日本未熟児新生児学会雑誌　第23巻第2号　90～95頁（2011年）

日本未熟児新生児学会雑誌　23(2)：300-305；2011　

受付日：平成23.01.11

受理日：平成23.04.25

小児病院の周産期センター化が超低出生体重児の母乳栄養に及ぼす影響

Effect of the Opening of an Obstetric Department on the Rate of Breastfeeding in Extremely-Low-Birth-Weight Infants in a Children’s Hospital

群馬県立小児医療センター　新生児科

Department of Neonatology, Gunma Children’s Medical Center, Gunma, Japan

丸山憲一・藤生　徹・浦野博央・井上貴博・関矢亜矢子・井上文孝

Kenichi MARUYAMA，Tohru FUJIU，Hironaka URANO，Takahiro INOUE，Ayako SEKIYA，Fumitaka INOUE

Key Words：breastfeeding，children’s hospital，extremely low birth weight infant，neonatal intensive care unit，obstetric department

　小児病院の周産期センター化が超低出生体重児の母乳栄養に与える影響を調べるために，2005 年5 月の当院産科開設前3 年間と開設後3 年間に生後24 時間以内に当科に入院し，生存退院したそれぞれ40 例と48 例の超低出生体重児を比較検討した。授乳開始日に母乳栄養のみの症例の割合は開設前8％，開設後52％，混合栄養をあわせると開設前25％，開設後79％で，いずれも開設後で有意に高かった。生後1 ヶ月では，母乳栄養のみと混合栄養をあわせると開設前後とも98％であったが，母乳栄養のみの症例は開設前28％，開設後54％と，開設後が有意に高かった。退院前1 週間では，母乳栄養のみの症例は開設前5％，開設後10％，混合栄養をあわせると開設前70％，開設後81％であった。開設後，入院初期の母乳栄養症例の割合は上昇していたが，退院時には開設前と同程度にまで低下しており，新生児科入院中の母乳育児支援について検討する必要がある。

　The Obstetric Department at Gunma Children’s Medical Center was opened in May 2005 for the management of preterm infants and infants with congenital abnormalities from the fetal period. To clarify the effect of the opening of the department on the rate of breastfeeding in extremely-low-birth-weight infants（ELBWIs）admitted to the Neonatal Intensive Care Unit（NICU）in a children’s hospital, we analyzed ELBWIs discharged alive who had been admitted to our NICU within 24 hours after birth in the 3 years before and 3 years after the opening of the department（n=40 and 48, respectively）．The proportion of infants breastfed on the first day of enteral nutrition showed a significant increase （from 25% to 79%）after opening the department, as did the proportion of infants who were exclusively breastfed（from 8% to 52%）．At 1 month of age, the proportion of infants who were exclusively breastfed was significantly higher after the opening than before（54% vs. 28%, respectively），although 98% of infants were breastfed both before and after the opening of the department. In the week prior to discharge, the proportions of infants being breastfed were 70% and 81% （5% and 10% were exclusively breastfed）before and after opening, respectively；these differences were not statistically significant. These results suggest that mothers of ELBWIs need more support for breastfeeding during their infants’ stay in the NICU.