運用發展性照護理論改善接受開心手術之晚期早產兒的自我調節與餵食困難之護理經驗

Applying Developmental Care Theory to the Improvement of Self-Regulation and Feeding Difficulties in a Late Preterm Infant Receiving Cardiac Surgery: A Nursing Experience

早產兒合併其他器官異常，且須於出生後即接受手術治療者，因神經系統尚未成熟，常難以因應手術及治療所帶來的壓力，進而出現自我調節困難與相關健康問題。個案為36+4週出生、於出生第五日接受心臟手術的晚期早產女嬰，術後出現自主神經調節障礙、無效性嬰兒吸吮–吞嚥反應及營養攝入不足等問題。照護期間自2025年4月22日至5月10日，並於5月14日進行電話追蹤。以Als統合發展理論（Synactive Theory of Development）為架構，融合七項發展性照護核心策略（The Neonatal Integrative Developmental Care Model：Seven Neuroprotective Core Measures），涵蓋環境控制、睡眠與姿勢支持、壓力與疼痛管理及以家庭為中心的參與照護，並結合早產兒經口餵食準備評估量表（Preterm Infant Oral Feeding Readiness Assessment Scale，POFRAS）進行客觀評估及介入。結果顯示個案自我調節與餵食困難之問題皆獲得改善，哭鬧頻率下降、能維持較長時間的安穩狀態，吸吮－吞嚥－呼吸協調提升，經口進食量上升，家屬能有效執行照護，POFRAS分數由21分升至32分。本報告提供結合理論與行為線索觀察的照護策略，有效改善接受侵入性手術之早產兒餵食困難與自我調節能力，並提升照護者效能與信心。

When preterm infants present with organ anomalies that require immediate surgical intervention after birth, their immature nervous systems often limit their ability to cope with the stress of surgery and subsequent treatments. This often results in difficulties with self-regulation and related health issues. The case described in this study involves a late preterm female infant born at 36+4 weeks of gestation who underwent cardiac surgery on the fifth day after birth. Postoperatively, she exhibited neonatal neurodevelopmental disorganization, ineffective suck–swallow reflexes, and inadequate nutritional intake. The first author provided nursing care between April 22 to May 10, 2025, with a telephone follow-up on May 14. The provided interventions were guided by Als’Synactive Theory of Development and integrated the Seven Neuroprotective Core Measures of the Neonatal Integrative Developmental Care Model, encompassing environmental regulation, sleep and positioning support, stress and pain management, and family-centered care. Objective evaluation was conducted using the Preterm Infant Oral Feeding Readiness Assessment Scale (POFRAS). The results demonstrated improvements in both self-regulation and feeding difficulties. Notably, the incidence of crying episodes decreased, the infant was able to sustain a calm state for longer periods, coordination of suck–swallow–breathing improved, and oral intake increased. Consequently, the amount of supplemental gavage feeding was reduced, caregivers were able to provide effective care, and the POFRAS score rose from 21 to 32. The comprehensive care approach described in this study integrates theoretical frameworks with behavioral cue–based observations to effectively improve feeding difficulties and self-regulation in preterm infants undergoing invasive surgery while simultaneously enhancing caregiver competence and confidence.