比較早產兒親餵與瓶餵之暗示行為

Breast- and Bottle-Feeding in Preterm Infants: A Comparison of Behavioral Cues

背景：早產兒發展性照護係藉由觀察暗示行為了解其生理壓力或需求。過去研究發現瓶餵過程所產生之生理壓力明顯高於親餵，但尚無研究探討是否亦會造成暗示行為的差異。目的：本研究旨在比較早產兒親餵與瓶餵所呈現之暗示行為型態和頻率之異同。方法：採用次級資料分析，以妊娠週數配對分別選取研究資料庫中去連結之親餵與瓶餵各7片哺餵影片，並依據「早產兒進食暗示譯碼系統（preterm feeding cues coding system，PFCCS）」包括「飢餓暗示」、「自我調節暗示」、「壓力暗示」及「飽足暗示」四類共24項進食暗示行為，進行譯碼及比較分析。結果：（一）親餵組表現飢餓暗示頻率顯著高於瓶餵（p=.013）；（二）瓶餵組表現壓力暗示頻率顯著較親餵多（p=.041）；（三）瓶餵及親餵各行為項目達顯著差異者有：「奶水流出」（瓶餵＞親餵，p=.008）、「口鼻周圍顏色改變」（瓶餵＞親餵，p=.024）及「手部姿勢」（親餵＞瓶餵，p=.034）。結論／實務應用：親餵者出現較少的壓力暗示，故建議提升母親與醫護人員觀察暗示行為之敏感度，鼓勵早產兒親餵。

Background: Developmental care has been broadly applied to identify the behavioral cues and care needs of preterm infants. Past studies indicate a significantly higher level of physical distress in bottle-fed preterm infants than in preterm infants who are breastfed. However, no evidence has yet been reported that supports the influence of feeding methods on behavioral cues.Purpose: This study compares differences in the type and frequency of behavioral cues between breast- and bottle-fed preterm infants.Methods: A comparison study design and secondary data analysis method were used to assess data from two previous research projects. Infant feeding behavioral cues were observed and compared between two groups: 7 preterm infants who were breastfed and 7 preterm infants who were bottle-fed. After cases were matched by infant gestational age, behavioral responses were coded according to the preterm feeding cues coding system (PFCCS) from 7 paired maternal-infant feeding videos that featured preterm infants of 25 to 32 weeks gestational age at birth.Results: The PFCCS classifies 24 feeding behavioral cues into hunger cues, self-regulatory cues, stress cues, and satiety cues. Infants in the breastfeeding group had a higher hunger cue frequency than their bottle-fed peers (p = .013), while bottle-fed infants had a higher stress cue frequency than their breastfed peers (p = .041). Other significant differences in behavioral cues between the two feeding methods included ”fluid spillage” (bottle- ＞ breast-, p = .008), ”central cyanosis” (bottle- ＞breast-, p = .024) and ”hand pushing” (breast- ＞ bottle-, p = .034).Conclusions/Implications for Practice: Preterm infants in this study who breastfed showed significantly fewer stress cues than those who bottle fed. These findings support the importance of enhancing care provider sensitivity with regard to behavioral-cue observation. Findings further support breastfeeding rather than bottle-feeding for preterm infants.