降低新生兒加護病房早產兒餵食不耐受之發生率

背景：營養對於早產兒至關重要，經現況調查發現單位護理人員對灌食照護認知正確率為74.8%，執行灌食照護流程完整率為74.3%，對胃殘餘量處理方式不一致，缺乏客觀評估胃殘餘量相關工具，專科照護指引未修定，以及無定期查核制度。目的：提升護理人員灌食照護認知正確率及照護流程完整率，以及降低早產兒餵食不耐受發生率。解決方案：制作「灌食標準作業流程手冊」及「胃殘餘色卡」以利護理人員在照護過程有所依循。舉辦灌食照護教育訓練，並透過臨床專科評核，以減少早產兒餵食不耐受發生率。結果：新生兒加護病房護理人員灌食照護認知正確率由74.8%提升至93.7%，執行灌食照護流程完整率由74.3%提升至95.5%，以及早產兒餵食不耐受發生率從71.8%下降至39.0%。結論：藉由此專案結果作為新生兒加護病房現行早產兒餵食照護模式之參考，改善了早產兒腸道營養的建立，提升照護品質，也使早產兒能獲得更完善及安全的照護。

關鍵字

餵食不耐受；早產兒；胃殘餘量；管灌餵食；新生兒加護病房

並列摘要

Background & Problems: Nutrition is very important for premature infants. Our recent research showed that the accuracy of recognition related to tube feeding was 74.8%, and the completeness of tube feeding was 74.3%. After analyzing this situation, the reasons found to be significantly associated with the low rates of tube-feeding recognition accuracy and completion included: inconsistent treatment of gastric residual by nurses in the neonatal intensive care unit (NICU), lack of sufficient assessment tools in the NICU, out-of-date specialist care guidelines, and lack of a regular inspection system. Purpose: Our aim was to improve tube-feeding-related recognition accuracy and completion to reduce the incidence of feeding intolerance. Resolutions: The intervention included developing a guideline manual for feeding procedures and making a gastric residual color card as a clinical-care reference. Holding on-the-job training and monitoring the quality of nursing care can reduce the incidence of feeding intolerance in preterm. Results: The accuracy of tube-feeding recognition increased from 74.8% to 93.7%. The completion of tube feeding increased from 74.3% to 95.5%. The incidence of feeding intolerance in premature infants decreased from 71.8% to 39.0%. Conclusions: The results and process of this project provides a reference for improving the clinical care model for preterm infants in the NICU and for improving the enteral nutrition of preterm infants. The implementation of this project may improve the quality of nursing care and enable preterm infants to receive safer and more-complete care.

並列關鍵字

feeding intolerance ； premature ； gastric residual volumes ； tube feeding ； neonatal intensive care unit

參考文獻

林鈺珊、江明洲（2020）．不同母乳添加劑劑型對於早產兒臨床預後差異之比較．台灣營養學會雜誌，44（1），18–25。[Lin, Y.-S., & Chiang, M.-C. (2020). Effects of two different human milk fortifiers on clinical outcomes in preterm infants. Nutritional Sciences Journal, 44(1), 18–25.] https://doi.org/10.6691/NSJ.202003_44(1).0002

葉奕廷（2018）．新生兒壞死性腸炎（一）：流行病學及病生理．臨床醫學月刊，82（6），713–715。[Yeh, Y.-T. (2018). Neonatal necrotizing enteritis (1): Epidemiology and pathophysiology. Clinical Medicine, 82(6), 713–715.] https://doi.org/10.6666/ClinMed.201812_82(6).0130

Barr, P. A., Mally, P. V., & Caprio, M. C. (2019). Standardized nutrition protocol for very low-birth-weight infants resulted in less use of parenteral nutrition and associated complications, better growth, and lower rates of necrotizing enterocolitis. Journal of Parenteral and Enteral Nutrition, 43(4), 540–549. https://doi.org/10.1002/jpen.1453

Binchy, Á., Moore, Z., & Patton, D. (2018). Feeding intervals in premature infants ≤ 1750 g: An integrative review. Advances in Neonatal Care, 18(3), 168–178. https://doi.org/10.1097/ANC.0000000000000486

Foster, J. P., Psaila, K., & Patterson, T. (2016). Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD001071.pub3

國際替代計量

降低新生兒加護病房早產兒餵食不耐受之發生率

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