親餵母乳是最自然且對母嬰雙方皆有利的方式。然新生兒不正確含乳，是影響母親成功親餵的重要原因之一，不正確的含乳會抑制泌乳機轉、增加母親的挫折，因而降低了其母乳哺餵的意願。哺餵輔助器曾被用來協助新生兒正確含乳，但過去很少研究探討其是否能改善新生兒的含乳不正確現象，故本研究目的為探討哺餵輔助器對新生兒含乳正確率及出生後一個月的母乳哺餵率的影響。
本研究採實驗設計，研究對象為：（一）新生兒出生週數大於35週，生理狀況能接受親子同室，且從母嬰第一次嘗試親餵24小時後，仍出現含乳不正確者。排除條件為先天性口腔構造異常者。（二）母親須為產後生理狀況穩定且有母乳哺餵意願者。排除條件為出現產後出血、發燒等急性合併症者。當符合收案條件之研究對象同意參與研究後，依母乳哺餵自信量表精簡版得分，分為高中低三組後，分別進行實驗組及對照組的隨機分配。二組皆給予常規照顧，僅實驗組一天至少使用三次哺餵輔助器。哺餵輔助器為6號餵食管連接10毫升空針筒之器具，針筒內盛裝乳汁，於母乳哺餵時附著在乳頭附近，使新生兒能夠有乳汁吸入的誘因，而引發正確的含乳。本研究的測量工具以LATCH量表評估新生兒進入研究前含乳正確與否之判斷依據，並以其為結果指標。
研究結果共收案60位有效個案，實驗組及對照組各30人，經過卡方考驗結果發現實驗組在出院日有80% ( n = 24 )的新生兒呈現正確含乳，而對照組僅23.3% ( n = 7 )，二組達到統計上的差異 （χ2 = 19.288, p < .001 ）。在追蹤產後一個月的親餵率，發現實驗組仍持續親餵的母親有76.7% ( n = 23 )，對照組有53.3% ( n = 16 )，但二組未達到統計上的差異（χ2 = 3.590, p = .058 ）。
本研究結果證實哺餵輔助器對能夠有效改善新生兒含乳不正確的現象，對產後一個月的親餵率並無影響。

INTRODUCTION

Breastfeeding is the most natural and beneficial for both mother and infant. Several conditions are required, including both mother and infant have normal anatomies and are well prepared, rooting, correct latch, effective sucking, and milk transfer (Mulder, 2006). The key point of successful breastfeeding is correct latch (Mulder, 2006). Previous report showed that 52% of infants are found to have incorrect latch for the first breastfeeding (Kronborg & Vaeth, 2009). When a neonate latches incorrectly, the mother’s nipple will feel sore and the infant cannot get enough milk. These are all negative feedbacks for lactation mechanism (洪，2008; 林、高、李、李，2008; Mulder, 2006; Rennie, Cowie, Hindin, & Jewell, 2009). Previous reports showed that using breastfeeding device could encourage the infant to suckle and reduce mother’s anxiety related to breastfeeding (Edgehouse & Radzyminski, 1990; Borucki, 2005). Breastfeeding device could be combined with N-G tube and syringe filled with human milk or formula. When the infant shows hunger cue, put the end of N-G tube near mother’s nipple. If the infant opens the mouth big enough to latch the nipple and the end of N-G tube, he could get milk from breast and breastfeeding device at the same time (國民健康局，無日期；Borucki, 2005). Breastfeeding device was also used in neonates to improve incorrect latch(王、林、侯、陳、陳，2011；Aquino & Osório, 2009). However, race study examined the effect of breastfeeding device on latch. The purpose of this study is to explore the effect of breastfeed device on neonates with incorrect latch.

