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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 郭年真(Nien-Chen Kuo) | |
dc.contributor.author | Lu Lu Zhao | en |
dc.contributor.author | 趙露露 | zh_TW |
dc.date.accessioned | 2021-06-17T06:19:49Z | - |
dc.date.available | 2023-08-30 | |
dc.date.copyright | 2018-08-30 | |
dc.date.issued | 2018 | |
dc.date.submitted | 2018-08-19 | |
dc.identifier.citation | Bertini, G., Dani, C., Tronchin, M., & Rubaltelli, F. F. (2001). Is breastfeeding really favoring early neonatal jaundice? Pediatrics, 107(3).
Boskabadi, H., Maamouri, G., Ebrahimi, M., Ghayour-Mobarhan, M., Esmaeily, H., Sahebkar, A., & Ferns, G. A. (2010). Neonatal hypernatremia and dehydration in infants receiving inadequate breastfeeding. Asia Pac J Clin Nutr, 19(3), 301-307. Burg, F. D., Ingelfinger, J. R., & Polin, R. A. (2006). Current Pediatric Therapy: Saunders Elsevier. Carbonell, X., Botet, F., Figueras, J., & Riu-Godo, A. (2001). Prediction of hyperbilirubinaemia in the healthy term newborn. Acta Paediatr, 90(2), 166-170. Chang, P. F., Lin, Y. C., Liu, K., Yeh, S. J., & Ni, Y. H. (2011). Risk of hyperbilirubinemia in breast-fed infants. J Pediatr, 159(4), 561-565. Chang, R.-J., Chou, H.-C., Chang, Y.-H., Chen, M.-H., Chen, C.-Y., Hsieh, W.-S., & Tsao, P.-N. (2012). Weight Loss Percentage Prediction of Subsequent Neonatal Hyperbilirubinemia in Exclusively Breastfed Neonates. Pediatrics & Neonatology, 53(1), 41-44. doi: 10.1016/j.pedneo.2011.11.008 Chen, M.-H., Su, Y.-N., Hsieh, W.-S., Chou, H.-C., Chen, C.-Y., & Tsao, P.-N. (2008). UDP-Glucuronosyl Transferase 1A1 (UGT1A1) Gene Polymorphism in Neonatal Hyperbilirubinemia-a Preliminary Report. Clinical Neonatology, 15(1), 20-25. doi: 10.7098/cn.200806.0020 Chou, H. C., Chen, M. H., Yang, H. I., Su, Y. N., Hsieh, W. S., Chen, C. Y., . . . Tsao, P. N. (2011). 211 G to a variation of UDP-glucuronosyl transferase 1A1 gene and neonatal breastfeeding jaundice. Pediatr Res, 69(2), 170-174. Consortium., N. C. N. (2016). Consensus Guidelines for Screening & Management of Hyperbilirubinemia in Neonates. 1-7. Dennery, P. A., Seidman, D. S., & Stevenson, D. K. (2001). Neonatal hyperbilirubinemia. N Engl J Med, 344(8), 581-590. Flaherman, V. J., Schaefer, E. W., Kuzniewicz, M. W., Li, S. X., Walsh, E. M., & Paul, I. M. (2015). Early weight loss nomograms for exclusively breastfed newborns. Pediatrics, 135(1), 2014-1532. Harding, D., Cairns, P., Gupta, S., & Cowan, F. (2001). Hypernatraemia: why bother weighing breast fed babies? : Arch Dis Child Fetal Neonatal Ed. 2001 Sep;85(2):F145. Heinig, M. J. (2001). Host defense benefits of breastfeeding for the infant. Effect of breastfeeding duration and exclusivity. Pediatr