| Abstract | Uvod: Isključivo dojenje tijekom prvih šest mjeseci života, a zatim nastavak dojenja tijekom dvije godine i dulje, uz odgovarajuću dohranu, osigurava optimalan rast i razvoj djeteta te štiti od brojnih bolesti². Stoga, SZO i UNICEF pokreću 1991. godine inicijativu ˝Rodilište-prijatelj djece˝ za promidžbu, zaštitu i potporu dojenju u rodilištima. Ova inicijativa temelji se na provedbi ˝Deset koraka prema uspješnom dojenju˝ od kojih 4. korak zagovara uspostavu kontakta koža-na-kožu (KNK) između majke i djeteta odmah po porodu. Brojne studije su pokazale pozitivne učinke 4. koraka na dojenje, ali su kontrolne skupine umotane djece u tim studijama bile vremenski i/ili prostorno odvojene od majke nakon poroda. U ovoj studiji obje skupine su odmah dana majci po porodu.
Cilj: Ispitati učinak kontakta koža-na-kožu između majke i djeteta, neposredno nakon poroda, te ga usporediti s učinkom kontakta između majke i umotanog djeteta na isključivo i ukupno dojenje kod zdrave djece do 12 mj. života.
Ispitanici i metode: Prospektivna kohortna deskriptivna studija, provedena je u Kliničkom bolničkom centru i na Medicinskom fakultetu u Splitu, od veljače 2008. do srpnja 2010. Uključene su sve žene s odjela Klinike za ženske bolesti i porode koje su rodile donošeno, zdravo dijete i koje su namjeravale dojiti i boraviti na području RH. Majke su na otpustu intervjuirane UNICEF-ovim upitnikom za praćenje „Rodilište prijatelj djeteta“ s pomoću kojeg smo odredili provođenje 4. Koraka. Podaci o prehrani djece su prikupljale sestre u rodilištu te istraživači pomoću telefonskih upitnika nakon 3, 6 i 12 mjeseci.
Rezultati: Većina majki je odmah po porodu ostvarila kontakt koža-na-kožu (KNK) njih 589/771 (76%), a ostatak 182/771 (24%) je primilo dijete koje je bilo umotano. Značajno je veći postotak majki, koje su dobile djecu umotanu, u odnosu na one koje nisu, držale dijete dulje od 30 minuta (P< 0,001.) Većina majki (98%) u skupini s kontaktom KNK je rodila vaginalnim putem i dobila dijete odmah nakon poroda, dok ih je u skupini s umotanom djecom bilo svega 45% (P< 0,001). Posljedično tome je 82 % majki iz skupine s kontaktom KNK prvi podoj ostvarilo unutar 12 sati od poroda dok ih je u skupini s umotanom djecom bilo 40, 9% (P< 0,001). U ovom istraživanju stopa isključivog dojenja je bila viša u skupini koja je ostvarila KNK, sve do perioda od 6 mjeseci, ali nije bila statistički značajna. Analiza stope ukupnog dojenja promatrana za periode od 3, 6 i 12 mjeseci također nije pokazala statistički značajnu razliku među ispitivanim skupinama.
Zaključak: U ovom istraživanju uočen je povećan broj isključivog dojenja kod majki koje su ostvarile prvi kontakt s djetetom kožom uz kožu. Iako nije statistički značajan, upućuje na pozitivan utjecaj provođenja 4. koraka inicijative ˝Rodilište-prijatelj djeteta˝. |
| Abstract (english) | Background: Exclusive breastfeeding during the first six months of life, and then continued breastfeeding for two years or longer, with appropriate supplemental feeding, ensures optimal growth and development of children and protects against many diseases. Hence, the WHO and UNICEF began the 'Baby-Friendly Hospital Initiative' in 1991 to promote, protect and support breastfeeding in maternity facilities. This initiative is based on 'Ten steps to successful breastfeeding', of which the fourth step promotes skin-to-skin contact (SSC) between mothers and their newborn upon birth. Numerous studies have shown positive effects of SSC on exclusivity and duration of breastfeeding in comparison to infants who were swaddled and separated from their mothers. This study compares newborns placed in immediate SSC with those swaddled first before being placed in non-SSC contact with their mothers.
Objective: To examine the effect of 'birth' SSC vs. non-SSC on breastfeeding practices in healthy, term infants.
Patients and Methods: This was a prospective cohort descriptive study, conducted at the University Hospital and Medical Faculty in Split between February 2008 and July 2010. All eligible mother-baby pairs were consecutively recruited from the postnatal ward. Mothers were interviewed at discharge using the UNICEF “Questionnaire for Monitoring Baby-Friendly Hospitals” to determine (amongst other things): if newborns were placed in SSC at birth or swaddled; the duration of SSC and the timing of the first breastfeed. Infant feeding data were collected using „Every-feed observation‟ charts² in hospital and via telephone interviews at 3, 6 and 12 months.
Results: Of the total number of mothers included in our analysis (n=771), 589 (76%) received their newborn at birth in SSC while 182/771 (24%) were given their child swaddled. Significantly more women who were given their infants swaddled, held their infants for more than 30 minutes (P<0,001). Most women (98%) who held their newborns in SSC had a vaginal delivery and received their infants immediately following birth versus 45% of women whose children were swaddled (P<0,001). As a result, 82% of mothers from the intervention group breastfed their newborn within 12 hours of birth versus 40,9% of control mothers (P<0,001). In this study, newborns placed in SSC at birth were exclusively breastfed, up until 6 months, more often than their swaddled counterparts, but this difference was not statistically significant. Breastfeeding rates at 3,6 and 12 months were not significantly higher in the group with SSC.
Conclusion: This study showed a trend towards higher exclusive breastfeeding rates among mothers who experienced birth SSC. Even though this did not reach statistical significance, implementing Step 4 of the Baby-Friendly Hospital Initiative suggests a positive effect on breastfeeding and therefore should be routinely performed in all maternity hospitals. |
