從實證護理的觀點談新生兒杯餵

A View of Evidence-based Nursing on Cupfeeding of Neonates

世界衛生組織／聯合國兒童基金會提倡的成功哺餵母乳十步驟，其中步驟六及步驟九明確的陳述非醫療需要應避免配方奶的添加以及人工奶嘴的使用，杯子餵食便被建議使用於無法達到純母乳哺餵的嬰兒餵食輔佐方案，然而杯子餵食對於促進哺乳的效益尚未具備穩固的實證基礎，卻已被廣為應用於母乳哺餵的領域，為了輔助臨床者於執行護理工作時之決策判斷，本文運用實證護理的五步驟，探索新生兒杯餵的實證基礎。結果發現杯餵適合應用在生理穩定的早產兒、剖腹出生的足月兒、母親具哺乳意願且持續擠奶的族群。在護理應用時宜同時增強母親的哺乳意願及衛教母親維持泌乳的方法。另外，現有的研究基礎尚不足以提供有效的證據支持杯餵於母乳哺育上的成效，其臨床應用僅符合不傷害原則，建議未來應就此現象做更深入的探討，以落實新生兒杯餵的實證護理。

Avoiding formula supplementation and pacifier use except medical necessary was emphasized by the step six and nine among the ten steps to successful breastfeeding suggested by World Health Organization / United Nations Children’s Fund (WHO/UNICEF). Cup feeding was recommended by WHO as a substitute for bottle feeding whenever the mother can not fully breastfeed her infant. Although the practice has been widely used to promote breastfeeding, the evidence of the benefit was insufficient. This article explored the benefit of cupfeeding based on the 5-step evidence-based approaches and reached final conclusion from literature appraisal. Several groups have been found to benefit from cupfeeding, including premature infants with stable physiological state, full-term babies delivered by cesarean section, and infants of postpartum mothers who intend to breast-feed and continue to express milk from breast. Increasing mother’s motivation of breastfeeding and educating mothers about maintaining milk production are both important elements of successful breastfeeding. The evidences of the benefit of cupfeeding were not significant enough to support clinical outcomes. At current stage, cupfeeding can only be proved as harmless at best. More researches are needed to support the use of cupfeeding in clinical settings.