Lessen Brenda S
School of Nursing, Illinois Wesleyan University, Bloomington, IL 61702, USA.
Adv Neonatal Care. 2011 Apr;11(2):129-39. doi: 10.1097/ANC.0b013e3182115a2a.
Preterm infants frequently experience oral feeding difficulties due to underdeveloped oral motor skills and the lack of coordination of sucking, swallowing, and respiration. The infants' ability to consume all feedings orally while maintaining physiologic stability and weight gain is necessary for their discharge. Therefore, difficulty with oral feeding leads to longer hospital stays and higher costs. For example, with more than half a million of premature infants born each year, a 3-day decrease in hospital stay would save more than 2 billion dollars annually. There is a need for evidenced-based interventions that facilitate development of oral-motor skills, leading to improved oral feeding, thus shortening hospital stays and lowering costs. The purpose of this research was to test the newly developed Premature Infant Oral Motor Intervention (PIOMI) beginning at 29 weeks postmenstrual age (PMA), before oral feedings were introduced, to determine whether the prefeeding intervention would result in a shorter transition from gavage to total oral feedings and a shorter length of hospital stay (LOS). The PIOMI is a 5-minute oral motor intervention that provides assisted movement to activate muscle contraction and provides movement against resistance to build strength. The focus of the intervention is to increase functional response to pressure and movement and control of movements for the lips, cheeks, jaw, and tongue. The cheeks (internal and external), lips, gums, tongue, and palate were stimulated per specific protocol with finger stroking.
A total of 19 infants from 1 level III NICU born between 26 and 29 weeks PMA: 10 in the experimental group and 9 in the control group.
A randomized, blinded, clinical trial was conducted to examine outcomes related to the newly developed PIOMI.
Beginning at 29 weeks PMA (and before the introduction of oral feeding), the experimental group received the PIOMI for 5 minutes per day for 7 consecutive days. The control group received a sham intervention to keep staff and parents blinded to the infants' group assignment. Physiological and behavioral stabilities were continually assessed throughout the intervention. A chart review was then conducted to compare the transition from gavage feeding to total oral feedings between the experimental and control group, as well as LOS.
The PIOMI was well tolerated by 29-week PMA infants, as evidenced by physiological and behavioral cues. Infants who received the once-daily PIOMI transitioned from their first oral feeding to total oral feedings 5 days sooner than controls (P = .043) and were discharged 2.6 days sooner than controls.
This pilot work supports further study on the use of the PIOMI with preterm infants to enhance oral-feeding skills and decrease LOS.
由于口腔运动技能发育不全以及吸吮、吞咽和呼吸协调能力不足，早产儿经常出现经口喂养困难。婴儿在保持生理稳定和体重增加的同时经口摄取所有喂养食物的能力是其出院所必需的。因此，经口喂养困难会导致住院时间延长和费用增加。例如，每年有超过50万早产儿出生，住院时间减少3天每年可节省超过20亿美元。需要有循证干预措施来促进口腔运动技能的发展，从而改善经口喂养，进而缩短住院时间并降低成本。本研究的目的是在月经龄（PMA）29周时（在引入经口喂养之前）测试新开发的早产儿口腔运动干预（PIOMI），以确定喂养前干预是否会使从管饲过渡到完全经口喂养的时间缩短以及住院时间（LOS）缩短。PIOMI是一种5分钟的口腔运动干预，提供辅助运动以激活肌肉收缩，并提供抗阻运动以增强力量。干预的重点是增加对压力和运动的功能反应以及嘴唇、脸颊、下巴和舌头运动的控制。按照特定方案用手指抚摸刺激脸颊（内外侧）、嘴唇、牙龈、舌头和上颚。
来自1家三级新生儿重症监护病房（NICU）的19名婴儿，出生时PMA在26至29周之间：实验组10名，对照组9名。
进行了一项随机、盲法临床试验，以检验与新开发的PIOMI相关的结果。
从PMA 29周开始（在引入经口喂养之前），实验组连续7天每天接受5分钟的PIOMI。对照组接受假干预，以使工作人员和家长对婴儿的分组情况不知情。在整个干预过程中持续评估生理和行为稳定性。然后进行病历审查，以比较实验组和对照组从管饲喂养过渡到完全经口喂养的情况以及住院时间。
29周PMA的婴儿对PIOMI耐受性良好，生理和行为线索证明了这一点。每天接受一次PIOMI的婴儿从首次经口喂养过渡到完全经口喂养的时间比对照组早5天（P = 0.043），出院时间比对照组早2.6天。
这项初步工作支持进一步研究将PIOMI用于早产儿，以提高经口喂养技能并缩短住院时间。
