口腔运动干预对喂养困难早产儿进食能力的改善及影响因素研究
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摘要
目的观察口腔运动干预(OMI)对经口喂养困难早产儿进食能力的改善,探讨胎龄及全身运动(GMs)质量评估结果与OMI次数是否存在关联并确定影响OMI次数的高危因素。方法 2015年3月-2016年2月选取89例完成GMs拍摄并接受OMI后自行经口进食的早产儿,根据胎龄分为<34周和≥34周两组,同时将GMs评估结果归纳为三个类别,分别统计比较两组间、各类别间OMI次数。以OMI次数为应变量,胎龄、出生体重、治疗起始周龄、GMs结果、是否伴随消化、呼吸、血液、神经和其他系统障碍、以上伴随障碍的合计个数为自变量进行多重逐步回归分析,确定影响OMI次数增多的高危因素。结果胎龄<34周组顺利完成新生儿科医生要求奶量前所需的OMI次数比≥34周组更多(P<0.05)。GMs表现越好的早产儿OMI次数越少,反之,GMs表现较差的早产儿OMI次数较多。结合临床表现分析,显示早产儿GMs评估结果越差、胎龄越小、伴有消化系统症状是导致OMI次数增多的高危因素,校正决定系数为0.34。结论胎龄是早产儿喂养困难的一个影响因素;早产儿GMs表现不佳提示可能同时存在喂养困难;伴有消化系统症状也是导致OMI次数增多的高危因素。
Objectives To observe the improvement of feeding ability of the preterm infants with oral feeding disorders after oral motor intervention(OMI),to explore the correlation between gestational age,general movements(GMs)results and OMI times,and to determine the risk factors influencing OMI times. Methods Totally 89 preterm infants who completed camera shooting of GMs and received self-feeding through their mouths after OMI were enrolled from March 2015 to February 2016,and were divided into two groups according to their birth gestational age,including group of<34 weeks and group of≥34 weeks.At the same time,the results of GMs assessment were classified into three categories,the OMI times between the two groups and different groups were statistically compared.OMI times was set as dependent variable,gestational age,birth weight and the age at the beginning of treatment,GMs results,complications of the digestive,respiratory,blood,nerves,and other system obstacles,and the total number of the symptoms were included as independent variables,and multiple stepwise regression analysis was used to determine the high risk factors influencing the OMI times. ResultsThe OMI times before reaching the feeding capacity required by the doctor,in gestational age<34 weeks group were more than those in the≥34 week group(P<0.05).The OMI times of preterm infants with the better GMs result were fewer.On the contrary,the OMI times with poor GMs result were more frequent.According to the analysis of clinical manifestations,the worse results of GMs assessment,the smaller gestational weeks and the symptoms of the digestive system were high risk factors for the increase of OMI times in preterm infants(R2=0.34). Conclusions Birth gestational age is one of the factors affecting the feeding disorder of preterm infants,and the poor result of GMs assessment in preterm infants may indicate the existence of feeding disorder at the same time.The symptoms of the digestive system are also the high risk factor for increasing times of OMI in preterm infants,suggesting that digestive disorders may affect the improvement of oral function.
