始经口喂养时间(x±s，d)	全经口喂养时间(x±s，d)	母乳喂养	混合喂养	人工喂养
DOL Ⅱ组	267	7.85±1.98	6.65±1.53	13.22±2.97	106(39.7)	130(48.7)	31(11.6)
非DOL Ⅱ组	267	7.19±1.67	5.89±1.21	12.84±2.85	121(45.3)	131(49.1)	15(5.6)
统计量		4.164^a	6.115^a	1.508^a	6.479^b
P值		＜0.001	＜0.001	0.132	0.039
注：^a为t值，^b为χ²值。

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表 3 DOL Ⅱ组与非DOL Ⅱ组早产儿母亲母乳喂养状况比较(x ±s)

Table 3. Comparison of breastfeeding status among premature mothers in DOL Ⅱ group and non-DOL Ⅱ group (x ±s)

组别	例数	早期日均泌乳量(mL)	婴儿喂养态度(分)	母乳喂养自我效能(分)
DOL Ⅱ组	267	28.65±7.85	61.44±13.13	48.17±12.41
非DOL Ⅱ组	267	30.75±7.94	68.43±14.52	52.27±13.74
t值		3.073	5.835	3.618
P值		0.002	＜0.001	＜0.001

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