日本新生児成育医学会雑誌　第32巻　第2号　115 ～ 122頁（2020年）

日本新生児成育医学会雑誌　32(2)：353-360；2020　

受付日：2019．10．04

受理日：2020．01．23

「赤ちゃんにやさしい病院」認定施設のNICU/GCU における母乳育児支援の現状

Breastfeeding Support and Infants’ Nutritional Status among Neonatal Intensive Care Units in Certified Baby Friendly Hospitals（ BFH） in Japan

一般社団法人日本母乳の会　BFNICU ワーキングチーム
＊ 1 愛仁会高槻病院　総合周産期母子医療センター　新生児科，＊ 2 富山県立中央病院　小児科，＊ 3 新潟市民病院　新生児内科，＊ 4 岐阜県総合医療センター　新生児内科，＊ 5 熊本市民病院　新生児内科

Baby Friendly NICU Working Team, Japan Breastfeeding Association ＊ 1 Department of Neonatology, Aijinkai Takatsuki General Hospital，＊ 2 Department of Pediatrics, Toyama Prefectural Central Hospital，＊ 3 Maternal and Perinatal Care Center, Niigata City General Hospital，＊ 4 Department of Neonatology, Gifu Prefectural General Medical Center，＊ 5 Department of Neonatology, Perinatal Center, Kumamoto City Hospital

菊池　新＊ 1・畑崎喜芳＊ 2・永山善久＊ 3・河野芳功＊ 4・近藤裕一＊ 5

Shin KIKUCHI ＊ 1，Kiyoshi HATASAKI ＊ 2，Yoshihisa NAGAYAMA ＊ 3，Yoshinori KOHNO ＊ 4，Yuuichi KONDO ＊ 5

Key Words：breastfeeding support，baby friendly hospital，nutrition，family centered care，kangaroo care

　NICU を有する赤ちゃんにやさしい病院認定施設の母乳育児支援の現状を調査した。NICU/GCU における母乳育児に関する方針があるのは67％で，うち61％は文書化されていた。母乳育児支援に関するスタッフ教育は96％で実施されていた。母親への産前教育や情報提供は93％で実施されていた。主たる支援者は内容にかかわらず助産師と看護師であり，NICU と産科病棟間のカルテによる情報共有は93％でされていた。搾乳を児の傍で行うのは81％で，そのうち手と搾乳器の併用が85％だった。早産児のカンガルーケアは81％，挿管中でも27％で行われ，開始時期は様々であった。きょうだい・祖父母面会が56％・74％で実施されている一方で，両親の面会制限が41％にあった。初乳分泌までの栄養は人工乳と絶食が多く，もらい乳は11％だった。実践の多くが「母乳育児成功のための10 か条」に準拠し，科学的根拠に基づく内容となっていた。施設方針の明文化や制限のない両親面会など，今後の課題も明らかとなった。

BACKGROUND：In 2009, the Nordic and Quebec working group developed a unified expansion of the Baby-Friendly Hospital Initiative to Neonatal Wards（ Neo-BFHI）. To start Baby-Friendly neonative intensive care unit（ NICU） designation in Japan, it was necessary to understand the present status of breastfeeding support among NICUs in certified BFHs.
METHODS：We conducted a questionnaire survey on breastfeeding support and nutritional policy among NICUs in Japanese BFHs. We sent pre-structured questionnaires to 28 participating facilities and asked them to respond to each question based on their status as of April 1, 2015.
RESULTS：Responses were obtained from all facilities except for one hospital that was out of service due to disastrous earthquake. Two-thirds had breastfeeding policy；of those, 61 percent also had a written policy. Education and training of the nursing staff and physicians on infant nutrition was routinely conducted in 96 percent. Breastfeeding was mainly supported by midwives and nurses, rather than physicians. Maternal breastfeeding information was shared via medical records between NICU and other wards in 93 percent. Mothers were encouraged to express milk nearby their infants in 81 percent；both with hands and pumps in 85 percent. Kangaroo mother care for preterm babies was implemented in 81 percent；even when continuous positive airway pressure（ CPAP） or intubated in 50 and 27 percent, respectively. While parental visit was partially restricted in 41 percent of facilities, siblings and grandparents were encouraged to meet infants in 56 and 74 percent, respectively. Most common options in nutrition before colostrum were artificial milk and non per os.
CONCLUSIONS：Most practices of breastfeeding support and nutritional policies in BFH NICUs were based on ten steps of successful breastfeeding or other evidence. More effort is expected to expand evidence-based breastfeeding support and practice in NICU.