發展性照護於早產兒視網膜病變檢查之臨床應用

The Clinical Application of Developmental Care in Retinopathy of Prematurity Eye Examinations

早產兒視網膜病變（retinopathy of prematurity）是因早產兒的視網膜血管生長情形異常，透過視網膜檢查早期發現或治療是相當重要的。然而，研究已證實此項眼科檢查會導致疼痛、壓力和生理徵象變化。近幾十年，發展性照護廣泛地實施於新生兒照護，文獻亦顯示運用此照護於早產兒視網膜病變檢查可有效減少疼痛分數、壓力表現、生理徵象恢復時間。本文介紹發展性照護措施中之五層面：環境安排（如：提供安靜與避免光線刺激的環境）、擺位（如：以圍巢或捲軸支持物，協助早產兒維持促進神經運動發展之姿勢）、氧氣供給（如：依早產兒個別臨床情形及血氧濃度變化，提供足夠氧氣支持）、接觸早產兒與互動方式（如：檢查前以柔和聲音說話，以及溫暖的手碰觸早產兒）、以及依需求和暗示行為個別化照護（如：觀察暗示行為，視需求提供休息、非營養性吸吮或安撫）。經由發展性照護策略，以期能最大程度減少早產兒在視網膜病變檢查引起之疼痛、壓力與能量耗損，提供舒適、支持和促進早產兒發展之個別化照護。

Retinopathy of prematurity (ROP) is a disorder affecting the development of retinal blood vessels in preterm infants. Eye screening examinations are important to the early detection and treatment of ROP. However, several studies have associated eye examinations with pain, stress, and negative physiological effects. Developmental care has been provided as part of neonatal care in recent decades, and some studies indicate that this care positively affects pain scores, stress response, and recovery time during ROP eye screenings. In this article, five elements of developmental care that are applicable for preterm infants undergoing eye examinations for ROP are highlighted and described. These five elements include environmental modifications (e.g., provide a quite environment and dim room lighting), positioning (e.g., offer a nest or positing support and promote the infant to achieve neuromotor development), oxygen delivery (provide adequate oxygen support according to clinical conditions), approach and interaction (e.g., talk softly to infants and gently touch them before the eye examination), and cue-based individual care (e.g., soothe infants, give them a short break or soother based on observations of needs and cue-based behavior). Effectively addressing these five elements may minimize the pain, stress, and energy consumption during ROP eye screenings and provide individualized care that is comfortable, supportive, and promotes the healthy development of preterm infants.