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  • 學位論文

多元餵食方案對早產兒母親哺餵能力及早產新生兒餵食結果之成效

The effects of a multiple feeding program on maternal feeding confidence and feeding outcomes premature babies

指導教授 : 周汎澔

摘要


早產兒吸吮哺餵的協調性被認定可用於評估新生兒健康、感覺神經統合的生長發育重要因素。但是人類的吸吮,吞嚥的反射需到32至34週才能發展成熟,在此之前,可能會因吸吮過程誘發嬰兒的呼吸暫停,心搏過緩、血氧飽和度下降等狀況,導致母親在學習新生兒餵養磨合階段失敗,嚴重也會降低母育信心,故臨床醫療人員會將早產兒的吸吮狀況列為出院的重要指標。雖然目前有跨領域照會由物理治療師給予單次口腔按摩,但實質上一次的介入,並不能改善早產兒口腔吸吮。故本研究將探討多元餵食方案對早產兒母親哺餵能力及早產新生兒餵食結果之成效。 本研究採實驗性設計,自2013年8月1日至2014年5月01日於南部某醫學中心新生兒病房執行,符合早產兒吸吮困難收案對象共31位,其中實驗組16位,對照組15位。研究對象為孕期週數小於34週或有餵食困難之37週早產兒,以隨機分配方式分為實驗及對照組。早產兒部分:實驗組採單盲方式每日由個案管理師及研究計畫主持人執行口腔訓練一次,兩組其餘時間則由護理人員登錄餵奶、溢吐奶變化、體重。母親部分:兩組於早產兒34週時、出院前及出院後2-3天回門診時,填寫哺餵母育信心、哺餵知識以檢測哺餵能力之成效,並於出院返家餵奶時填寫餵食滿意度及溢吐奶改善成效。以SPSS forWindows 18.0版統計軟體進行資料分析,描述性統計以次數分佈、百分比、平均值、標準差為主,分析性統計包括t檢定、卡方檢定(chi-square test)及線性混合模式隨機效應分析。研究結果顯示:早產兒母親在接受多元餵食方案後,其哺餵能力三次測試,皆達顯著差異(p<.05),顯示多元餵食方案可改善早產兒吸吮能力。另外早產兒之體重增加百分比、溢吐奶變化,於多元餵食方案介入後皆達顯著差異,實驗組溢吐奶量較少,平均為-.58± .81㏄、對照組溢吐奶量為.05±.51㏄,體重增加百分比平均為13.58± 11.67%、對照組為6.60±5.25%。故本研究結果證實多元餵食方案可強化早產兒之吸吮,並增加體重百分比及降低溢吐奶現象,且可強化早產而母親哺餵能力;未來希望透過此次研究結果提供早產兒之吸吮訓練的衛教設計參考。

並列摘要


Abstract The coordination of feeding process is thought to be a key factor of well growth in nursing premature infants; however, the reflexes of sucking and swallowing need 32-34 weeks to be mature. Before that, preterm infants often have oromotor discoordination, apnea, bradycardia, and oxygen desaturation during oral feeding. These situations stress mothers when premature babies are prepared to discharge. Even so far, the effectiveness of the improved oral feeding process for preterm infants is limited. Therefore, a comprehensive oral feeding skill training program was developed by the interdisciplinary team. An experimental design was conducted in the neonatal ward of a medical center in southern from Aug. 1, 2013 to May 1, 2014. Participants were received cases who were less than 34-week gestation or 37-week gestation with feeding difficulties. These preterm babies with sucking difficulties, totally 31, were randomly assigned. There were 16 in the experimental group(EG) and 15 in the control group(CG). To the infants, the single-blind approach was taken daily by the case manager and the researcher in EG. Oral training was performed once a day. In the rest of a day, nurses recorded the feeding, overflow spits changes and weight in both groups. To all the mothers, while the babies were 34-week-old, the 2-3 days prior to discharge and discharge back to the clinic, the questionnaires of feeding capabilities (including: feeding maternal confidence and knowledge change) were filled out to test the effectiveness of breastfeeding for three times. More, the questionnaires of feeding satisfaction and improved results of overflow spits were completed after they discharged home. Statistical Methods: descriptive statistics were analyzed by frequency, percentage, mean, standard deviation based. Analytical statistics included T-test, Chi-square test and linear mixed models with random effects analysis. The results: the three tests of feeding capacity of mothers who received multi-feeding program all showed significant differences (p <.05); simultaneously, percentage of weight gain and overflow spits change of preterm children showed significant differences after the intervention of the feeding program. This study confirmed the results of multivariate feeding programs can strengthen the sucking ability of preterm children, increase the percentage of body weight, and reduce overflow spits phenomenon. Besides, mothers can also strengthen breastfeeding partially ability. The researcher referred to the above findings and made related recommendations for the further training of sucking in preterm children and health education.

參考文獻


參考文獻
內政部(2012).內政部統計通報.2012年11月23日取http://
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早產兒基金會訊(2006,10月8日).完整孕護,避免早產.2010 年11月20日取自http://www.pbf.org.tw.
洪漢陽(2006).臨床心生兒科學(四版).台北市:嘉洲。

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