Joshi Rohan, van Pul Carola, Sanders Anouk, Weda Hans, Bikker Jan Willem, Feijs Loe, Andriessen Peter
Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands.
Department of Clinical Physics, Máxima Medical Center, Veldhoven, Netherlands.
Interact J Med Res. 2017 Oct 20;6(2):e20. doi: 10.2196/ijmr.7756.
Many preterm infants require enteral feeding as they cannot coordinate sucking, swallowing, and breathing. In enteral feeding, milk feeds are delivered through a small feeding tube passed via the nose or mouth into the stomach. Intermittent milk feeds may either be administered using a syringe to gently push milk into the infant's stomach (push feed) or milk can be poured into a syringe attached to the tube and allowed to drip in by gravity (gravity feed). This practice of enteral feeding is common in neonatal intensive care units. There is, however, no evidence in the literature to recommend the use of one method of feeding over the other.
The aim of this study was to investigate which of the two methods of feeding is physiologically better tolerated by infants, as measured by the incidence of critical cardiorespiratory alarms during and immediately after feeding.
We conducted a prospectively designed observational study with records of all feeding episodes in infants of gestational age less than 30 weeks at birth and with a minimum enteral intake of 100 mL/kg/day. In total, 2140 enteral feeding episodes were noted from 25 infants over 308 infant-days with records for several characteristics of the infants (eg, gestational age), feeding (eg, the position of infants), and of nursing-care events before feeding (eg, diapering). Logistic regression with mixed effects was used to model cardiorespiratory alarms for the push and gravity methods of feeding.
After adjustments were made for all confounding variables, the position of infants was found to be statistically significant in changing the outcome of critical alarms for the two methods of feeding (P=.02). For infants in the lateral position, push feeds led to 40% more instances of one or more critical cardiorespiratory alarms in comparison with the gravity method. Both methods of feeding created a statistically comparable number of alarms for infants in the prone position.
This study provides objective data that may assist in optimizing enteral feeding protocols for premature infants. The incidence of critical cardiorespiratory alarms for infants in the lateral position can be lowered by the use of gravity instead of push feeding. No differences were observed between the two types of feeding when infants were in the prone position.
许多早产儿因无法协调吸吮、吞咽和呼吸而需要进行肠内喂养。在肠内喂养中，乳汁通过一根经鼻或口腔插入胃内的小 feeding 管输送。间歇性乳汁喂养可以使用注射器轻轻将乳汁推入婴儿胃内（推注喂养），也可以将乳汁倒入连接到 feeding 管的注射器中，让其靠重力滴入（重力喂养）。这种肠内喂养方法在新生儿重症监护病房很常见。然而，文献中没有证据表明推荐使用一种喂养方法优于另一种。
本研究的目的是通过喂养期间及喂养后即刻关键心肺警报的发生率，调查两种喂养方法中哪一种在生理上更易被婴儿耐受。
我们进行了一项前瞻性设计的观察性研究，记录了出生时胎龄小于 30 周且肠内摄入量至少为 100 mL/kg/天的婴儿的所有喂养情况。总共从 25 名婴儿的 308 个婴儿日中记录了 2140 次肠内喂养情况，记录了婴儿的几个特征（如胎龄）、喂养情况（如婴儿体位）以及喂养前护理事件（如换尿布）。使用具有混合效应的逻辑回归对推注喂养和重力喂养两种方法的心肺警报进行建模。
在对所有混杂变量进行调整后，发现婴儿体位在改变两种喂养方法的关键警报结果方面具有统计学意义（P = 0.02）。对于侧卧位的婴儿，与重力喂养方法相比，推注喂养导致一次或多次关键心肺警报的情况多出 40%。对于俯卧位的婴儿，两种喂养方法产生的警报数量在统计学上具有可比性。
本研究提供了客观数据，可能有助于优化早产儿的肠内喂养方案。对于侧卧位的婴儿，使用重力喂养而非推注喂养可降低关键心肺警报的发生率。当婴儿处于俯卧位时，两种喂养方式未观察到差异。
