對於醫療人員和父母來說，早產兒母乳哺餵是一項複雜的任務，特別是在理解嬰兒暗示行為方面。早產兒通常難以協調吸吮、吞嚥和調節呼吸，導致行為不協調，也因此造成護理人員和家長間對早產兒行為含義的錯誤解讀，阻礙嬰兒基本需求的滿足。
早產兒母乳哺餵是一個複雜的過程，涉及嬰兒向母親發送合適暗示的能力，而母親對這些暗示行為的理解至關重要。嬰兒的發展對這些暗示行為有顯著影響。本研究旨在探討印尼在醫院和居家環境中早產兒進食暗示行為和母親餵食行為的差異。研究目的為：(1) 了解印尼早產兒在醫院和居家環境，母乳哺餵過程中出現的進食暗示行為；(2) 了解印尼母親在醫院和居家環境，母乳哺餵過程中出現的餵食行為；(3) 比較印尼早產兒在醫院和居家環境，母乳哺餵過程中出現的進食暗示行為差異；(4) 比較印尼母親在醫院和居家環境，母乳哺餵過程中出現的餵食行為差異；(5) 探討影響母親餵食行為的因素。
本觀察性研究在印尼Margono Soekarjo醫院1級和2級(level 1/level 2)新生兒照護單位以方便取樣進行收案，共45對早產兒及其母親參與。研究使用參與研究的早產兒及其母親分別在醫院和居家環境中所拍攝的母乳哺育影片進行譯碼分析。早產兒納入條件為在加入研究與開始進行母乳哺餵時能保持臨床狀態的穩定；參與本研究的母親均識字並且為自願參與。研究使用的工具是自行設計的人口學資料問卷和印尼版本的早產兒母親餵食互動觀察系統，特別是母親餵食行為譯碼系統。本研究的譯碼員為研究者和一名經過譯碼訓練的研究助理，早產兒進食暗示行為和母親餵食行為的評估者間和評估者內一致性測試結果超過80%。
研究結果呈現出母乳哺餵早產兒所面臨的獨特挑戰和機遇，特別是在印尼的醫院和居家環境中。結果顯示，早產兒出生時之妊娠週數為34.2週，體重為2232公克；加入研究時之受孕後年齡（PMA）為34.9週，體重為2111公克；在居家環境時之受孕後年齡(PMA)為39.28週。加入研究的早產兒以單胞胎自然產女性為主，且多數於醫院2級新生兒照護單位，僅24.4%早產兒有接受過3級新生兒照護單位照護的經驗，新生兒加護病房住院天數平均為2天。參與研究的母親平均年齡為30.86歲，平均受教育年限10.42年，多數無工作、生育過兩胎、有母乳喂養經驗，有在醫院或居家進行母乳喂養的意願，曾接受過母乳喂餵信息和支持，並且只有少數曾面臨母乳哺餵困境。住家離醫院較遠被認為是母乳哺育嬰兒最常見的原因，僅少數母親有經歷過焦慮經驗。在居家環境中，大多數母親都是純母乳哺餵。
研究發現，當早產兒在醫院環境中時，嬰兒進食暗示行為總數除以影片持續總時間(分鐘)的數值較居家低。在兩種環境中分別有較低百分比的飢餓暗示和飽足暗示(醫院>居家)且有統計上顯著差異。然而，在自我調節和壓力暗示行為方面兩種環境都沒有達到統計上顯著差異。此外，醫院和居家環境中母親餵食行為的低敏感性、主控和互惠三類行為的百分比，低敏感和主控行為的百分比在醫院環境中更為顯著，在居家環境中以互惠行為為主。迴歸檢驗結果發現，嬰兒妊娠週數增加對母親在醫院母乳哺餵嬰兒時表現出互惠行為的影響是9.3倍。同時，在醫院哺餵嬰兒時，母親年齡的增加對母親的互惠行為的影響是0.152倍。沒有變數可以預測居家環境中母親的餵食行為。
雖然研究的結果提供了有價值的見解，但也強調了未來在該領域進行深入研究的必要性。研究指出，在醫院裡早產兒和母親對餵食互動敏感性較低，餵食過程中母親出現的主控行為頻率較高；反之，在居家環境中母親則比較會表現出互惠行為。本研究建議新生兒單位的護理人員能對嬰兒的暗示行為保持敏感，並教導母親識別嬰兒的暗示行為，並提供教育以對嬰兒的進食暗示行為做出適當的反應。然而，還需要進一步的研究來增進我們對早產兒進食行為的理解。這些建議如果得到實施，可以大幅改善早產兒的照護和餵食，為新生兒照護和母乳哺餵支持帶來光明的未來

Breastfeeding premature infants is a complex task for health workers and parents, particularly in understanding baby signals. Premature babies often have difficulty coordinating sucking, swallowing, and regulating breathing, leading to uncoordinated behavior. This can cause misunderstandings between nurses and parents, hindering the fulfillment of the infants’ basic needs.
