早產兒需求性餵食之實證探討

Evidence-based Approach in Demand Feeding Among Preterm Infants

早產兒因神經發展尚未成熟，進行早產兒口腔餵食之護理時，需考量其發展階段、行為狀態、與暗示性行為，以決定其口腔餵食之時機，然而臨床上餵食早產兒時多採用定時定量方法，故本文以實證觀點，探討基於早產兒行為狀態需求之餵食方式，相較於定時定量餵食對其餵食成效的影響，並依證據提出臨床建議與評值方法。擬定之實證臨床問題為「矯正年齡32週以上之早產兒在口腔餵食過渡期時，採需求性餵食方法相較於定時定量餵食方法，其臨床效益是否不同？」。透過搜尋2000-2013年實證文獻、精要與評讀實證文獻後，現有證據支持早產兒在餵食過渡期時採用需求性餵食，能夠縮短其口腔餵食過渡期天數、縮短住院天數、增進行為統合、及增加餵食時生理穩定，在體重成長速率與口腔進食量方面缺乏有力證據支持此兩項餵食效益，建議臨床上口腔餵食矯正年齡32週以上之早產兒時，每餐前5-10分鐘先給予非營養性吸吮並評估行為狀態、與暗示性行為以決定給予口腔餵食之時機，故護理人員之餵食評估能力乃是發揮此餵食方法對於早產兒餵食成效之重要關鍵。

Because of the immature neurological development among premature infants, the timing of oral feeding is based on infants’ development, behavioral states, and cues. However, premature infants are often clinically fed at scheduled intervals with prescribed volumes. The purpose of this review is to determine the effectiveness of feeding policy in response to premature infants’ needs for their feeding benefit by an evidence-based approach and the clinical recommendations. The clinical question is “For oral feeding among premature infants with postmenstrual age of greater than 32 weeks, is there a difference between the clinical benefi t of demand feeding policy and the standard feeding?” After systemic review of evidences from 2000 to 2013, the results support that demand feeding reduces the duration of transition time, allows earlier hospital discharge, and improves infant behavioral and physiological stability. Limited evidence supports that feeding premature infants with demand feeding policy improves infants’ growth and their total intake of milk. Results of this systemic review indicated that health professionals should provide non-nutritive sucking and assess infants’ behavioral states for 5-10 minutes before the scheduled time and then decide whether to proceed with feeding. Nurses’ competence in assessing appropriate time for feeding is an important factor in improving the feeding outcome of premature infants.