Objectives To observe the improvement of feeding ability of the preterm infants with oral feeding disorders after oral motor intervention(OMI),to explore the correlation between gestational age,general movements(GMs)results and OMI times,and to determine the risk factors influencing OMI times. Methods Totally 89 preterm infants who completed camera shooting of GMs and received self-feeding through their mouths after OMI were enrolled from March 2015 to February 2016,and were divided into two groups according to their birth gestational age,including group of<34 weeks and group of≥34 weeks.At the same time,the results of GMs assessment were classified into three categories,the OMI times between the two groups and different groups were statistically compared.OMI times was set as dependent variable,gestational age,birth weight and the age at the beginning of treatment,GMs results,complications of the digestive,respiratory,blood,nerves,and other system obstacles,and the total number of the symptoms were included as independent variables,and multiple stepwise regression analysis was used to determine the high risk factors influencing the OMI times. ResultsThe OMI times before reaching the feeding capacity required by the doctor,in gestational age<34 weeks group were more than those in the≥34 week group(P<0.05).The OMI times of preterm infants with the better GMs result were fewer.On the contrary,the OMI times with poor GMs result were more frequent.According to the analysis of clinical manifestations,the worse results of GMs assessment,the smaller gestational weeks and the symptoms of the digestive system were high risk factors for the increase of OMI times in preterm infants(R2=0.34). Conclusions Birth gestational age is one of the factors affecting the feeding disorder of preterm infants,and the poor result of GMs assessment in preterm infants may indicate the existence of feeding disorder at the same time.The symptoms of the digestive system are also the high risk factor for increasing times of OMI in preterm infants,suggesting that digestive disorders may affect the improvement of oral function.
引文
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[11] Tsai SW,Chen CH,Lin MC.Prediction for developmental delay on Neonatal Oral Motor Assessment Scale in preterm infants without brain lesion[J].Pediatr Int,2010,52(1):65-68.
[12]余晓娟,李琛,王昌燕,等.经口喂养困难早产儿的早期综合干预[J].护理学杂志,2013,28(13):44-46.
[13] Kostovic'I,Kostovi c'-Srzenti c'M,Benjak V,et al.Developmental dynamics of radial vulnerability in the cerebral compartments in preterm infants and neonates[J].Front Neurol,2014,5:139.
[14] Ravinder K.Motor function of the pharynx,esophagus,and its sphincters[M].San Rafael(CA):Morgan&Claypool Life Sciences,2011.
[2]兰雅平,陈喻萍,彭映华,等.口腔按摩改善极低出生体重早产儿喂养效果观察[J].护理研究,2014,28(10):1214-1215.
[3]李琳琳,陈京立,崔国凤,等.经口喂养促进项目在早产儿中的应用效果[J].中华现代护理杂志,2016,22(24):3489-3493.
[4] Foster JP,Psaila K,Patterson T.Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants[J].Cochrane Database Syst Rev,2016,10:CD001071.
[5]尹欢欢,杨红,曹佳燕,等.全身运动细化评估在高危儿运动发育中的信度研究[J].中国儿童保健杂志,2017,25(3),230-233.
[6] Nieuwenhuis T,da Costa SP,Bilderbeek E,et a1.Uncoordinated sucking patterns in preterm infants are associated with abnormal general movements[J].J Pediatr,2012,161(5):792-798.
[7]杨红,邵肖梅,全身运动质量评估[J].中国循证儿科杂志,2007,2(2):138-143.
[8] Tsai SW,Chen CH,Lin MC.Prediction for developmental delay on Neonatal Oral Motor Assessment Scale in preterm infants without brain lesion[J].Pediatr Int,2010,52:65-66.
[9]吕天禅.口腔运动干预改善早产儿经口喂养的效果评价[D].上海:复旦大学,2013.
[10] Lau C.Development of infant oral feeding skills:what do we know[J].Am J Clin Nutr,2016,103(Suppl 2):616-621.
[11] Tsai SW,Chen CH,Lin MC.Prediction for developmental delay on Neonatal Oral Motor Assessment Scale in preterm infants without brain lesion[J].Pediatr Int,2010,52(1):65-68.
[12]余晓娟,李琛,王昌燕,等.经口喂养困难早产儿的早期综合干预[J].护理学杂志,2013,28(13):44-46.
[13] Kostovic'I,Kostovi c'-Srzenti c'M,Benjak V,et al.Developmental dynamics of radial vulnerability in the cerebral compartments in preterm infants and neonates[J].Front Neurol,2014,5:139.
[14] Ravinder K.Motor function of the pharynx,esophagus,and its sphincters[M].San Rafael(CA):Morgan&Claypool Life Sciences,2011.