Breastfeeding a preterm infant is a complex process that involves the infant's ability to send appropriate signals to the mother, and the mother's understanding of these signals is crucial. The infant's development significantly influences these behavioral cues. The general study aims to uncover differences in preterm infants' signals and maternal feeding patterns in hospital and home settings in Indonesia. The specific aims were (1) investigated the Indonesian preterm infants’ cues during breastfeeding in hospital and home settings; (2) investigated the Indonesian maternal feeding patterns during breastfeeding in hospitals and homes; (3) compared the Indonesian preterm infants’ cues during breastfeeding in hospital and home settings; (4) compared the Indonesian maternal feeding patterns during breastfeeding in hospitals and homes; and (5) investigated factors influencing the maternal feeding patterns.
This observational study was a collaborative effort involving a convenience sample of 45 preterm infants and 45 mothers of preterm infants treated at level 1 and 2 neonatal care (at the time enrolled to study) at Margono Soekarjo Hospital, Indonesia. The output variables were preterm infant cues and maternal feeding patterns, analyzed using coders from breastfeeding videos of respondents in hospital and home settings. The eligibility criteria ensured the stability of the infants at enrollment and their initiation into breastfeeding. The mothers involved were literate and voluntarily joined the study. The instruments used were a self-designed demographic data survey and the Indonesian version of the Coding System for Feeding Interaction Observation, particularly the Maternal Feeding Patterns Coding System. The coders in this study were the researcher and one trained research assistant. The inter-rater and intra-rater reliability test results for preterm infants' cues and maternal feeding patterns, which exceeded 80%.
These findings illuminate the unique challenges and opportunities in breastfeeding preterm infants, particularly in the context of hospital and home settings in Indonesia. The results revealed that the preterm infants were gestational age of 34.2 weeks, postmenstrual age (PMA) of 34.9 weeks at enrollment, 39.28 weeks PMA at home setting, birth weight of 2232 grams, birth weight at enrollment of 2111 grams, predominantly female, singleton, predominantly vaginal delivery, most of the infants were treated at level 2 neonatal care, only 24.4% have history treat at level 3 neonatal care, and the length of Neonatal Intensive Care Unit amount two days. Meanwhile, the dominant mothers were 30.86 years old and non-workers, with an average of 10.42 years of education, a parity of two, had breastfeeding experience, breastfeeding intention both at the hospital or at home, receiving breastfeeding information and support, and only limited mothers experienced breastfeeding obstacles. Distance home from the hospital was perceived as the most common reason for breastfeeding infants. Maternal anxiety was experienced only by a limited number of mothers. In the home setting, the majority of mothers breastfeed exclusively.
The study found that the number of infant signals divided by the video duration was lower when the infant was in the hospital setting. The study also found that the percentage of low hunger and satiation cues differed in the two settings. However, neither setting showed differences in self-regulation and stress cues. Further, the study results showed a significant difference in the percentage of low sensitivity, control, and reciprocal behavior in the hospital and home settings. In detail, the percentage of low sensitive and controlled behavior was more significant in the hospital setting. In the home setting, reciprocal behavior was dominant. The logistic regression test results found that enhanced the infant's gestational age contributed 9.3 times to the mother displaying reciprocal behavior when breastfeeding the infant in a hospital setting. Meanwhile, enhanced maternal age contributes .152 times to mothers' reciprocal behavior when breastfeeding infants in a hospital setting. No variables could predict the maternal feeding patterns in a home setting.
While the results of this study provide valuable insights, they also highlight the need for further research in this area. The study indicates that preterm infants and mothers in hospitals are less sensitive to feeding interaction, including controlling the behavior of mothers during feeding. Conversely, in a home setting, the mother displays reciprocal behavior. This study recommends that nurses in the neonatal room be sensitive to the infant's signals, teach mothers to recognize the infant's signals, and provide education to respond appropriately to the infant's signals. These recommendations, if implemented, could significantly improve the care and feeding of preterm infants. However, further research is needed to advance our understanding of preterm infant feeding behaviors. These recommendation, if implemented, could significantly improve the care and feeding of preterm infants, offering a promising future for neonatal care and breastfeeding support.

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