目的 探讨硬膜外分娩镇痛对新生儿吸吮能力和母乳喂养的影响。 方法 采用前瞻性队列研究设计，研究对象为2022年1月至2022年12月在南通大学附属妇幼保健院分娩的产妇。按是否选择硬膜外分娩镇痛，将其分为硬膜外镇痛组和未镇痛组。采用吸吮负压测量仪在新生儿生后3 d内每天测量新生儿吸吮母亲乳头时的口腔负压，记录吸吮负压均值、峰值和谷值。采用中文版婴儿母乳喂养评估工具（Infant Breastfeeding Assessment Tool，IBAT）评估新生儿吸吮姿势。记录并随访产妇在院期间和出院后第1、4、6个月的母乳喂养情况。采用两独立样本t检验、χ2检验（或Fisher精确概率法）及广义估计方程等方法对数据进行统计分析。 结果 共156例产妇纳入最终分析，2组各78例。镇痛组比未镇痛组产妇的总产程、第一产程和第二产程时间更长［M（P25~P75），430 min（353～541 min）与300 min（235～422 min），Z=－5.65；385 min（310～490 min）与260 min（205～347 min），Z=－5.81；40 min（26～67 min）与33 min（18～45 min），Z=－2.33；P值均<0.05］，产前使用催产素和选择导乐分娩者更多［94.8%（74/78）与43.6%（34/78），χ2=48.15；42.3%（33/78）与19.2%（15/78），χ2=9.75；P值均<0.05］。2组产妇的产后疲乏、抑郁和睡眠情况，以及孕期生活事件量表评分的差异均无统计学意义。广义估计方程分析控制混杂因素后，镇痛组新生儿生后3 d内（0~24 h、>24~48 h、>48~72 h）中位吸吮负压均值低于未镇痛组［分别为5.14 kPa（3.39~6.52 kPa）与6.39 kPa（4.95~9.15 kPa）、5.07 kPa（3.94~7.38 kPa）与6.20 kPa（5.08~8.54 kPa）和6.19 kPa（4.64~8.36 kPa）与6.81 kPa（5.88~8.05 kPa），Waldχ2=5.59，P=0.018］；峰值也低于未镇痛组［15.81 kPa（9.74~21.68 kPa）与16.21 kPa（13.58~24.88 kPa）、13.50 kPa（9.83~16.50 kPa）与17.62 kPa（14.01~22.40 kPa）和14.66 kPa（10.47~18.71 kPa）与18.04 kPa（15.33~19.85 kPa），Waldχ2=7.25，P=0.007］；谷值在2组间差异无统计学意义。镇痛组新生儿生后3 d内每天吸吮姿势的IBAT得分低于未镇痛组新生儿［分别为10分（9~10分）与10分（10～11分）、10分（9~11分）与11分（10~11分）和10分（10~11分）与11分（11~12分），Waldχ2=17.05，P=0.001］。镇痛组产后3 d内的纯母乳喂养率［分别为67.9%（53/78）、41.0%（32/78）和38.5%（30/78）］低于未镇痛组［分别为75.6%（59/78）、44.9%（35/78）与55.1%（43/78），Waldχ2=4.21，P=0.040）。2组产后1、4和6个月纯母乳喂养率差异均无统计学意义。 结论 硬膜外分娩镇痛可导致新生儿早期吸吮负压下降，影响新生儿吸吮姿势，降低在院期间的纯母乳喂养率，但与产后6个月内纯母乳喂养率无明显相关性。 Objective To investigate the effects of epidural labor analgesia on neonatal sucking ability and breastfeeding. Methods This was a prospective cohort study. Convenience sampling was used to enroll women who delivered with or without epidural analgesia (epidural analgesia and non-analgesia groups) in the Affiliated Maternity and Child Health Care Hospital of Nantong University from January 2022 to December 2022. Intra-oral negative pressure values during breastfeeding were measured by a pressure measuring instrument within 3 d after birth (0-24 h, >24-48 h, and >48-72 h), and the mean, maximum, and minimum pressure values were recorded. The Infant Breastfeeding Assessment Tool (IBAT) (Chinese version) was used to evaluate sucking posture. Breastfeeding status during hospitalization and within 1, 4, and 6 months after discharge were followed up. Two independent samples t-test, Chi-square (Fisher's exact) test, and generalized estimating equations were used for data analysis. Results A total of 156 mother-infant pairs were analyzed in this study, with 78 pairs in the epidural analgesia group and 78 pairs in the non-analgesia group. The whole, first, and second stages of labor were longer in the analgesia group than those in the non-analgesia group [M(P25-P75), total: 430 min (353-541 min) vs. 300 min (235-422 min), Z=－5.65 first stage: 385 min (310-490 min) vs. 260 min (205-347 min), Z=－5.81 second stage: 40 min (26-67 min) vs. 33 min (18-45 min), Z=－2.33 all P<0.05], and more women in the analgesia group accepted oxytocin and doula before delivery [94.8% (74/78)vs. 43.6% (34/78), χ2=48.15 42.3% (33/78) vs. 19.2% (15/78), χ2=9.75 both P<0.05]. There was no significant difference in scores on the Fatigue Scale-14, Edinburgh Postnatal Depression Scale, Pittsburgh Sleep Quality Index, and Life Events Scale for Pregnant Women between the two groups. After adjusting for confounding factors by generalized estimating equations, the mean intra-oral negative pressure values in the epidural analgesia group were lower than those in the non-analgesia group at 0-24 h, >24-48 h, and >48-72 h after birth [5.14 (3.39-6.52)vs. 6.39 (4.95-9.15) kPa, 5.07 (3.94-7.38) vs. 6.20 (5.08-8.54) kPa, and 6.19 (4.64-8.36) vs. 6.81 (5.88-8.05) kPa, Waldχ2=5.59, P=0.018] the peak value in the epidural analgesia group was also lower than that in the non-analgesia group [15.81 (9.74-21.68) vs. 16.21 (13.58- 24.88) kPa, 13.50 (9.83-16.50) vs. 17.62 (14.01-22.40) kPa, and 14.66 (10.47-18.71) vs. 18.04 (15.33- 19.85) kPa, Waldχ2=7.25, P=0.007] there were no significant differences in the trough value between the two groups. The daily IBAT scores for the sucking position of neonates in the epidural analgesia group were all lower than those in the non-analgesia group in the first three days after delivery [10 (9-10) vs. 10 (10- 11) scores, 10 (9-11) vs. 11 (10-11) scores, and 10 (10-11) vs. 11 (11-12) scores, Waldχ2=17.05, P=0.001]. The rates of early exclusive breastfeeding within postpartum 3 d were also lower in the epidural analgesia group than those in the non-analgesia group [67.9% (53/78) vs. 75.6% (59/78), 41.0% (32/78) vs. 44.9% (35/78), and 38.5% (30/78) vs. 55.1% (43/78), Waldχ2=4.21, P=0.040]. No significant differences were found in the exclusive breastfeeding rates between the two groups at 1, 4, and 6 months after delivery. Conclusion Epidural labor analgesia can lead to decreased early intra-oral negative pressure in neonates, affect neonatal sucking posture, and reduce the rate of exclusive breastfeeding during hospitalization, but has no significant correlation with the exclusive breastfeeding rate within six months after delivery.
