当前位置:科学网首页 > 小柯机器人 >详情
“袋鼠妈妈护理法”可提高低出生体重婴儿存活率
作者:小柯机器人 发布时间:2019/10/11 11:24:20

近日,印度卫生研究与发展中心教授Nita Bhandari及其团队的最新研究探讨了社区发起的“袋鼠妈妈护理”对低出生体重婴儿存活率的影响。这一研究成果于2019年10月4日在线发表于《柳叶刀》。

2015年7月30日至2018年10月31日,这项随机对照的优越性试验在印度哈里亚纳邦进行,研究组共招募了8402名出生72小时之内,体重为1500-2250克的婴儿,其中81.4%在卫生机构分娩,36.2%在出生后1小时内进行母乳喂养。将这些婴儿按1:1随机分组,其中干预组4480名,在家接受社区指导的袋鼠妈妈护理,即进行皮肤接触和纯母乳喂养,并在第1-3天、第5天、第7天、第10天、第14天、第21天和第28天接受相应的检查;对照组3922名,接受常规护理。

28天后,干预组有4423名婴儿接受随访,死亡73例;对照组中有3859名婴儿接受随访,死亡90例,风险比为0.70,差异显著。180天后,干预组有3965名婴儿接受随访,共死亡158名;对照组中有3514名婴儿接受随访,共死亡184名,风险比为0.75,差异显著。

综上,社区指导的“袋鼠妈妈护理”大大提高了新生儿和婴儿的存活率。在中低收入国家为所有出生体重较低的婴儿提供袋鼠妈妈护理,可大大降低新生儿死亡率。

据悉,尽管世界卫生组织已经呼吁了十多年,要在卫生机构中推广“袋鼠妈妈护理”,但其覆盖率仍然很低,而在社区层面开展“袋鼠妈妈护理”有望提高覆盖率。

附:英文原文

Title: Effect of community-initiated kangaroo mother care on survival of infants with low birthweight: a randomised controlled trial

Author: Sarmila Mazumder, Sunita Taneja, Brinda Dube, Kiran Bhatia, Runa Ghosh, Medha Shekhar, Bireshwar Sinha, Rajiv Bahl, Jose Martines, Maharaj Kishan Bhan, Halvor Sommerfelt, Nita Bhandari

Issue&Volume: 4 October 2019

Abstract: 

Background

Coverage of kangaroo mother care remains very low despite WHO recommendations for its use for babies with low birthweight in health facilities for over a decade. Initiating kangaroo mother care at the community level is a promising strategy to increase coverage. However, knowledge of the efficacy of community-initiated kangaroo mother care is still lacking. We aimed to assess the effect of community-initiated kangaroo mother care provided to babies weighing 1500–2250 g on neonatal and infant survival.

Methods

In this randomised controlled, superiority trial, undertaken in Haryana, India, we enrolled babies weighing 1500–2250 g at home within 72 h of birth, if not already initiated in kangaroo mother care, irrespective of place of birth (ie, home or health facility) and who were stable and feeding. The first eligible infants in households were randomly assigned (1:1) to the intervention (community-initiated kangaroo mother care) or control group by block randomisation using permuted blocks of variable size. Twins were allocated to the same group. For second eligible infants in the same household as an enrolled infant, if the first infant was assigned to the intervention group the second infant was also assigned to this group, whereas if the first infant was assigned to the control group the second infant was randomly assigned (1:1) to the intervention or control group. Mothers and infants in the intervention group were visited at home (days 1–3, 5, 7, 10, 14, 21, and 28) to support kangaroo mother care (ie, skin-to-skin contact and exclusive breastfeeding). The control group received routine care. The two primary outcomes were mortality between enrolment and 28 days and between enrolment and 180 days. Analysis was by intention to treat and adjusted for clustering within households. The effect of the intervention on mortality was assessed with person-time in the denominator using Cox proportional hazards model. This study is registered with ClinicalTrials.gov, NCT02653534 and NCT02631343, and is now closed to new participants.

Findings

Between July 30, 2015, and Oct 31, 2018, 8402 babies were enrolled, of whom 4480 were assigned to the intervention group and 3922 to the control group. Most births (6837 [81·4%]) occurred at a health facility, 36·2% (n=3045) had initiated breastfeeding within 1 h of birth, and infants were enrolled at an average of about 30 h (SD 17) of age. Vital status was known for 4470 infants in the intervention group and 3914 in the control group at age 28 days, and for 3653 in the intervention group and 3331 in the control group at age 180 days. Between enrolment and 28 days, 73 infants died in 4423 periods of 28 days in the intervention group and 90 deaths in 3859 periods of 28 days in the control group (hazard ratio [HR] 0·70, 95% CI 0·51–0·96; p=0·027). Between enrolment and 180 days, 158 infants died in 3965 periods of 180 days in the intervention group and 184 infants died in 3514 periods of 180 days in the control group (HR 0·75, 0·60–0·93; p=0·010). The risk ratios for death were almost the same as the HRs (28-day mortality 0·71, 95% CI 0·52– 0·97; p=0·032; 180-day mortality 0·76, 0·60–0·95; p=0·017).

Interpretation

Community-initiated kangaroo mother care substantially improves newborn baby and infant survival. In low-income and middle-income countries, incorporation of kangaroo mother care for all infants with low birthweight, irrespective of place of birth, could substantially reduce neonatal and infant mortality.

DOI: 10.1016/S0140-6736(19)32223-8

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32223-8/fulltext

期刊信息

LANCET:《柳叶刀》,创刊于1823年。隶属于爱思唯尔出版社,最新IF:59.102
官方网址:http://www.thelancet.com/
投稿链接:http://ees.elsevier.com/thelancet