Razi Journal of Medical Sciences

fa تماس پوست با پوست مادر- نوزاد و تغذیه انحصاری در دو ماه اول زندگی :کا رآزمایی با لینی Advantage mother-neonate skin-to-skin contact in exclusive breastfeeding: A clinical trial نوزادان Neonatology پژوهشي Research زمینه و هدف: شیر مادر بهترین غذا و با ارزشترین هدیه ای است که هر مادری به فرزندش عرضه می‌کند و تغذیه انحصاری بهترین روش تغذیه نوزاد می‌باشد. برقراری تماس پوست با پوست مادر و نوزاد روشی موثر بر افزایش آن است. هدف این مطالعه بررسی اثر آموزش تماس پوست با پوست مادرو نوزاد درمیزان تغذیه انحصاری دردو ماه اول زندگی است. روش کار: در این مطالعه کارآزمایی بالینی ۲۵۰ مادر که نوزاد ۳ الی ۵ روزه دارند و برای دریافت مراقبت به کلینیک والفجرمراجعه کرده بودند در قالب یک مطالعه کارآزمایی بالینی تصادفی سازی شده در دو گروه ۱۲۵ نفری مداخله وکنترل دسته بندی شدند. گروه مداخله آموزش تماس پوست با پوست مادر و نوزاد دریافت کردند. میزان تغذیه انحصاری، وزن قد، دور سر، میزان خواب و گریه نوزاد و نمره کیفیت زندگی مادر در زمان پایه و دو ماه بعد با هم مقایسه شدند. متغیر اصلی که تغذیه انحصاری با شیر مادر بود، از طریق چک لیست سنجیده شد. سطح معنی‌داری کمتر از ۰٫۰۵ در نظر گرفته شد. یافته‌ها: میزان شیردهی انحصاری (۰٫۰۰۰۱p=)، میزان گریه (۰٫۰۱۸p=) و خواب نوزاد (۰٫۰۲۵p=) و کیفیت زندگی مادر دو ماه بعد (۰٫۰۱۳p=) بین دو گروه اختلاف معنی‌داری داشت. نتیجه‌گیری: آموزش تماس پوست با پوست به مادران و انجام آن درطی دو ماه اول زندگی توسط آن‌ها در افزایش تغذیه انحصاری، بهبود کیفیت زندگی مادران، افزایش خواب وکاهش میزان گریه نوزادان در دو ماه اول زندگی تأثیر به سزایی دارد.   Background & Aims: reast milk is the best food and the most valuable gift that any mother can give to her infant. After breastfeeding, 19 digestive hormones are released in the mother and neonate. Some of these hormones stimulate the growth of intestinal villi and cause more nutrients to be absorbed. Exclusive breastfeeding is the best nutrition for infants up to 6 months of age, in addition to providing physical and biological needs, it completes the psychological needs of infants and also mothers. This has been one of the most important recommendations of the World Health Organization and UNICEF in recent years. In recent years, malnutrition, respiratory infections and diarrhea have been the leading causes of child mortality. In this regard, there are reports that breastfeeding significantly reduces the incidence of these diseases. Exclusive breastfeeding in addition to the beneficial effects on the infant and mother, has obvious economic effects on family and society, due to lack of consumption of formula. Also, among the intervention programs that have been carried out in order to continue breastfeeding in developing countries, few studies have used an appropriate theoretical framework for breastfeeding continuity, therefore, in order to increase the effectiveness of educational programs, by understanding the mechanism responsible for change, it is necessary to design and evaluate interventions focusing on the mediating psychological variables. Success in breastfeeding requires several steps: Sufficient awareness - Comprehensive support for the mother - Acquiring the necessary skills. Education of benefits of breastfeeding should begin in the second half of pregnancy and continue immediately after delivery with the help and training of how to properly place the neonate on the mother's breast and support the mother. In recent years, many studies have been conducted on the effect of skin-to-skin contact in premature neonates and significant results have been obtained. advantages of skin-to-skin contact between mother and infant include: Improving infant's weight gain, improving infant's sleep quality, reducing mother's stress and anxiety, reducing infant's crying rates, improving brain development, increasing maternal confidence in the ability of taking care of infant and reducing postpartum depression symptoms in mother. Considering the numerous benefits of skin-to-skin contact between mother and infant and the failure to find a study that examined the relationship between teaching this type of contact with exclusive breastfeeding in healthy non- hospitalized term neonate, this study aimed to investigate the effect of skin-to-skin contact education to mothers on rate of exclusive breastfeeding in the first two months of life. Methods: This study is a randomized clinical trial. The study population included mothers with 3 to 5-day-old neonate and referred them for receiving usual care to Valfajr Clinic in West Tehran Health Center (University Center affiliated to Iran University of Medical Sciences) in the year 2019.Inclusion criteria: term infant born NVD or cesarean section whose mother wanted to participate in the study and collaborate, she was literate, and did not have any contraindication for breastfeeding. These mothers should breastfeed infants often until day 3 to 5. Data collection tools included demographic and midwifery information form and postpartum information form and breastfeeding nutrition evaluation and 12 Question of Quality of Life Questionnaire, the shortened form of Quality of Life Questionnaire is 36 questions that are widely used in various studies. Eligible mothers were taught in a session how to breastfeed properly, and it was recommended that