Clin North Am, 48(1), 105-123. Horne, R. S., Parslow, P. M., Ferens, D., Watts, A. M., & Adamson, T. M. (2004). Comparison of evoked arousability in breast and formula fed infants. Arch Dis Child, 89(1), 22-25. Howie, P. W., Forsyth, J. S., Ogston, S. A., Clark, A., & Florey, C. D. (1990). Protective effect of breast feeding against infection. Bmj, 300(6716), 11-16. Ip, S., Chung, M., Kulig, J., O'Brien, R., Sege, R., Glicken, S., . . . Lau, J. (2004). An evidence-based review of important issues concerning neonatal hyperbilirubinemia. Pediatrics, 114(1), e130-153. Jones, E. G., Jones, E., & King, C. (2005). Feeding and Nutrition in the Preterm Infant: Elsevier Churchill Livingstone. Kliegman, R. (2011). Nelson Textbook of Pediatrics: Elsevier/Saunders. Labbok, M. H. (2001). Effects of Breastfeeding on the Mother. Pediatric Clinics of North America, 48(1), 143-158. doi: https://doi.org/10.1016/S0031-3955(05)70290-X Mahan, L. K., & Escott-Stump, S. (2000). Krause's Food, Nutrition, & Diet Therapy: W.B. Saunders. Maisels, M. J., Bhutani, V. K., Bogen, D., Newman, T. B., Stark, A. R., & Watchko, J. F. (2009). Hyperbilirubinemia in the Newborn Infant ≥35 Weeks’ Gestation: An Update With Clarifications. Pediatrics, 124(4), 1193-1198. doi: 10.1542/peds.2009-0329 Maisels, M. J., & Gifford, K. (1986). Normal serum bilirubin levels in the newborn and the effect of breast-feeding. Pediatrics, 78(5), 837-843. Maurer, H. M., Shumway, C. N., Draper, D. A., & Hossaini, A. A. (1973). Controlled trial comparing agar, intermittent phototherapy, and continuous phototherapy for reducing neonatal hyperbilirubinemia. J Pediatr, 82(1), 73-76. Newman, T. B., Escobar, G. J., Gonzales, V. M., Armstrong, M. A., Gardner, M. N., & Folck, B. F. (1999). Frequency of neonatal bilirubin testing and hyperbilirubinemia in a large health maintenance organization. Pediatrics, 104(5 Pt 2), 1198-1203. Pediatrics., A. A. o. (2004). Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics, 114(1), 297-316. doi: 10.1542/peds.114.1.297 Picciano, M. F. (2001). Nutrient composition of human milk. Pediatr Clin North Am, 48(1), 53-67. Rubaltelli, F. F. (1993). Unconjugated and conjugated bilirubin pigments during perinatal development. IV. The influence of breast-feeding on neonatal hyperbilirubinemia. Biol Neonate, 64(2-3), 104-109. Schanler, R. J. (2001). The use of human milk for premature infants. Pediatr Clin North Am, 48(1), 207-219. Singhal, A., Farooqi, I. S., O'Rahilly, S., Cole, T. J., Fewtrell, M., & Lucas, A. (2002). Early nutrition and leptin concentrations in later life. Am J Clin Nutr, 75(6), 993-999. Slonim, A. D., & Pollack, M. M. (2006). Pediatric Critical Care Medicine: Lippincott Williams & Wilkins. Soldi, A., Tonetto, P., Varalda, A., & Bertino, E. (2011). Neonatal jaundice and human milk. J Matern Fetal Neonatal Med, 1, 85-87. Tarcan, A., Tiker, F., Vatandas, N. S., Haberal, A., & Gurakan, B. (2005). Weight loss and hypernatremia in breast-fed babies: frequency in neonates with non-hemolytic jaundice. J Paediatr Child Health, 41(9-10), 484-487. Yang, W.