Representaciones maternas sobre salud y lactancia del hijo prematuro en hospitales con y sin certificación de Hospital Amigo del Niño y de la Madre

Abstract

ANTECEDENTES: la prevalencia de la lactancia materna en prematuros mexicanos es baja, a pesar de ser una medida accesible y de bajo costo recomendada por la Organización Mundial de la Salud. Uno de os factores de abandono es la percepción de baja producción láctea. OBJETIVO: comparar las representaciones maternas de salud y lactancia en hijos prematuros internados en hospitales de referencia, en tanto certificado o no como Hospital Amigo del Niño y de la Madre.MATERIAL Y MÉTODOS: estudio cualitativo efectuado en dos hospitales de referencia: uno de ellos certificado como amigo del niño y la madre (17 madres y 1 padre de prematuros) y otro no certificado (13 madres). Instrumento de recolección: guía de entrevista semiestructurada que se realizó cara a cara por personal capacitado. Se aplicó análisis de contenido temático a las comunicaciones hasta aprehender las representaciones de acuerdo con el objetivo. Se obtuvo la aprobación de los comités de ética de cada hospital y los participantes firmaron el consentimiento informado. RESULTADOS: se aprehendieron tres representaciones: 1) la saludcorporalidad del hijo prematuro internado; 2) elegir el mejor alimento la leche materna versus fórmula para el hijo prematuro y 3) las informaciones recibidas sobre lactancia materna.CONCLUSIONES: la salud del hijo prematuro se representa en la corporalidad, principalmente el peso. En las representaciones maternas se manifestó la construcción de conocimiento de la leche como alimento “bueno”, que les permitió optar, inicialmente, por alimentar al hijo con su leche. La percepción de producción insuficiente, la creencia de que la leche materna daña, la actividad laboral materna y la prescripción de sucedáneos posibilita el abandono de la lactancia materna. En el Hospital Amigo del Niño y de la Madre se denotó sistematización en pro de la lactancia, con personal e infraestructura asignados a esa labor; en el hospital no certificado se denotaron solamente acciones informativas verbales o gráficas.

Factors and survival of exclusive breastfeeding in preterm infants upon discharge at six months of age

“…Although also among the reasons to abandon breastfeeding is the medical prescription to suspend it. [13] Currently, the Mexican clinical guidelines for enteral feeding of preterm infants of 32 weeks or less of gestational age include the use of formulas for preterm infants. [12] This is part of the challenges for BFHI hospitals and health personnel.…”

“…[12] A qualitative study revealed that for mothers of preterm inpatients "health is related to the corporality of the preterm infant", thus, weight represents the key to health. [13] A Brazilian cohort of 42 preterm infants with 40 weeks of corrected age and with assessment at different cut-off points for home follow-up (at 15 and 45 days after hospital discharge, at the third and sixth month of life), studied the prevalence of types of feeding and weight gain. At 15 days the EBF had the highest peak (71.5%), followed by MBF (19%) and finally, AF (9.5%) and the average daily weight gain in preterm infants was 18.16 g, 13.37 g and 21.17 g per day for EBF, MBF, and AF respectively.…”

Breastfeeding in adolescent mothers-premature infant dyads

“…[12,14] In a qualitative study whose objective was to reveal the social representations, that is, the form of socially elaborated knowledge that generates opinions, beliefs, and meanings that are socialized and produce an impact on practices, in this case, the social representations of mothers < 20 years with a preterm infant about Exclusive Breastfeeding, findings revealed that exclusive breastfeeding represents them that they would shorten the duration or change this option for artificial feeding, for their return to school and for some beliefs such as "the child does not fill up", the child "does not digest milk well" or "milk is harmful", nevertheless they had received information about the benefits and the recommendation of a minimum duration of six months of Exclusive Breastfeeding in the hospital, and although they believed that Exclusive Breastfeeding was the best option for their child's growth. [15] However there is also the counterpart, that is, adolescent mothers do not receive guidance, orientation, or advice to start and continue with exclusive breastfeeding, this is associated with discontinuation or abandonment of Exclusive Breastfeeding. [12] In this regard, a Mexican organization the Pro-Breastfeeding Association (APROLAM) reports barriers to Exclusive Breastfeeding due to ignorance of the advantages as well as of the practical aspects to start it, [14] and the Mexican project (Official Standard PROY-NOM-050-SSA2-2018), for the promotion, protection, and support of Exclusive Breastfeeding, establishes that should be promoted especially in marginalized areas until the sixth month.…”