背景

母乳喂养对母亲和新生儿都有好处。但是，出院时的母乳喂养率低于建议的水平，因此确定有出院时不进行母乳喂养的风险的妇女可以使专业人员优先进行护理。

目标

开发和验证出院时纯母乳喂养的预测模型。

设计

针对2014年至2019年在西班牙生产的妇女进行回顾性队列研究。

数据源

数据来源是通过西班牙母乳喂养协会分发的问卷。在3387名女性的队列中进行预测模型的开发，并在1694名女性的队列中进行了验证。使用Logistic回归进行多元分析，并且通过ROC曲线下的面积（AUC）确定预测能力。

结果

80.2％（2717）的女性在出院队列中母乳喂养，而在验证队列中，只有82.1％（1390）进行母乳喂养。最终模型中的预测因素是：出生时的母亲年龄；BMI；儿童数量; 以前的母乳喂养；生育计划；引产；硬膜外镇痛；出生类型；早产; 多胎; 巨大儿；在第一个小时内开始母乳喂养和皮肤接触。开发队列的预测能力（ROC AUC）为0.76（95％CI ：0.74-0.78），而在验证队列中为0.74（ 95％CI：0.71-0.77）。

结论

根据13个变量开发出了出院时纯母乳喂养的预测模型，根据Swets的标准，在开发队列和验证队列中均具有令人满意的预测能力。该模型可以识别出院时不进行母乳喂养的高风险女性。

关键词

出院时母乳喂养

预测模型验证

 

   

Background

The benefits of breastfeeding for both mother and newborn have been widely demonstrated. However, breastfeeding rates at discharge are lower than recommended, so being able to identify women at risk of not breastfeeding at discharge could allow professionals to prioritise care.

Objective

To develop and validate a predictive model of exclusive breastfeeding at hospital discharge.

Design

Retrospective cohort study on women who gave birth between 2014 and 2019 in Spain.

Data Sources

The data source was a questionnaire distributed through the Spanish breastfeeding associations. The development of the predictive model was made on a cohort of 3387 women and was validated on a cohort of 1694 women. A multivariate analysis was performed by means of logistic regression, and predictive ability was determined by areas under the ROC curve (AUC).

Results

80.2% (2717) women exclusively breastfed at discharge in the derivation cohort, and 82.1% (1390) in the validation cohort. The predictive factors in the final model were: maternal age at birth; BMI; number of children; previous breastfeeding; birth plan; induced birth; epidural analgesia; type of birth; prematurity; multiple pregnancy; macrosomia; onset of breastfeeding within the first hour; and skin-to-skin contact. The predictive ability (ROC AUC) in the derivation cohort was 0.76 (CI 95%: 0.74-0.78), while in the validation cohort it was 0.74 (CI 95%: 0.71-0.77).

Conclusions

A predictive model of exclusive maternal breastfeeding at hospital discharge has been developed, based on thirteen variables, with satisfactory predictive ability in both the derivation cohort and the validation cohort according to the Swets' criteria. This model can identify women who are at high risk of not breastfeeding at hospital discharge.

Key words

Breastfeeding at hospital discharge

Predictive model validation

原文链接：

https://www.sciencedirect.com/science/article/abs/pii/S0020748921000304