以暗示行為為基礎之發展性照護－協助一位早產兒度過餵食轉換期

Helping a Preterm Infant Through the Transitional Feeding Period Using a Cue-Based Feeding Approach of Developmental Care

黃淳琪(Chun-Chi HUANG) ； 黃美智(Mei-Chih HUANG)

《護理雜誌》 66卷2期 (2019/04) Pp. 101-106

https://doi.org/10.6224/JN.201904_66(2).13

摘要

對於新生兒加護病房之醫護人員而言，決定何時為早產兒開始口腔餵食之最佳時機以協助早產兒度過餵食轉換期需有足夠之臨床判斷能力。而依據暗示行為之餵食（cue-based feeding）方式，可藉由觀察早產兒行為判斷其餵食準備度並協助其順利轉換為完全經口進食。本文描述照護一位低出生體重早產兒於管灌餵食期間，於31週時在餐前出現明顯飢餓暗示，但評估其吸吮、吞嚥及呼吸尚未協調，故開始介入照護計畫，協助其由管灌餵食轉換至全經口進食。照護期間自2017年9月21日至11月2日，並將照護過程分為口腔刺激期：給予口腔刺激增加口腔肌肉運動之成熟度；口腔進食訓練期：依據暗示性行為決定開始及結束口腔餵食之時機，餐前以POFRAS（Preterm Oral Feeding Readiness Scale）量表評估其進食準備程度；需求性餵食期：轉換至全經口進食，配合暗示行為決定餵食時機。隨著個案週數增加，進食量及體重呈正成長且無合併症，並達到需求性餵食之目標。此報告可作為訂定以暗示行為為基礎之早產兒餵食轉換期臨床照護準則之參考。

關鍵字

早產兒 ； 暗示行為 ； 發展性照護 ； 餵食轉換期

並列摘要

The aim of this case report was to identify the optimal point to start oral feeding in order to help a preterm infant successfully pass through the transitional feeding period. Because all preterm infants must go through a transitional feeding period, going through this period successfully is very important. This case report described a nursing experience related to caring for a low-birth-weight preterm infant who showed hunger cues before feeding at around 31gestational weeks during the tube-feeding period. An assessment revealed that the preterm infant did not exhibit good sucking, breathing, and swallowing coordination. Therefore, we decided to design a nursing care plan to help the preterm infant transition smoothly from tube feeding to oral feeding. The nursing care period was from September 21st to November 2th, 2017. The care processes included: 1) the oral stimulation phase: provision of oral stimulation to increase oral motor function, 2) the oral feeding training phase: use of the Preterm Oral Feeding Readiness Scale (POFRAS) assessment tool to assess feeding readiness before oral feeding, 3) use of a cue-based approach to decide the starting and stopping points, and, finally, 4) the transition to the demand feeding phase. As the preterm infant grew, the body weight and feeding amount both increased positively and without complications. This experience may serve as a model for developing clinical guidelines for a cue-based feeding approach for preterm infants during the transitional feeding period.

並列關鍵字

preterm infant ； cue-based ； developmental care ； transitional feeding period

參考文獻

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