Effects of epidural labor analgesia on early neonatal sucking and breastfeeding
Objective To investigate the effects of epidural labor analgesia on neonatal sucking ability and breastfeeding. Methods This was a prospective cohort study. Convenience sampling was used to enroll women who delivered with or without epidural analgesia (epidural analgesia and non-analgesia groups) in the Affiliated Maternity and Child Health Care Hospital of Nantong University from January 2022 to December 2022. Intra-oral negative pressure values during breastfeeding were measured by a pressure measuring instrument within 3 d after birth (0-24 h, >24-48 h, and >48-72 h), and the mean, maximum, and minimum pressure values were recorded. The Infant Breastfeeding Assessment Tool (IBAT) (Chinese version) was used to evaluate sucking posture. Breastfeeding status during hospitalization and within 1, 4, and 6 months after discharge were followed up. Two independent samples t-test, Chi-square (Fisher's exact) test, and generalized estimating equations were used for data analysis. Results A total of 156 mother-infant pairs were analyzed in this study, with 78 pairs in the epidural analgesia group and 78 pairs in the non-analgesia group. The whole, first, and second stages of labor were longer in the analgesia group than those in the non-analgesia group [M(P25-P75), total: 430 min (353-541 min) vs. 300 min (235-422 min), Z=－5.65 first stage: 385 min (310-490 min) vs. 260 min (205-347 min), Z=－5.81 second stage: 40 min (26-67 min) vs. 33 min (18-45 min), Z=－2.33 all P<0.05], and more women in the analgesia group accepted oxytocin and doula before delivery [94.8% (74/78)vs. 43.6% (34/78), χ2=48.15 42.3% (33/78) vs. 19.2% (15/78), χ2=9.75 both P<0.05]. There was no significant difference in scores on the Fatigue Scale-14, Edinburgh Postnatal Depression Scale, Pittsburgh Sleep Quality Index, and Life Events Scale for Pregnant Women between the two groups. After adjusting for confounding factors by generalized estimating equations, the mean intra-oral negative pressure values in the epidural analgesia group were lower than those in the non-analgesia group at 0-24 h, >24-48 h, and >48-72 h after birth [5.14 (3.39-6.52)vs. 6.39 (4.95-9.15) kPa, 5.07 (3.94-7.38) vs. 6.20 (5.08-8.54) kPa, and 6.19 (4.64-8.36) vs. 6.81 (5.88-8.05) kPa, Waldχ2=5.59, P=0.018] the peak value in the epidural analgesia group was also lower than that in the non-analgesia group [15.81 (9.74-21.68) vs. 16.21 (13.58- 24.88) kPa, 13.50 (9.83-16.50) vs. 17.62 (14.01-22.40) kPa, and 14.66 (10.47-18.71) vs. 18.04 (15.33- 19.85) kPa, Waldχ2=7.25, P=0.007] there were no significant differences in the trough value between the two groups. The daily IBAT scores for the sucking position of neonates in the epidural analgesia group were all lower than those in the non-analgesia group in the first three days after delivery [10 (9-10) vs. 10 (10- 11) scores, 10 (9-11) vs. 11 (10-11) scores, and 10 (10-11) vs. 11 (11-12) scores, Waldχ2=17.05, P=0.001]. The rates of early exclusive breastfeeding within postpartum 3 d were also lower in the epidural analgesia group than those in the non-analgesia group [67.9% (53/78) vs. 75.6% (59/78), 41.0% (32/78) vs. 44.9% (35/78), and 38.5% (30/78) vs. 55.1% (43/78), Waldχ2=4.21, P=0.040]. No significant differences were found in the exclusive breastfeeding rates between the two groups at 1, 4, and 6 months after delivery. Conclusion Epidural labor analgesia can lead to decreased early intra-oral negative pressure in neonates, affect neonatal sucking posture, and reduce the rate of exclusive breastfeeding during hospitalization, but has no significant correlation with the exclusive breastfeeding rate within six months after delivery.
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