they should exclusively be breastfed for two months. The source of the education was a "Maternal Guide for Breastfeeding" developed by UNICEF and the Ministry of Health. After a half-hour education session on how to properly breastfeed for all participating in the study, the intervention group was trained about the benefits and methods of doing skin-to-skin contact for at least 60 minutes a day and was recommended to do it after ending breastfeeding at 21-26°C. The procedure was that the mother should place her naked infant (only with a diaper cover) between her two bare breasts. The intervention group additionally was trained how to complete the forms, how to complete the daily skin-to-skin contact form was also added to the mothers' training, so that mothers should have registered daily skin-to-skin contact time, daily sleep and a crying period during these two months. The control group included mothers who was not receive any training on the benefits of skin-to-skin contact, but were taught how to breastfeed properly, and was appointed to check their infant's daily sleep and crying for two months and register at the checklist. At the end of the training session, both groups completed the demographic and midwifery information forms, the postpartum information form and the breastfeeding nutrition evaluation form, and a 12-question questionnaire on the quality of life. Mothers randomly entered the study to reach the required number of samples. Two months after the first visit, when the mother and infant were referred to receive usual care in both groups, weight, height, and head circumference were measured and recorded, Completed forms were collected and a questionnaire of 12 Questions on Quality of Life and 24-hours nutrition reminder form were filled out by the researcher with a question from the mother to evaluate the amount of exclusive breastfeeding. Data were analyzed by SPSS 18th edition software. Exclusive breastfeeding amount, height, head circumference, infant sleep and crying, and maternal quality of life scores at baseline and two months later were compared. The main variable, which was exclusive breastfeeding, was evaluated by questioning (self-declaration) and completing a checklist. The significance level for all tests on this study was 0.05 and 95% confidence interval was considered. Results: The study included 250 mothers and their infants. Demographic information was compared between the two groups. The results showed that there were no significant differences between the two groups in terms of mother's age, education, employment, underlying disease, maternity and quality of life scores of the mother, education of the father, sex of the neonate, weight, height and head circumference of the neonate at the birth time. After the conducted training at the beginning of the study, exclusive breastfeeding in the intervention group was significantly higher than the control group (p=0.0001). Study on the variables of infant crying and sleeping showed that these variables had a significant change in skin-to-skin contact group so that the amount of crying decreased (p=0.018) and the amount of sleep increased (p=0.025). Furthermore, the mean score of maternal quality of life in the intervention group was significantly higher than the control group (p=0.013). The variables of weight, height and head circumference of the infant after two months were not significantly different between the two groups. Conclusion: Education of skin-to-skin contact to mothers and doing it during the first two months of life by them has a significant effect on increasing exclusive breastfeeding, improving the quality of life of mothers scores, increasing sleep and reducing the infants crying rates in the first two months of life. The results of this clinical trial support health policies that recommend facilitating breastfeeding as soon as possible after birth, while recommending persistent skin-to-skin contact after birth and during the first two months of life. Skin-to-skin contact has protected infants against a wide range of negative outcomes. This safe and cost-effective intervention can prevent many of the complications associated with preterm delivery and can also bring benefits to term neonates   تماس پوست با پوست , تغذیه انحصاری , کیفیت زندگی, میزان گریه , میزان خواب Skin-to-Skin contact, Exclusive Breastfeeding, Quality of Life,Crying Rate,Sleep Rate 75 83 http://rjms.iums.ac.ir/browse.php?a_code=A-10-5270-1&slc_lang=fa&sid=1 Zahra Sadr زهرا صدر sadr.z@iums.ac.ir 3900319475328460056730 3900319475328460056730 No Iran University of Medical Sciences, Tehran, Iran دانشگاه علوم پزشکی ایران، تهران، ایران Zahra Rampisheh زهرا رام پیشه rampisheh@gmail.com 3900319475328460056731 3900319475328460056731 No Iran University of Medical Sciences, Tehran, Iran دانشگاه علوم پزشکی ایران، تهران، ایران Parisa Mohagheghy پریسا محققی pmohagh@yahoo.com 3900319475328460056732 3900319475328460056732 No Iran University of Medical Sciences, Tehran, Iran دانشگاه علوم پزشکی ایران، تهران، ایران Leila Elmi لیلا علمی Elmi12leila@yahoo.com 3900319475328460056729 3900319475328460056729 Yes Iran University of Medical Sciences, Tehran, Iran دانشگاه علوم پزشکی ایران، تهران، ایران