An integrated review of the literature on demand feedings for preterm infants.
An integrated review of the literature on demand feedings for preterm infants.
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DOI：
10.1016/j.adnc.2004.05.004
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发表时间：
2004-08-01
期刊：
影响因子：
--
通讯作者：
Pickler, Rita H
中科院分区：
文献类型：
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作者：
Crosson, Denise D;Pickler, Rita H
在过去 50 年中，仅发表了 7 项评估早产儿按需喂养的研究。这些研究采用了多种研究方法，包括非实验、准实验和实验设计。由于样本量不足和方法描述不完整，最早的需求喂养研究很难解释。 20 世纪 80 年代和 90 年代初的试验得到了更好的描述；然而，他们的设计所产生的结果可能与单位、护士或婴儿特定的治疗相互作用密切相关，因此这些结果不太可能在其他环境中复制。最近的研究得到了更好的构思和描述。总体而言，过去 50 年的研究结果表明，与采用其他喂养方式的早产儿相比，按需喂养的早产儿表现出一定的临床改善。与不按需喂养的婴儿相比，按需喂养的婴儿表现出更多的饥饿信号，行为状态组织得到改善，住院时间更短，体重增加速度相同或更快。尽管所审查的每项研究都存在一些方法学上的弱点，但不同研究人员、环境、经验指标和年份的研究结果的一致性支持了谨慎的论点，即要求喂养可能被证明是大多数健康早产儿的首选喂养方法。有必要在这一领域进行进一步的研究，以补充有关喂养各种早产儿群体的安全性和有效性的现有知识。还需要开展研究来解决亚人群（即患有先天性心脏病或口面部病变的婴儿）在早产儿喂养护理的时间、方法和途径方面的差异。
In the past 50 years, only 7 studies evaluating demand feedings in preterm infants have been published. The studies employed a variety of research methods including nonexperimental, quasi-experimental, and experimental designs. The earliest demand feeding studies are difficult to interpret due to inadequate sample sizes and incomplete descriptions of methodology. Trials in the 1980s and early 1990s were better described; however, they suffered from designs that produced findings that likely were strongly related to unit, nurse, or infant-specific interactions with the treatment, making it unlikely that findings could be replicated in other settings. The most recent studies are better conceived and described. Overall, the pattern of findings across the past 50 years indicates that preterm infants who were fed on demand showed some clinical improvement when compared to those infants offered other feeding patterns. Demand-fed infants exhibited more hunger cues and had improved behavior state organization, shorter duration of hospitalization, and gained weight at the same rate or faster than infants not fed on demand. Although each of the studies reviewed had some methodologic weaknesses, the consistency of findings across differing researchers, settings, empirical indicators, and years supports the cautious contention that demand feeding might prove to be the feeding approach of choice for most healthy preterm infants. Further studies in this area are warranted to add to current knowledge regarding the safety and efficacy of feeding various preterm infant populations. Research to address subpopulation differences (i.e., infants with congenital heart disease or orofacial lesions) in timing, method, and approaches to preterm infant feeding care is also needed.