-C., Zhao, L.-L., Li, Y.-C., Chen, C.-H., Chang, Y.-J., Fu, Y.-C., & Wu, H.-P. (2013). Bodyweight loss in predicting neonatal hyperbilirubinemia 72 hours after birth in term newborn infants. BMC Pediatrics, 13, 145-145. doi: 10.1186/1471-2431-13-145 Zuppa, A. A., Sindico, P., Antichi, E., Carducci, C., Alighieri, G., Cardiello, V., . . . Romagnoli, C. (2009). Weight loss and jaundice in healthy term newborns in partial and full rooming-in. J Matern Fetal Neonatal Med, 22(9), 801-805. 台大小兒科部編輯委員群. (2014). 實用新生兒科醫療手冊 (2 ed.). 台北: 國立臺灣大學醫學院. 母乳哺育醫療學會臨床程序制訂委員會. (2009). 母乳哺育醫療學會臨床程序#3:醫院中健康足月哺乳嬰兒使用添加物餵食的指導方針,2009 更新版. Breastfeeding Medicine, 4(3), 175-182. doi: 10.1089/bfm.2009.9991 佛教慈濟醫療財團法人臺北慈濟醫院. (2006). 認識慈院/服務理念/設立目的, from http://taipei.tzuchi.com.tw/162/index.php/%E8%AA%8D%E8%AD%98%E6%85%88%E9%99%A2/%E6%9C%8D%E5%8B%99%E7%90%86%E5%BF%B5/%E8%A8%AD%E7%AB%8B%E7%9B%AE%E7%9A%84 佛教慈濟醫療財團法人臺北慈濟醫院. (2015). 婦產部, from http://taipei.tzuchi.com.tw/162/index.php/%E5%A9%A6%E7%94%A2%E9%83%A8 佛教慈濟醫療財團法人臺北慈濟醫院. (2016). 認識慈院/服務理念/大事記要, from http://taipei.tzuchi.com.tw/162/index.php/%E8%AA%8D%E8%AD%98%E6%85%88%E9%99%A2/%E6%9C%8D%E5%8B%99%E7%90%86%E5%BF%B5/%E5%A4%A7%E4%BA%8B%E8%A8%98%E8%A6%81 行政院衛生福利部國民健康署. (2015a). 奶水不足的可能原因與因應對策, from http://health99.hpa.gov.tw/txt/PreciousLifeZone/print.aspx?TopIcNo=891&DS=1-life 行政院衛生福利部國民健康署. (2015b). 母嬰親善醫院, from https://www.hpa.gov.tw/Pages/List.aspx?nodeid=422 行政院衛生福利部國民健康署. (2018). 107年10+母嬰親善醫療院所認證試評基準及評量原則, from https://webcache.googleusercontent.com/search?q=cache:VZUJekC5x4AJ:https://www.hpa.gov.tw/Pages/Detail.aspx%3Fnodeid%3D508%26pid%3D8658+&cd=4&hl=zh-TW&ct=clnk&gl=tw | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/72028 | - |
dc.description.abstract | 研究背景:
隨著衛生福利部國民健康署積極鼓勵全面哺餵母乳的推行,常發現臨床上新生兒因奶量攝取不足以及體重流失比率增加,進而增加高膽紅素血症發生的機會。此項相關性已被一些回溯性研究文獻證實,並找出會導致高膽紅素血症的出生前三天體重流失率的理想預測值,當做介入補充新生兒的奶量之重要依據,但都僅限於回溯性病歷資料分析所得的預測值,並未於臨床上實際應用和證實。 研究目的: 因此本研究將進行前瞻性的臨床研究,探討出生前三天體重流失率已達到預測值的新生兒,及時介入補充奶量,是否可以減少出生72小時以後高膽紅素血症的發生率。 研究方法: 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。 研究結果: 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)。 結論: 新生兒出生第一天體重流失達預測值(大於4.5%)的新生兒,給予即時介入補充奶量,可有效減少發生出生72小時高膽紅素血症的機率。因此,上述預測值,可以作為決定是否介入補充新生兒奶量之有效參考依據。此外新生兒出生後連續補充奶量的天數越多,其出生72小時的膽紅素值會越低,對於減少高膽紅素血症,更加有顯著效果,因此建議及早並且連續的補充奶量。 | zh_TW |
dc.description.abstract | Background:
