BREASTFEEDING SERVICES FOR LBW INFANTS-OUTCOMES AND COST

低出生体重婴儿的母乳喂养服务 - 结果和成本

• 批准号: 2257882
• 负责人: LINDA P BROWN
• 金额: $ 67.21万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 1995
• 资助国家: 美国
• 起止时间: 1995-09-01 至 2000-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2257882
• 关键词: breast feeding; clinical trials; developmental nutrition; female; health care cost /financing; health care model; health care service; human subject; low birth weight infant human; nurse practitioners; prognosis

DESCRIPTION: (Adapted from applicant abstract) Human milk affords specific health benefits for low birth weight (LBW < 2500g) infants. While increasing the frequency and duration of breastfeeding is a national priority, only 35% of mothers who deliver LBW infants initiate breastfeeding and of these, less than 50% sustain breastfeeding beyond infant hospital discharge. These lower breastfeeding rates among mothers of LBW infants can be explained by the fact that these women experience numerous problems that are unique to breastfed LBW infants. Although models for providing breastfeeding support services have been described, these services are geared to mothers of healthy term infants and are inadequate for meeting the unique needs of mothers of LBW infants. Only one research-based model for providing in-hospital breastfeeding support services for mothers and preterm/high risk infants has been described in the literature; no models for providing post- discharge breastfeeding services for mothers of LBW infants have been described. Mothers of LBW infants need consistent, comprehensive breastfeeding services provided by individuals who are skilled in both the care of LBW infants and management of lactation. The Perinatal Advanced Practice Nurse (PAPN) is the ideal professional to meet this health care need. The PAPN would provide breastfeeding services (pre- and post-infant discharge) that are specific to mothers and LBW infants, including skilled assessment, technical assistance, education, and support. The purpose of this randomized clinical trial is to compare maternal outcomes, infant outcomes and cost of care between two groups of women who breastfeed their LBW infants; a control group receiving routine breastfeeding care and an intervention group receiving a structured program of breastfeeding services provided by PAPNs. The study will test the following hypotheses: A structured program of breastfeeding services provided by PAPNs compared to routine care for breastfeeding will result in: 1) Improved maternal outcomes: more frequent and earlier transition to breast; increased milk volume; increased duration of breastfeeding; and greater attainment of breastfeeding goals; decreased anxiety and depression and greater satisfaction with care; 2) Improved infant outcomes: fewer acute care visits and rehospitalizations; and improved mental and motor development; 3) Decreased cost of care: decreased total costs per subject and decreased average rehospitalization cost. Additionally, the study will examine differences in growth between the two groups, predictors of improved maternal/infant outcomes and interventions used by PAPNs. Both groups will be followed for 1 year post infant discharge. Data analysis will include MANOVA, chi-square and t-tests. Data will be important to consumers, researchers, providers, insurers, and policy makers.

描述：（改编自申请人摘要）人牛奶负担得起 低出生体重（LBW <2500G）的特定健康益处。 同时增加母乳喂养的频率和持续时间是 国家优先事项，只有35％的母亲启动LBW婴儿 母乳喂养和这些，不到50％的母乳喂养 婴儿医院出院。这些较低的母乳喂养率 LBW婴儿的母亲可以通过这些妇女来解释 经历了许多母乳喂养婴儿独有的问题。 尽管提供母乳喂养支持服务的模型已经 描述的是，这些服务适用于健康的婴儿的母亲 并且不足以满足LBW母亲的独特需求 婴儿。只有一个基于研究的模型来提供院内 母亲的母乳喂养支持服务和早产/高风险婴儿 在文献中已经描述了；没有提供后的模型 LBW婴儿母亲的出院母乳喂养服务已经 描述。 LBW婴儿的母亲需要一致，全面 熟练的个人提供的母乳喂养服务 LBW婴儿的护理和哺乳治疗。围产期 高级练习护士（PAPN）是满足这一目标的理想专业人士 医疗保健需求。纸纸将提供母乳喂养服务（前 特定于母亲和LBW婴儿的侵害后出院） 包括熟练的评估，技术援助，教育和 支持。这项随机临床试验的目的是比较 两组之间的孕产妇结果，婴儿结果和护理成本 母乳喂养LBW婴儿的女性；接收对照组 常规母乳喂养护理和一个接受干预组 Papn提供的母乳喂养服务的结构化计划。这 研究将检验以下假设：一个结构化程序 与常规护理相比，Papn提供的母乳喂养服务 母乳喂养将导致：1）改善母亲的预后：更多 经常过渡到乳房；增加牛奶量； 母乳喂养持续时间增加；并获得更大的成就 母乳喂养目标；减轻焦虑和抑郁和更大的 对护理的满意； 2）改善婴儿结局：较少的急性护理 访问和复兴；并改善了心理和运动的发展； 3）降低护理成本：每人总成本降低，并且 平均重新住院成本降低。此外，该研究将 检查两组之间的生长差异，预测指标 纸纸使用的改善的母亲/婴儿的结果和干预措施。两个都 婴儿出院后1年将遵循小组。数据分析 将包括Manova，卡方和T检验。数据对 消费者，研究人员，提供者，保险公司和政策制定者。