Características determinantes cruciales para el diagnóstico de enfermería acerca de la lactancia ineficaz

Alvarenga, Sandra Cristina de; Castro, Denise Silveira de; Leite, Franciéle Marabotti Costa; Garcia, Telma Ribeiro; Brandão, Marcos Antônio Gomes; Primo, Cândida Caniçali

doi:10.1590/0034-7167-2016-0549

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RESEARCH • Rev. Bras. Enferm. 71 (2) • Mar-Apr 2018 • https://doi.org/10.1590/0034-7167-2016-0549 copiar

Características determinantes cruciales para el diagnóstico de enfermería acerca de la lactancia ineficaz

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Investigar las medidas de exactitud diagnóstica de enfermería y proponer un modelo para el uso de características determinantes en el juicio del diagnóstico de enfermería de lactancia ineficaz.

Método:

Estudio transversal, con muestra de 73 binomios madre-hijo hospitalizados en la Maternidad de un Hospital Universitario en el período de julio a agosto de 2014.

Resultados:

La prevalencia del diagnóstico fue del 58.9%. Las características que mejor atendieron al modelo de regresión logística fueron: discontinuidad de la succión de la mama; incapacidad del lactante para agarrar la región aréola-mamilar correctamente; la ocurrencia de llanto del lactante a la primera hora después de la lactancia y el suministro de leche inadecuada percibido.

Conclusión:

El proceso de lactancia es dinámico; el juicio diagnóstico puede sufrir modificaciones según el tiempo en que se recoja el dato; las características determinantes son mejores predictores si se asocian con modelos y reglas de uso.

Descriptores:
Lactancia Materna; Diagnóstico de Enfermería; Desmame; Clasificación; Procesos de Enfermería

Defining characteristics	Ineffective breastfeeding
	Yes		No		Total
	n	%	n	%	n	%
Absence of observable signs of oxytocin release
Yes	24	32.9	4	5.5	28	38.4
No	19	26.0	26	35.6	45	61.6
Discontinuance of breast sucking
Yes	23	31.5	2	2.7	25	34.2
No	20	27.4	28	38.4	48	65.8
Insufficient drainage of the breast when breastfeeding
Yes	5	6.8	0	0.0	5	6.8
No	38	52.1	30	41.1	68	93.2
Infant's inability of seizing the areola-nipple region correctly
Yes	41	56.2	8	11.0	49	67.1
No	2	2.7	22	30.1	24	32.9
Occurrence of crying of the infant when it is put on the breast
Yes	13	17.8	0	0.0	13	17.8
No	30	41.1	30	41.1	60	82.2
Infant's crying one hour after breastfeeding
Yes	12	16.4	4	5.5	16	21.9
No	31	42.5	26	35.6	57	78.1
Infant's excitement one hour after breastfeeding
Yes	5	6.8	6	8.2	11	15.1
No	38	52.1	24	32.9	62	84.9
Infant's bending on the breast
Yes	6	8.2	0	0.0	6	8.2
No	37	50.7	30	41.1	67	91.8
Insufficient opportunity of sucking the breast
Yes	9	12.3	2	2.7	11	15.1
No	34	46.6	28	38.4	62	84.9
Resistance of the infant in seizing the nipple region with the mouth
Yes	14	19.2	0	0.0	14	19.2
No	29	39.7	30	41.1	59	80.8
Inappropriate milk supply perceived
Yes	32	43.8	4	5.5	36	49.3
No	11	15.1	26	35.6	37	50.7