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. Methods: 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. Results: 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). Conclusion: 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. | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T06:19:49Z (GMT). No. of bitstreams: 1 ntu-107-R02847017-1.pdf: 52302680 bytes, checksum: 2990703ff3ac6b23f703c4725ad36f8f (MD5) Previous issue date: 2018 | en |
dc.description.tableofcontents | 誌 謝 I
中文摘要 II ABSTRACT IV 圖目錄 IX 表目錄 X 第壹章 導論 1 第一節 實習單位特色與簡介 1 第貳章 文獻回顧 4 第一節 母嬰親善(BABY-FRIENDLY) 4 第二節 哺餵母乳(BREASTFEEDING)的優點 5 第三節 新生兒高膽紅素血症(NEONATAL HYPERBILIRUBINEMIA) 7 第四節 新生兒體重流失與高膽紅素血症關係 10 第參章 研究設計與方法 20 第一節 資料來源及研究對象 20 第二節 研究設計與架構 21 第三節 研究變項與操作型定義 21 第肆章 研究結果 28 第一節 研究對象的基本屬性 28 第二節 出生後第一、二及第三天介入措施與膽紅素質的關係 29 第伍章 討論 36 第一節 出生前三天體重流失達預測值的新生兒,即時額外補充奶量對出生72小時高膽紅素血症的影響 36 第二節 母嬰親善醫院評鑑針對補充額外奶量的界定 37 第三節 新生兒生理性脫水的標準常模 38 第陸章 結論與建議 40 第一節 結論 40 第二節 建議 40 第三節 研究限制及未來展望 41 參考文獻 43 附 錄 46 附錄一 人體試驗同意書 46 附錄二 臨床試驗受試者同意書 47 圖目錄 圖 2 1 Guidelines for phototherapy in hospitalized infants of 35 or more weeks' gestation. 14 圖 2 2 Guidelines for exchange transfusion in infants 35 or more weeks gestation 14 圖 2 3 New Phototherapy Thresholds for babies with no neurotoxicity risk factors (NT RF) 15 圖 2 4 New Phototherapy Thresholds for babies with neurotoxicity risk factors (NT RF) 15 圖 2 5 New Exchange Transfusion Thresholds for Babies WITHOUT Neurotoxicity Risk Factors 16 圖 2 6 New Exchange Transfusion Thresholds for Babies WITH Neurotoxicity Risk Factors (NT RF) 16 圖 2 7 出生新生兒體重流失(生理性脫水)的標準常模 17 圖 2 8 新生兒膽紅素值常規標準圖 18 圖 3 1 研究架構圖1 24 圖 3 2 研究架構圖2 24 圖 3 3 研究變項1 25 圖 3 4 研究變項2 25 表目錄 表2 1、照光標準 18 表2 2、換血標準 19 表2 3、積極照光標準 19 表2 4、導致嚴重高膽紅素血症的危險因子 19 表3 1、操作型定義 26 表4 1、研究對象的基本屬性 33 表4 2、出生第一天介入措施與膽紅素質的差異 33 表4 3、出生第二天介入措施與膽紅素質的差異 34 表4 4、出生第三天介入措施與膽紅素質的差異 34 表4 5、出生後連續三天介入措施與膽紅素值的關係 35 表4 6、出生後連續三天介入補充奶水措施與其72小時膽紅素值的差異 35 | |
dc.language.iso | zh-TW | |
dc.title | 出生後三日內介入補充奶水可否減少新生兒出生後72小時的高膽紅素血症之探討 | zh_TW |
dc.title | 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 | en |
dc.type | Thesis | |
dc.date.schoolyear | 106-2 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 黃思誠(Su-Cheng Huang),吳漢屏(Han-Ping Wu) | |
dc.contributor.oralexamcommittee | 楊銘欽(Ming-Chin Yang) | |
dc.subject.keyword | 脫水,新生兒,黃疸,高膽紅素血症,母乳哺餵,體重流失, | zh_TW |
dc.subject.keyword | dehydration,neonatal,jaundice,hyperbilirubinemia,breastfeeding,body weight loss, | en |
dc.relation.page | 50 | |
dc.identifier.doi | 10.6342/NTU201700785 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2018-08-20 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 公共衛生碩士學位學程 | zh_TW |
顯示於系所單位: | 公共衛生碩士學位學程 |
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