杯餵與瓶餵對早產兒影響之系統性文獻回顧與實證臨床應用

A Systematic Literature Review and Clinical Evidence Application of the Effects of Cup Feeding versus Bottle Feeding Among Preterm Infants

本研究以系統性文獻回顧檢視杯餵與瓶餵對早產兒的影響並檢視臨床應用之成效，透過實證醫學五大步驟來執行與評值實證措施：（一）形成一個臨床可回答的問題；（二）尋找最佳文獻證據；（三）實證文獻評析，評析所納入之四篇文章以RevMan5.0軟體進行統合分析發現：早產兒杯餵僅限於增加出院時之純母乳哺餵率，無法延續至出院後；（四）將證據應用在病人身上，以病歷回溯方式收集杯餵組92人、瓶餵組12人，結果發現：早產兒出院時杯餵組與瓶餵組之母乳哺餵率(100%vs91.7%)、純母乳哺餵率(21.7%vs0%)，杯餵組皆高於瓶餵組，但兩組於母乳哺餵率與純母乳哺餵率上，皆未呈現統計顯著差異；副作用方面兩組間都有嗆吐事件發生，但都能恢復生命徵象穩定；（五）最後評值實證執行步驟。研究結果雖顯示早產兒杯餵與瓶餵間母乳哺餵率兩者並無差異，不過在臨床應用上，建議仍須考量早產兒個別生理及發展的狀況，尤其在先天性唇、顎裂及補充餵食的早期，宜採行杯餵，以避免瓶餵所造成的嗆吐及乳頭混淆。至於杯餵與瓶餵間之成效，有待未來研究加以證實。

This study is to review the effect of cup feeding versus bottle feeding among preterm infants by means of systematic literature review as well as to inspect the result of the clinical application. To practice and evaluate evidence, fi ve steps of Evidence-Based Medicine were applied: 1. Asking an answerable question. 2. Acquiring the best available evidence. 3. Appraising the evidence of its validity and usefulness: The selected four articles were meta-analyzed by software RevMan5.0 and it was found that the increase of fully breastfeeding rate (RR: 0.75, 95%CI: 0.61- 0.92) of cup feeding among preterm infants was only at hospital discharge but was not able to be continued at home. 4.Application of results in practice: In the method of case history review, 92 infants were selected in cup feeding group and 12 infants in bottle feeding group and it was found that the cup feeding group was both higher in breastfeeding rate (100% vs 91.7%) and fully breastfeeding rate (21.7% vs 0%) compared to the bottle feeding group but there was no statistically signifi cant difference in breastfeeding (P= .115) and fully breastfeeding rate (P= .117) for both groups. For side effects, there were chokes and spits for both groups but stable sign of life was restored afterwards. 5. Evaluation of performance (the fi nal step): Although the result of the study showed that the breastfeeding rate was equal between cup feeding and bottle feeding among preterm infants, it is still recommended for clinical application to consider the circumstances of individual physiology and its development especially for medical conditions like congenital cleft lip, cleft palate and early supplementary feeding where cup feeding is recommended to avoid choking and nipple confusion. As for the effectiveness between cup feeding and bottle feeding, it is yet to be substantiated by current studies.