本帖最後由 yanjw2000 於 2009-7-28 21:45 編輯
作者：Laurie Barclay, MD
出處：WebMD醫學新聞
July 14, 2009 — 根據一項線上發表在7月14日兒童疾病學誌上收集定性與定量研究的系統性綜論，餵食營養品的母親們，其需求經常是被忽略的，這使得他們的嬰兒處於潛在風險中。
英國劍橋大學MRC流行病學單位的R. Lakshman寫到，大部分嬰兒使用至少部分配方奶。配方餵食的方法差異可能對健康有短期與長期的影響。這篇文獻系統性地評論病患對餵食營養品的經驗，以瞭解如何做出配方餵食的決定。
透過搜尋12個電子資料庫、參考資料清單、以及相關文獻，還有與相關文獻的第一作者連繫，作者們系統性地搜尋並且評估符合主題的英文文獻。藉由論述與主題方式，作者們分析收納的研究，並在最後的結論、闡釋、以及形成研究中達成共識。
收納的研究包括6篇定性研究與17篇定量研究，總共收納了13,263位受試者。雖然實驗設計、內容、焦點與品質上有相當的差異，仍有許多共通的發現。
提供營養品的母親們表示有罪惡感、在哺乳壓力下的氣憤、擔心人工營養品對她們寶寶的影響、不確定性、感到失敗、以及其他負面情感。
因為母親們對於營養品的資訊並不充足，她們並未感到有足夠能力做出決定，且她們在準備營養品時經常犯錯，這可能增加感染、體重過重、或是營養不良的風險。部分採用營養品餵食的媽媽覺得醫院的助產士花比較多的時間對待餵母乳的媽媽，而部分媽媽表示餵食營養品讓她們比較輕鬆。研究團隊並沒有找到研究這些母親們如何決定餵食頻率或是量的文獻。
研究團隊寫到，資訊與支持的缺乏對決定以營養品餵食的媽媽而言，可能致使其寶寶的健康處於風險下。鼓勵哺餵母乳是很重要的，但也需要確保符合餵食營養品母親們的需求。
這項研究的限制包括，大部分的研究都於英國或美國進行，缺乏應用到其他國家的一般性，以及缺乏報告父親的經驗與態度的研究。
研究團隊的結論是，因為絕大部分的寶寶在一歲前至少接受一種以上配方奶，安全且正確地準備及給予這些營養品是很重要的。雖然增加餵母乳的意願或時間很重要，也有必要對選擇以營養品餵食的父母們，以敏感與客觀的方式，透過提供足夠的資訊及支持來降低與餵食營養品相關的風險。
醫療研究局贊助這項研究且提供其中一位作者經費。研究作者們表示沒有相關資金上的往來。
Needs of Bottle-Feeding Mothers May Require More Attention
By Laurie Barclay, MD
Medscape Medical News
July 14, 2009 — The needs of mothers who bottle-feed are being neglected, potentially risking the health of their infants, according to the results of a systematic review of qualitative and quantitative studies reported online first in the July 14 issue of the Archives of Disease in Childhood.
"Most babies receive at least some formula milk," write R. Lakshman, from the MRC Epidemiology Unit, University of Cambridge, United Kingdom, and colleagues. "Variations in formula-feeding practices can have both short- and long-term health consequences. The literature on parents' experiences of bottle-feeding was systematically reviewed to understand how formula-feeding decisions are made."
By searching 12 electronic databases, reference lists, and related articles, and by contacting first authors of identified papers, the reviewers systematically searched for and evaluated pertinent English-language papers. Using narrative as well as thematic approaches, the reviewers analyzed the included studies and reached consensus on the final inclusion, interpretation, and synthesis of studies.
The included studies were 6 qualitative studies and 17 quantitative studies enrolling a total of 13,263 participants. There were several consistent findings despite considerable heterogeneity in study design, context, focus, and quality.
Guilt, anger regarding feeling under pressure to breast-feed, worry about the effect of bottle-feeding on their baby, uncertainty, a sense of failure, and other negative emotions were reported by mothers who bottle-fed their babies.
Because mothers received little information on bottle-feeding, they did not feel empowered for decision-making, and they often made mistakes when preparing bottles, which could increase the risk for infection, excessive weight gain, or malnourishment. Some bottle-feeding mothers felt that hospital midwives spent far more time with breast-feeding mothers, and others reported a sense of relief that they were bottle-feeding. The reviewers identified no studies reporting on how mothers made decisions regarding the frequency or quantity of bottle-feeding.
"Inadequate information and support for mothers who decide to bottle-feed may put the health of their babies at risk," the study authors write. "While it is important to promote breast-feeding, it is also necessary to ensure that the needs of bottle-feeding mothers are met."
Limitations of this study include that most studies were conducted in the United Kingdom or the United States, a lack of generalizability to developing countries, and a lack of studies reporting on fathers' experiences or attitudes.
"Since the vast majority of babies receive at least some formula milk during the first year of life, it is important that this is prepared and administered safely and correctly," the review authors conclude. "While it is important to increase the initiation and duration of breast-feeding, it is also necessary to minimize the risks associated with bottle-feeding by providing adequate information and support in a sensitive and non-judgmental manner to parents who choose to bottle-feed their infants."
The Medical Research Council supported this study and funded one of its authors. The authors have disclosed no relevant financial relationships.
Arch Dis Childhood. Published online July 14, 2009. |
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