早產兒餵食困難之評估與介入

Evaluation and Physical Therapy Intervention of Oral Feeding Difficulty in Preterm Infants-Literature Review

黃希文(Hsi-Wen Huang) ； 陳佩珊(Pei-Shan Chen) ； 鄭素芳(Suh-Fang Jeng) ； 王儷穎(Li-Ying Wang)

《物理治療》 33卷3期 (2008/06) Pp. 188-196

摘要

早產兒餵食困難的問題已存在於新生兒加護病房長久的時間，由於早產兒神經動作發展仍尚未成熟，加上其他因早產而導致之併發症，都使得經口餵食困難的危險性大為提高，目前也尚無系統化研究或專科醫學來解決。物理治療師在新生兒加護病房中扮演加強其神經動作發展的角色，此一口腔動作發展之領域亟需物理治療師去拓展開發。為了更全面性的了解此一問題，本文簡介了新生兒的正常口腔動作發展，並對照早產兒的發展，列出早產兒口腔動作發展之劣勢，除此之外，早產兒本身的行為情緒之統合能力以及與餵食者間的互動情形，也都已被證實會影響經口餵食之表現。餵食困難的評估方式包括問題導向之評估、口腔動作之評估與餵食互動之評估。利用文獻回顧方式，列舉出目前已被證實有療效的非侵入性早期介入方式，包括口腔刺激、口腔支持、無營養性吸吮以及擺位方式。本文的資料將有助於物理治療師了解早產兒餵食困難的原因以及影響因子，以針對這些高危險性早產兒進行早期的經口餵食評估與設計適合的介入治療計畫。

關鍵字

餵食困難 ； 早產兒 ； 口腔動作 ； 早期介入

並列摘要

Feeding difficulty is a common problem in preterm infants who survived at the neonatal intensive care unit (NICU). The combination of neuromotor immaturity and neonatal complications may increase the risk of feeding difficulty. However, a systematic review of feeding problems and their management are needed. Physical therapists working in the NICU are frequently consulted to evaluate and treat the oral-motor problems in preterm infants. The aim of the present report was therefore to review the typical oral-motor development in full-term infants and to contrast the information with that of preterm infants. The neonatal self-regulatory behavior and the caregivers factors that may be contributing to feeding disorder were also reviewed. The evaluation of feeding difficulty in preterm infants includes taking a focused feeding history, oral-motor development assessment, and observations of infant-caregiver interactions during feeding. Beneficial evidence of the common practice skills such as oral stimulation, oral support, non-nutritive sucking practice and proper positioning in this population were also reviewed. The overview of these topics will help physical therapists understand the contributing factors of feeding difficulty and develop proper evaluation and treatment strategies for high-risk preterm infants.

並列關鍵字

Feeding difficulty ； Preterm infants ； Oromotor development ； Early intervention