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Can Early Intervention of Supplementary Feeding within the First Three Days after Birth to Decrease Significant Hyper-Bilirubinemia 72 hours after Birth in Term Newborn Infants
|Authors:||Lu Lu Zhao|
dehydration,neonatal,jaundice,hyperbilirubinemia,breastfeeding,body weight loss,
|Publication Year :||2018|
於西元2016年11月至2018年05月期間，收集395位台北慈濟醫院嬰兒室，出生時週數等於或大於37週，且出生體重等於或大於2500公克的新生兒；其中280位於出生前3天體重流失率達本研究設定之預測值（體重流失預測值為出生第一、二、三天分別：4.5%、7.5%、8%，預期會導致出生72小時以後續發高膽紅素血症者）的新生兒納入本研究個案。將納入個案分為介入補充奶量的實驗組及不介入的對照組。使用SPSS 22.0版統計套裝軟體分析此兩組於出生72小時以後膽紅素值是否有差異。此外將符合納入研究者，依出生後連續0天，一天，兩天，三天介入補充新生兒奶量分為Ⅰ、Ⅱ、Ⅲ、Ⅳ四組，以連續介入補充奶量0天組（即不介入補充奶量）A組為基準，使用Kruskal Wallis Test，Jonckheere-Terpstra Test及Multiple linear regression test，進行統計分析，比較各組間的膽紅素值是否有差異。
於西元2016年至2018年期間，395位嬰兒室的新生兒，其中280位體重流失率已達預測值的新生兒納入本研究個案。結果顯示出生第一天體重流失達預測值之新生兒，因而介入補充奶量的實驗組，其膽紅素值比不介入的對照組低，並且達到顯著標準。出生第二天，第三天體重流失達預測值之新生兒，因而介入補充奶量的實驗組，其膽紅素值相對於不介入的對照組略低，但未達到統計上顯著差異。此外，新生兒出生後，連續三天介入補充奶量，與出生後只連續兩天及一天介入補充奶量這兩組相較，除了其出生72小時以後膽紅素值最低外，此三組的膽紅素值下降有越來越低的趨勢，並且P值達到顯著標準(p < 0.05)。
According to the Health Promotion Administration Ministry of Health and Welfare recommendation full implementation of breastfeeding clinically commonly leads to insufficient milk intake of newborns and increase the rate of body weight loss and hyperbilirubinemia in newborn. This correlation has been confirmed by a number of retrospective studies and identified an ideal predictive value for the first three-day weight loss rate after birth to predict hyperbilirubinemia. This finding may be important for early intervention of supplemental feeding in newborn. However, the results obtained from the retrospective analysis have not been actually applied and confirmed in clinical practice. Therefore, we aim to conduct a prospective clinical study to investigate whether early intervention of supplemental feeding to newborns whose birth weight loss rate has reached the predictive value for the first three days after birth can decrease the incidence of hyperbilirubinemia at 72 hours of birth.
We collected all neonates with gestational age ≧37 weeks and birth body weight ≧2500g, born between November 2016 and May 2018 from nursery in Taipei Tzu Chi Hospital. A total of 395 neonates were born during this study period, and among them 280 neonates with the body weight loss rate reaching the predictive value (4.5%, 7.5%, 8% on the first, second, third day after birth, respectively) for subsequent hyperbilirubinemia at the 72 hours after birth were enrolled in further analysis. The enrolled cases were divided into experimental groups with interventional milk supply and non-involved control groups. We used the SPSS statistical software to analyze and compare the difference in serum bilirubin levels between the two groups at the 72 hours of birth. In addition, the cases enrolled were further divided into four subgroups (Ⅰ,Ⅱ,Ⅲ andⅣ) as interventional consecutive milk supplement for 0, 1, 2, and 3 days after birth. We used Kruskal Wallis Test, Jonckheere-Terpstra Test and multiple linear regression analysis to analyze and compare the difference in serum bilirubin levels at 72 hours after birth aroung the 4 groups.
During the study period, 280 neonates with the body weight loss rate reaching the predictive values for potential hyperbilirubinemia at the 72 hours after birth were enrolled in our study. For newborns with birth weight loss reaching the predictive value on the first day after birth, the serum bilirubin levels were lower in the experimental group than those in the non-involved control group (p<0.05). Newborns with birth weight loss reached the predictive values on the second and third days of birth had lower serum bilirubin levels than those in the non-involved control group, but there was no statistically significant difference. In addition, for newborns with three consecutive days of interventional milk supplementation, the serum bilirubin levels at the 72 hours after birth showed the lowest levels compared with the other sub-groups with two consecutive days and one consecutive day of interventional milk supplementation (p<0.05). Moreover, there was a significantly decreasing trend in the consecutive days of interventional milk supplementation (p<0.05).
Newborns with body weight loss over 4.5% on the first day after birth receiving early intervention milk supplementation could significantly reduce serum biliruin levels at the 72 hours after birth. Therefore, the above predictive value of body weight loss over 4.5% may serve as a helpful criterion to identify those needing the intervention for supplemental feeding. In addition, the more days of consecutive milk supplementation after birth, the lower the 72 hours serum bilirubin levels. It is recommended to early and consecutive milk supplementation after birth to be an effective way in reducing serum, bilirubin levels.
|Appears in Collections:||公共衛生碩士學位學程|
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