미숙아의 퇴원 후 모유수유 지속실태 및 관련요인

Abstract

[한글]

본 연구는 퇴원 후 지속적인 모유수유 실태와 관련 요인을 파악하기 위한 횡단적 서술적 조사연구이다. 연구대상은 서울시의 Y대학병원 신생아집중치료실에 입원하였다가 퇴원한 미숙아의 어머니 81명을 대상으로 하였다.본 연구의 도구는 구조화된 설문지를 사용하여 퇴원 후 수유실태, 모유수유 지속 및 중단사유, 지속적 모유수유를 위한 필요 등을 사정하였으며, 자료수집은 2007년 4월 30일부터 5월 31일까지였으며, 우편조사를 통해 실시하였다. 수집된 자료는 SPSS WIN 11.5 프로그램을 이용하여 분석하였으며, 빈도분석과 χ2 검증, Logistic Regression을 실시하였다.본 연구결과는 다음과 같다.1. 미숙아 어머니들의 평균 연령은 31.4세이었으며, 대학교 이상이 74.1%로 대부분을 차지하였고, 직업이 없는 어머니가 64.2%였다. 분만 전 수유계획은 92.6%이고, 모유수유 교육에 참여 경험이 없는 어머니가 56.8%였다.2. 미숙아의 출생순위로는 첫째가 60.5%, 여아가 55.6%였으며, 평균 재태기간은 33.2주, 평균 체중은 1829.3g이었다. 제왕절개로 출산한 경우가 72.8%였으며, 평균 신생아집중치료실 입원기간은 28.5일이었다.3. 입원 중 평균 모유수유 지속기간은 8.8일이었으며, 퇴원 후 혼합유가 56.8%로 가장 많았고, ‘직접 젖을 물려서’와 ‘젖을 짜서 젖병에 담아서’ 수유한 어머니가 각각 34.6%를 차지하였다. 퇴원 후 모유수유를 3개월 이상 지속한 어머니가 66.7%이었다.4. 퇴원 후에 모유수유를 지속한 이유로는 ‘아기의 건강을 위해서’와 모‘모유가 좋다는 이야기를 듣고’가 87.7%로 가장 많았으며, 퇴원 후에 모유수유를 중단한 이유로는 ‘모유량의 부족’이 39.5%로 가장 많았다. 또한 퇴원 후 모유수유를 지속적으로 할 수 있도록 도움이 필요한 사항에 대해서는 ‘입원병실에서의 교육’이 필요하다가 81.0%로 가장 많았다.5. 모유수유 지속 여부는 어머니의 분만 전 수유계획(χ2=7.29, p<.01)과 미숙아의 재태기간(χ2=9.15, p<.01), 출생체중(χ2=8.01 p<.01), 입원기간(χ2= 14.18, p<.01)에 따라 차이를 보였다.이상의 유의한 특성이 모유수유 지속 여부에 영향을 미치는지를 확인하기 위해 Logistic Regression으로 분석한 결과, 어머니의 분만 전 수유계획 시 계획 하지 않았을 때 보다 모유수유 지속기간이 18배 길며, 재태기간이 35주 이상이 34주이하 보다 모유수유 기간이 2배 길어 통계적으로 유의하게 영향을 미치는 것으로 나타났다.따라서, 모유수유를 지속적으로 실천하기 위해서는 미숙아를 위한 모유수유 관리 프로그램을 개발, 실시하며 집중치료실에서 모유수유를 격려하는 환경조성이 필요하고, 분만 전 모유수유 계획을 가지고 있는 경우 분만 초기부터 모유수유를 촉진시킬 수 있는 방안을 모색하여 적극적인 간호중재를 제공해야 한다.

[영문]The purpose of this study was to identify the state of post-discharge breastfeeding practices and related factors for premature infants through employing a cross-sectional descriptive design. Participants in this study were 81 mothers whose premature babies were discharged from Y university hospital''s neonatal intensive care unit in Seoul, Korea.Structured questionnaires were used to identify post-discharge feeding practices, reasons for continuing or quitting breastfeeding, and needs related to continuing breastfeeding. The data were gathered from April 30 through May 31, 2007, by conducting a mail survey (return rate 85%). The data were analyzed by description statistics frequency analysis, χ2 test and logistic regression analysis, utilizing SPSS WIN 11.5 program.The findings of the study were as follows:1. The mean age of participating mothers was 31.4 years. Most of them (74.1%) received college or higher education, and had no occupation (64.2%). Although the majority intended to breastfeed their newborn babies before giving birth (92.6%), more than half had never received education about breastfeeding (56.8%).2. Sixty percent of the participating premature infants were first -born, and 55.6 percent were baby girls. Their average gestational age was 33.2 weeks, and their mean body weight was 1829.3 grams. Most were born through cesarean section (72.8%), and were hospitalized for a mean of 28.5 days.3. The premature infants were breast-fed for a mean of 8.8 days in the hospital. Following discharge mothers most commonly used mixed feeding using both their own breastmilk and formula (56.8%). The most common method of breastfeeding noted was putting baby to breast (34.6%) and breast milk given in bottle (34.6%). Mother who continued to breastfeed their babies for three months or more after leaving the hospital accounted for 66.7 percent.4. As for the reason for continuing breastfeeding, the most common reason was because they heard that breastfeeding is conducive to the health of their babies (87.7%). Among those who stopped breastfeeding after leaving the hospital, 34.6 percent cited a shortage of breast milk as the reason. In regard to what help they needed to keep on breastfeeding after being discharged from the hospital, the majority noted the need for education on breastfeeding during hospitalization (81%).5. Whether mothers continued to breastfeed their babies or not was significantly different according to prenatal breastfeeding plans (χ2=7.29, p<.01), the baby''s gestational age (χ2=9.15, p<.01), birth weight (χ2=8.01, p<.01), and length of stay in the hospital (χ2=14.18, p<.01).Logistic regression analysis was done to identify whether these significant characteristics affected the continuation of breastfeeding, and found statistically significant influences that mothers who had a prenatal maternal feeding plans breastfed 18 times longer than mothers who had no plans and people whose gestational age were more than 35 weeks had twice longer periods than people whose gestational age were less than 34 weeks.Accordingly, it is proposed that we need to produce and practice a breastfeeding program for prematures, to make an environment for encouraging mothers to breastfeed in neonatal intensive care unit, to develop methods for the promotion of breastfeeding from the early stage of delivery when they have a breastfeeding plan and to offer nursing interventions in order to continue breastfeeding their babies.