MATERIALS AND METHODS

A randomly controlled designed study was conducted at a medical center in southern Taiwan. Participants included the healthy mothers and neonates. The inclusion criteria were infants with gestation age more than 35 weeks and all of their latches were still incorrect after 24 hours from first breastfeed, and their mothers were willing to breastfeed. The exclusion criteria were infants with abnormal oral anatomy, or the mother with fever or postpartum hemorrhage. We used permuted block randomization design. An independent researcher developed a separated randomization schedule and the assignments were sealed in sequentially numbered opaque envelopes. When the participants signed the informed consent and finished Breastfeeding Self Efficacy Scale Short Form (BSES-SF) (Dennis, 2003), the mothers were assigned to one of three groups: low, moderate, and high self-efficacy according to their score of BSES-SF. They were further assigned to experimental group or control group by the randomization schedule. In this study, we combined 6# N-G tube and 10cc syringe to be the breastfeeding device. The experimental group used breastfeeding device three times a day and the control group received one by one nursing care followed by Baby Friendly Health Initiative (BFHI) 10 steps. During data collection, the researcher evaluated every participants’ latch with LATCH scale (Jensen, Wallace, & Kelsay, 1994) every day and used the LATCH scale result of the discharge day to be the outcome indicator. After one month postpartum, the researcher called the mother to follow up whether breastfeeding or not as the indicator of breastfeeding rate for one month postpartum.

RESULTS AND DISCUSSION

We included 60 pairs of mothers and neonates, and separated into 30 experimental groups and 30 control groups. The average gestation age of neonates were 38.5±1.4 weeks, and BW were 3091.1±426.5 grams. Among them 58.3% were of males and 61.7% were cesarean delivery. The average age of the mothers were 34.28±4.1 years old and 45% were university graduates. There were 61.7% of primiparas, and 60.9% of multipara women had breastfeeding experience for 9.79±8.5 month, and all of mothers’ BSES-SF scale of average 41.3. There were no significant difference in demography and confounding factor between two groups. There were 80% neonates latched correctly in experimental group and 23.3% in control group at discharge day, which is statistically different (χ2 = 19.288, p < .001). Figure 1 shows two groups of the correct latch rate of cumulative daily. After 1 month, 76.7% of mothers continue breastfeeding in experimental group and 53.3% in control group, results in no significant difference between two groups (χ2 = 3.590, p = .058). According to the results, breastfeeding device can effectively increase correct latch of neonates. Correct latch rate of experimental group continuously increases after using device for 2 days, but there is no change in control group. It is similar to the result published by Matthews (1989), which showed that the infants established effective breastfeeding behavior through learning during post birth 24 hours; however, lacking of effective intervention to help those infants, they will keep latching incorrectly. In this study, correct latch rate can be effectively increased using breastfeeding device for 3 days. Compared with using the device for 5~10 days in research reported by Aquino & Osório (2009), our study can improve incorrect latch by breastfeeding device in shorter duration. We used 6# N-G tube and 10cc syringe to be the breastfeeding device which cost NT $10, it is much cheaper than Supplemental Nursing System (SNS) in Borucki (2005) which costs NT $1700. In subgroup analysis, all the experimental groups have significant higher correct latch rate compare to control groups no matter what delivery method is used or difference in breastfeeding experience. However, there are no statistically differences of the breastfeeding rate after 1 month postpartum between two groups. The reason may be 1) using latch to be the outcome indicator to calculate effect size and 2) lactation status are not assessment in this study. If the experimental group used breastfeeding device to improve latch with family support, 100% of mothers would continue breastfeeding. This result is similar to previous studies, which showed that successful breastfeeding needs strong support from family (李、黃、謝，2011；楊、郭，2007；國民健康局，2013； Buckley & Charles, 2006; Lewallen, et al., 2006).

Figure 1. change of two groups of the correct latch rate of cumulative

CONCLUSION

Breastfeeding device can effectively increase correct latch rate, and it is not affected by different delivery method or breastfeeding experience. We suggest the health workers to use the breastfeeding device at early postpartum when the infants show incorrect latch to avoid frustration at breast by infants. After the infant can latch correctly, encouraging the family to join the breastfeeding process can have more positive impact on the long-term breastfeeding. For future related research, lactation of mothers should be assessed to clarify the relationship between breastfeeding device and long-term breastfeeding.

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