日本新生児成育医学会雑誌　第30巻　第1号　54～61頁（2018年）

日本新生児成育医学会雑誌　30(1)：54-61；2018　

受付日：平成29．02．21

受理日：平成29．07．04

早産児，低出生体重児のNICU 退院時の母乳投与に関する検討

Breastfeeding at Discharge from the NICU in Preterm and/or Low-Birth-Weight Infants

群馬県立小児医療センター　新生児科

Department of Neonatology, Gunma Children’s Medical Center

丸山憲一・小泉亜矢・井上文孝・福田一代・市之宮健二・山﨑　優・宮川陽一

Kenichi MARUYAMA，Aya KOIZUMI，Fumitaka INOUE，Kazuyo FUKUDA， Kenji ICHINOMIYA，Yuu YAMAZAKI，Youichi MIYAKAWA

Key Words：breastfeeding，preterm infant，low-birth-weight infant，neonatal intensive care unit

　早産児，低出生体重児のNICU 退院時の母乳投与の実態とそれに関連する因子を解明するために2013 年3 月～ 2015 年2 月に当科に生後24 時間未満で入院した在胎36 週未満もしくは出生体重2,300g 未満の児196 例を対象に退院時に母乳を投与されていた児の割合および母親と児の病歴等と退院時の母乳投与の関連について検討した。退院時，混合栄養を含め母乳投与のあった児は183 例（93.4％）で，母親の学歴，経産回数，児の性別で退院時，人工栄養の児と有意差を認めた。退院時，母乳のみの児は41 例（20.9％）で，その割合は在胎期間が長く出生体重が多いほど有意に低下し，母乳のみの児とそれ以外の児では，母親の不妊治療，妊娠高血圧症候群，児の授乳開始日齢，退院日齢等で有意差を認めた。出生体重で調整した多変量解析では不妊治療が退院時，母乳のみの投与と関連する有意な因子として見出された。今回の検討で明らかになった因子を考慮して母乳育児支援を行うことが望まれる。

　To clarify the rate of breastfeeding in preterm and/or low-birth-weight infants at discharge from the NICU and the factors associated with breastfeeding at discharge, we reviewed the database and medical records of 196 infants at＜36 weeks of gestational age and/or birth weight＜2,300g who were admitted to our NICU＜24 hours after birth between March 2013 and February 2015. Of the 196 infants, 93.4％ had received breast milk and 20.9％ were exclusively breastfed. The rate of exclusive breastfeeding had a significantly negative correlation with gestational age and birth weight. Compared with formula-fed infants at discharge, those given breast milk had mothers who received significantly higher education and had less maternal parity, and the rate of female infants was higher. Factors, such as maternal fertility treatments and pregnancy-induced hypertension, gestational age, birth weight, Apgar score, artificial ventilation, and age at discharge were significantly different between infants that were exclusively breastfed at discharge in comparison with other infants. A Multivariate analysis adjusted for birth weight revealed that fertility treatment was the sole factor significantly associated with exclusive breastfeeding at discharge. To support breastfeeding in the NICU, these factors should be considered.