運用多元方案照顧一位餵食困難早產兒之照護經驗

Using Multiple Programs to Nurse a Premature Infant with Feeding Difficulties

江昱瑤(Yu-Yao Jiang) ； 余培筠(Pei-Yun Yu) ； 許瀞棻(Ching-Fen Hsu)

《榮總護理》 38卷1期 (2021/03) Pp. 100-107

https://doi.org/10.6142/VGHN.202103_38(1).0012

摘要

早產兒餵食困難為臨床上常見問題，因此成功由管灌過渡至全口餵食是醫療人員及家屬的共同目標，本文描述一位餵食困難早產兒之照護經驗，病嬰因肺支氣管發育不全而長期依賴氧氣及鼻胃管灌食，導致新手父母焦慮及拒絕出院返家，故引發筆者撰文動機。照護期間為2019年4月3日至5月12日，筆者運用系統性身體評估，透過直接照顧、病歷查閱及家庭會談等方式進行整體性的評估及資料收集，確立病嬰有低效性呼吸型態、低效性嬰兒哺餵型態、混亂性嬰兒行為及照顧者角色緊張的健康問題。護理期間藉由文獻探討擬定個別性的護理措施，除了維持呼吸道通暢及提供氧合，亦結合發展性照護、口腔按摩及音樂治療等多元方案使病嬰盡早脫離胃管，運用傾聽及鼓勵父母表達內心感受，並結合醫療團隊提供完整的照護資訊，以助父母於返家後照顧能夠有信心及把握。建議臨床上應盡早介入口腔評估及復健，才能使早產兒盡快由管灌過渡至全口餵食，降低神經發育遲緩機率並縮短其住院天數。

關鍵字

早產兒 ； 餵食困難 ； 口腔按摩

並列摘要

Difficulty in feeding premature infants is a common clinical problem. Therefore, a successful transition from tube feeding to full mouth feeding is a goal shared by both medical staff and patients' families. This paper describes the experience of nursing a premature infant with feeding difficulties. The infant had long relied on oxygen and nasogastric tube feeding due to pulmonary and bronchial dysplasia, leading to the new parents' anxiety and refusal to discharge the infant from the hospital; this situation inspired this research. During the nursing period from April 3 to May 12, 2019, the author used systematic physical assessments to conduct an overall assessment and collected data by providing direct care, reviewing medical records, and talking to the patient's family. The author determined that the overall case involved several health problems, including ineffective breathing patterns, ineffective infant feeding patterns, chaotic infant behavior, and caregiver role strain. During the nursing care period, the author applied individualized nursing methods based on a literature review. In addition to the maintenance of airway patency and oxygenation, multiple programs that integrated developmental care, oral massage, and music therapy were used to eliminate the patients' need for a gastric tube as soon as possible. The author helped to boost the parents' confidence and assurance regarding the proper postdischarge home care by listening to them, encouraging them to earnestly express their feelings, and providing them with complete care information with the support of the medical team. This article recommends that clinical interventions such as oral assessments and rehabilitation should be implemented as soon as possible to facilitate premature infants' timely transition from tube feeding to full mouth feeding, reduce the incidence of neurodevelopmental retardation, and shorten the duration of hospital stay.

並列關鍵字

preterm infants ； feeding skills training program ； oral motor

參考文獻

翁敏雪、周弘傑 (2016)．父母於早產兒住院 期間的親職議題及護理．護理雜誌，63 (6)，114-119。

許欣潔、羅慧萍、賴羿妤、曾貴芳、楊佩欣 (2017)．運用仿居家概念提升早產兒出院 前準備之成效．長庚護理，28(3)，414-425。

謝伶瑜、陳碧惠 (2018)．日夜週期性光照介入 早產兒照護之實證．台灣醫學，22(4)， 446-453。10.6320/FJM.

Chorna, O. D., Slaughter, J. C., Wang, L., Stark, A. R., & Maitr, N. L. (2020). A pacifier-activated music player with mother's voice improves oral feeding in preterm infants. Pediatrics, 133(3), 462-468.

Ghomi, H., Yadegari, F., Soleimani, F., Knoll, B. L., Noroozi, M., & Mazourie, A. (2019). The effects of premature infant oral motor intervention (PIOMI) on oral feeding of preterm infants: A randomized clinical trial. International Journal of Pediatric Otorhinolaryngology, 120, 202-209.