Effect of Tactile Experience During Preterm Infant Feeding on Clinical Outcomes.
Effect of Tactile Experience During Preterm Infant Feeding on Clinical Outcomes.
复制标题
早产儿喂养期间触觉体验对临床结果的影响。
DOI：
10.1097/nnr.0000000000000453
复制
发表时间：
2020
期刊：
影响因子：
2.5
通讯作者：
Tepe,Karin
中科院分区：
文献类型：
--
作者：
Pickler,RitaH;Meinzen-Derr,Jareen;Moore,Margo;Sealschott,Stephanie;Tepe,Karin
尽管极早产儿的存活率有所提高，但随后的神经行为障碍的发生率仍然很高。与不良神经行为和发育结局有关的一个因素是新生儿重症监护室的住院和不一致的住院模式。尽管许多潜在的脑损伤发生在子宫内或出生后不久，但神经保护策略可能会阻止损伤的进展，特别是当这些策略在足月前2-3个月的神经可塑性最敏感的时期使用时。这项分析的目的是测试涉及触觉成分的模式化喂养体验的效果（触摸和/或持有）喂养期间提供的早产儿的临床结果，通过口服喂养的进展，作为神经发育的早期指标。早产儿（n= 120）在生命的第一周内被招募，并随机分配到一个实验组接受模式喂养的经验或对照组接受通常的喂养care.ResultsAnalysis的数据从91名婴儿表明，婴儿接受触摸超过25%的早期管饲喂养更快地实现充分的口服喂养;随着触摸接触的增加，从第一次经口到完全经口进食的时间减少。早期管饲喂养或触摸过渡喂养和充分口服feeding.DiscussionNeurological的期望在关键时期的发展是很重要的婴儿之间没有关联。然而，早产儿的环境是不可预测的：照顾者定期更换，医疗程序规定触摸和持有，以及基于婴儿线索的护理提供是有限的。目前的知识支持与自然发生的感觉（即饥饿）一起发生的饥饿，以与神经系统的期望一致的方式提供，并且以足够的规律性发生以增强神经元和突触发育。在这项研究中，我们模拟了婴儿如果不在新生儿重症监护室就会“期望”的经历，并证明了从第一次经口喂养到完全经口喂养的时间较短，这是一个重要的临床结果，具有神经发育意义。我们建议进行进一步的研究，以确定模式化的体验对其他神经发育领域的影响，特别是那些可能在以后的生活中发生的影响。
BackgroundAlthough the survival rate of very preterm infants has improved, rates of subsequent neurobehavioral disabilities remain high. One factor implicated in poor neurobehavioral and developmental outcomes is hospitalization and inconsistent caregiving patterns in the neonatal intensive care unit. Although much underlying brain damage occurs in utero or shortly after birth, neuroprotective strategies may stop progression of damage, particularly when these strategies are used during the most sensitive periods of neural plasticity 2–3 months before term age.ObjectiveThe purpose of this analysis was to test the effect of a patterned feeding experience involving a tactile component (touch and/or holding) provided during feedings on preterm infants’ clinical outcomes, measured by oral feeding progress, as an early indicator of neurodevelopment.MethodsWe used an experimental, longitudinal, two-group random assignment design. Preterm infants (n= 120) were enrolled within the first week of life and randomized to an experimental group receiving a patterned feeding experience or to a control group receiving usual feeding care.ResultsAnalysis of data from 91 infants showed that infants receiving touch at more than 25% of early gavage feedings achieved full oral feeding more quickly; as touch exposure increased, time from first oral to full oral feeding decreased. There was no association between holding during early gavage feedings or touch during transition feedings and time to full oral feeding.DiscussionNeurological expectation during critical periods of development is important for infants. However, a preterm infant’s environment is not predictable: Caregivers change regularly, medical procedures dictate touch and holding, and care provision based on infant cues is limited. Current knowledge supports caregiving that occurs with a naturally occurring sensation (ie, hunger), is provided in a manner that is congruent with the expectation of the neurological system, and occurs with enough regularity to enhance neuronal and synaptic development. In this study, we modeled an experience infants would “expect” if they were not in the neonatal intensive care unit and demonstrated a shorter time from first oral feeding to full oral feeding, an important clinical outcome with neurodevelopmental implications. We recommend further research to determine the effect of patterned caregiving experiences on other areas of neurodevelopment, particularly those that may occur later in life.