[논문]Effects of a Breastfeeding Support Program on the Prevalence of Exclusive Breastfeeding and Growth in Late Preterm Infants

Jang, Gun Ja; Hong, Yeon Ran

doi:10.4094/chnr.2020.26.1.90

Effects of a Breastfeeding Support Program on the Prevalence of Exclusive Breastfeeding and Growth in Late Preterm Infants 원문보기

CHNR : Child health nursing research, v.26 no.1, 2020년, pp.90 - 97

Jang, Gun Ja (Department of Nursing, Daegu University) , Hong, Yeon Ran (Department of Nursing, Sunchon National University)

Abstract ▼ AI-Helper

Purpose: The purpose of this study was to investigate the effects of a breastfeeding support program (BSP) on the prevalence of exclusive breastfeeding and growth in late-preterm infants. Methods: A quasi-experimental study was conducted. The participants were 40 late preterm infants (LPIs), of whom 20 were assigned to the experimental group and 20 to the control group. For the mothers in the experimental group, a BSP was provided prior to the LPIs' discharge and reinforced once a week for 4 weeks. Information on the feeding type was collected by observation and the LPIs' body weight was measured. Results: There were significant differences in feeding type by group and time. Exclusive breastfeeding was 5.18 times more common in the experimental group than in the control group (odds ratio=5.18, 95% confidence interval=1.11~16.70). However, weekly weight gain did not show a significant relationship with group and time (F=0.40, p=.712). Conclusion: The BSP was helpful for increasing the rate of exclusive breastfeeding in LPIs. Furthermore, the LPIs in the experimental group, which had a higher likelihood of being exclusively breastfed, showed an equivalent amount of weight gain as the LPIs in the control group, in which infants were more likely to be formula-fed.

주제어

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문제 정의

This was the first study in Korea to develop a BSP for mothers with LPIs and to determine the effect of the BSP on exclusive feeding in LPIs from discharge to the fourth week after discharge. The BSP, a vital program for establishing exclusive breastfeeding in LPIs, was developed to reinforce and supplement breastfeeding education during LPIs’ hospitalization, as there are few standard guidelines for breastfeeding LPIs.
Thus, the purpose of this study was to investigate the effects of a BSP on the prevalence of exclusive breastfeeding and weekly weight gain in late-preterm infants for 4 weeks after hospital discharge.

제안 방법

At third and fourth week, LPIs’ mothers were taught how to encourage their infants to latch and to properly breastfeed, with the aim of establishing exclusive breastfeeding.
LPIs’ body weight was measured using an electric scale (CAS Computing Scale, CAS Corp., Gyeonggi-do, Korea) at each of the four weekly visits.
The first few weeks after LPIs’ discharge are a crucial period of transition from any feeding into exclusive breastfeeding, so LPIs’ mothers were provided with breastfeeding support on a weekly basis. Mothers in both groups received home visits from the same researcher, a certified lactation consultant, once a week for 4 weeks. LPIs’ body weight was measured using an electric scale (CAS Computing Scale, CAS Corp.
The following criteria were considered: a significance level of 5%, a power of 80%, the presence of two parallel groups with four sets of repeated measures, and breastfeeding proportions in the experimental and control group of 50% and 20%, respectively.
This program consisted of a web-based breastfeeding education program (http://momfeed.co.kr/) and practical breastfeeding support based on LPIs’ feeding ability and mothers’ health issues once a week from the first week to the fourth week, provided by the researcher at home visits.
This study also expanded upon the limitations of previous studies, which analyzed feeding types based on mothers’ self-reports, rather than on reliable findings obtained through direct observations.
This study utilized a quasi-experimental design with a time -series, and data were collected four times after LPIs’ discharge.

대상 데이터

Based on these assumptions, the required sample size was calculated to be 36 LPIs and the targeted sample size was 40 LPIs, anticipating a 10% dropout rate. The participants consisted of 40 LPIs hospitalized in a nursery or NICU of one hospital in Daegu city between March 2015 and January 2016. Twenty LPIs and 16 of their mothers were assigned to the experimental group, and twenty LPIs and 16 of their mothers to the control group.

데이터처리

The x² test was used to compare feeding types between the two groups at each week for 4 weeks. As the feeding type for the 4 weeks after discharge was repeatedly measured over time, the effects of BSP on exclusive feeding were analyzed by generalized estimating equations (GEE), and weekly weight gain by repeated-measures ANOVA. For the GEE analysis, feeding type was transformed into a binary variable by grouping formula feeding and mixed feeding together, versus exclusive feeding.

성능/효과

A statistically significant difference between the groups was found in terms of whether the LPIs engaged in “exclusive breastfeeding” or “mixed or formula feeding” (odds ratio [OR] =5.18, 95% confidence interval [CI]=1.11~16.70).
The following criteria were considered: a significance level of 5%, a power of 80%, the presence of two parallel groups with four sets of repeated measures, and breastfeeding proportions in the experimental and control group of 50% and 20%, respectively. Based on these assumptions, the required sample size was calculated to be 36 LPIs and the targeted sample size was 40 LPIs, anticipating a 10% dropout rate. The participants consisted of 40 LPIs hospitalized in a nursery or NICU of one hospital in Daegu city between March 2015 and January 2016.
Despite the differences across various clinical settings in terms of breastfeeding for LPIs, this study demonstrated that the breastfeeding support provided by a BSP enhanced the breastfeeding rate for LPIs.
Furthermore, when comparing “exclusive breastfeeding” to “mixed or formula feeding” by time, statistically significant differences were found at the second week (OR=7.05, 95% CI=1.66~29.90), third week (OR=11.98, 95% CI=2.71~52.89), and fourth week (OR=15.21, 95% CI=3.34~69.19).
0%) at the fourth week. In contrast, the exclusive breastfeeding rate in the control group increased by 15.0% from two LPIs (10.0%) at the first week to five LPIs (25.0%) at the fourth week, while the rate of formula feeding also increased by 45.0% from four LPIs (20.0%) at the first week to 13 LPIs (65.0%) at the fourth week after discharge. The BSP demonstrated a positive association with a transition to exclusive breastfeeding from mixed feeding.
No significant differences in the LPIs’ weekly weight gain were found by group (F=0.01, p=.912), time (F=1.83, p=.158), and the interaction of group and time (F=0.40, p=.712) (Table 4).
One of the most important results of this study was that the BSP provided to the experimental group was effective for increasing the prevalence of exclusive breastfeeding at the fourth week after discharge. For instance, the exclusive breastfeeding rate in the experimental group increased by 45.

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