Defining characteristics	Diagnostic accuracy measures									pvalue
	SP	Low	High	ES	Low	High	EF	Low	High
	%	%	%	%	%	%	%	%	%
Absence of observable signs of oxytocin release	55.8	39.9	70.9	86.7	69.3	96.2	68.5	56.6	78.9	*0.0002^ *() significant value of p in the Fisher's exact test. In bold, defining characteristics with EF greater than or equal to 70%.
Discontinuance of breast sucking	53.5	37.7	68.8	93.3	77.9	99.2	69.9	58.0	80.1	*<0.0001^ *() significant value of p in the Fisher's exact test. In bold, defining characteristics with EF greater than or equal to 70%.
Insufficient drainage of the breast when breastfeeding	11.6	3.9	25.1	100.0	88.4	100.0	47.9	36.1	60.0	0.0736
Infant's inability of seizing the areola-nipple region correctly	95.3	84.2	99.4	73.3	54.1	87.7	86.3	76.2	93.2	*<0.0001^ *() significant value of p in the Fisher's exact test. In bold, defining characteristics with EF greater than or equal to 70%.
Occurrence of crying of the infant when it is put on the breast	30.2	17.2	46.1	100.0	88.4	100.0	58.9	46.8	70.3	*0.0005^ *() significant value of p in the Fisher's exact test. In bold, defining characteristics with EF greater than or equal to 70%.
Infant's crying one hour after breastfeeding	27.9	15.3	43.7	86.7	69.3	96.2	52.1	40.0	63.9	0.1623
Infant's excitement one hour after breastfeeding	11.6	3.9	25.1	80.0	61.4	92.3	39.7	28.5	51.9	0.3422
Infant's bending on the breast	14.0	5.3	27.9	100.0	88.4	100.0	49.3	37.4	61.3	0.0393^* *()** significant value of p in the Fisher's exact test. In bold, defining characteristics with EF greater than or equal to 70%.
Insufficient opportunity of sucking the breast	20.9	10.0	36.0	93.3	77.9	99.2	50.7	38.7	62.6	0.1110
Resistance of the infant in seizing the nipple region with the mouth	32.6	19.1	48.5	100.0	88.4	100.0	60.3	48.1	71.5	*0.0004^ *() significant value of p in the Fisher's exact test. In bold, defining characteristics with EF greater than or equal to 70%.
Inappropriate milk supply perceived	74.4	58.8	86.5	86.7	69.3	96.2	79.5	68.4	88.0	*<0.0001^ *() significant value of p in the Fisher's exact test. In bold, defining characteristics with EF greater than or equal to 70%.
Absence of observable signs of oxytocin release	8.2	2.4	27.6	85.7	67.3	96.0	57.8	42.2	72.3	*0.0002^ *() significant value of p in the Fisher's exact test. In bold, defining characteristics with EF greater than or equal to 70%.
Discontinuance of breast sucking	16.1	3.4	76.2	92.0	74.0	99.0	58.3	43.2	72.4	*<0.0001^ *() significant value of p in the Fisher's exact test. In bold, defining characteristics with EF greater than or equal to 70%.
Insufficient drainage of the breast when breastfeeding	11.3	0.6	211.3	100.0	47.8	100.0	44.1	32.1	56.7	0.0736
Infant's inability of seizing the areola-nipple region correctly	56.4	11.0	288.9	83.7	70.3	92.7	91.7	73.0	99.0	*<0.0001^ *() significant value of p in the Fisher's exact test. In bold, defining characteristics with EF greater than or equal to 70%.
Occurrence of crying of the infant when it is put on the breast	27.0	1.5	475.1	100.0	75.3	100.0	50.0	36.8	63.2	*0.0005^ *() significant value of p in the Fisher's exact test. In bold, defining characteristics with EF greater than or equal to 70%.
Infant's crying one hour after breastfeeding	2.5	0.7	8.7	75.0	47.6	92.7	45.6	32.4	59.3	0.1623
Infant's excitement one hour after breastfeeding	0.5	0.1	1.9	45.5	16.7	76.6	38.7	26.6	51.9	0.3422
Infant's bending on the breast	10.6	0.6	195.4	100.0	54.1	100.0	44.8	32.6	57.4	0.0393^* *()** significant value of p in the Fisher's exact test. In bold, defining characteristics with EF greater than or equal to 70%.
Insufficient opportunity of sucking the breast	3.7	0.7	18.6	81.8	48.2	97.7	45.2	32.5	58.3	0.1110
Resistance of the infant in seizing the nipple region with the mouth	30.0	1.7	526.2	100.0	76.8	100.0	50.8	37.5	64.1	*0.0004^ *() significant value of p in the Fisher's exact test. In bold, defining characteristics with EF greater than or equal to 70%.
Inappropriate milk supply perceived	18.9	5.4	66.4	88.9	73.9	96.9	70.3	53.0	84.1	*<0.0001^ *() significant value of p in the Fisher's exact test. In bold, defining characteristics with EF greater than or equal to 70%.

Defining characteristics	Coefficient	Standard error	Wald	Odds ratio	Limits (CI 95%)	p value
Discontinuance of breast sucking	5.28397	1.90360	7.7049	197.1502	4.7252 a 8225.7355	0.005
Infant's inability of seizing the areola-nipple region correctly	5.12074	1.46784	12.1704	167.4591	9.4288 a 2974.1483	0.0005
Infant's crying one hour after breastfeeding	4.59100	1.85159	6.1479	98.5926	2.6166 a 3714.9224	0.0132
Inappropriate milk supply perceived	5.22807	1.61086	10.5334	186.4326	7.9311 a 4382.3896	0.0012
Constant	-7.1611
Chi-square	DF	Significance	R² of Cox & Snell		R² of Nagelkerke
78.313	4	p< 0.0001	0.6579		0.8868

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[1] CORRESPONDING AUTHOR: Cândida Caniçali Primo. E-mail: candida.primo@ufes.br