Lambda Beta-At-Large, Doctoral Student, Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei City, Taiwan, R.O.C, and Lecturer, Department of Nursing, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan, R.O.C.
Associate Professor, Department of Social Work, Hsuan Chuang University, Hsinchu, Taiwan, R.O.C.
J Nurs Scholarsh. 2020 Sep;52(5):467-475. doi: 10.1111/jnu.12571. Epub 2020 Jun 20.
Even routine procedures can cause pain and stress, and can be harmful to the fast-growing brain of preterm infants. Mitigating pain and stress with sucrose and analgesics has side effects; thus, an alternate choice is the use of natural breast milk and infants' sensory capabilities. Therefore, this study examined the effects of different integrations of sensory experiences-mother's breast milk odor and taste (BM-OT), heartbeat sounds (HBs), and non-nutritive sucking (NNS)-on preterm infant's behavioral stress during venipuncture.
This study was a prospective, randomized controlled trial.
Infants born preterm (<37 weeks' gestational age) were enrolled in the study through convenience sampling, and randomly assigned to the following conditions: (condition 1) routine care (n = 36); (condition 2) BM-OT (n = 33); (condition 3) BM-OT + HBs (n = 33); or (condition 4) BM-OT + HBs + NNS (n = 36). Crying duration from puncture to recovery period was recorded using a voice recorder. Facial actions and body movements were measured using an infant behavioral coding scheme and transformed into frequencies during seven stages: baseline (stage 0), disinfecting (stage 1), venipuncture (stage 2), and the recovery period for 10 minutes (stages 3-6).
Data were analyzed for 138 preterm infants. The corresponding median times to stop crying for conditions 1, 2, 3, and 4 were 137, 79, 81, and 39 s, respectively; the instantaneous occurrence rates of stopping crying for conditions 2, 3, and 4 were 1.469, 1.574, and 2.996 times greater than for condition 1, respectively. Infants receiving conditions 3 and 4 had significantly fewer occurrences of facial actions (stage 6 and stages 4-6, respectively) and body movements (stages 3-6 for both); however, there were no significant reductions in stress behaviors for condition 2 (BM-OT).
The combination of BM-OT, HBs, and NNS could be provided to preterm infants as interventions to prevent and reduce behavioral stress, and facilitate pain recovery during venipuncture procedures.
Clinicians should be educated about how to recognize preterm infants' behavioral stress, and to incorporate different sensory combinations of respective mothers' BM, HBs, and NNS into painful procedures to help preterm infants recover from distress.
即使是常规程序也会引起疼痛和压力，并且可能对早产儿快速发育的大脑有害。用蔗糖和镇痛药减轻疼痛和压力会有副作用；因此，另一种选择是使用母乳和婴儿的感官能力。因此，本研究探讨了不同感官体验整合（母亲的母乳气味和味道[BM-OT]、心跳声[HBs]和非营养吸吮[NNS]）对早产儿静脉穿刺时行为压力的影响。
本研究为前瞻性、随机对照试验。
通过便利抽样，将早产儿（<37 周胎龄）纳入研究，并随机分配至以下条件：（条件 1）常规护理（n=36）；（条件 2）BM-OT（n=33）；（条件 3）BM-OT+HBs（n=33）；或（条件 4）BM-OT+HBs+NNS（n=36）。使用录音机记录从穿刺到恢复期的哭泣持续时间。使用婴儿行为编码方案测量面部动作和身体运动，并在七个阶段将其转换为频率：基线（阶段 0）、消毒（阶段 1）、静脉穿刺（阶段 2）和 10 分钟恢复期（阶段 3-6）。
对 138 名早产儿进行了数据分析。条件 1、2、3 和 4 停止哭泣的相应中位数时间分别为 137、79、81 和 39 秒；条件 2、3 和 4 停止哭泣的瞬时发生率分别比条件 1 高 1.469、1.574 和 2.996 倍。接受条件 3 和 4 的婴儿的面部动作（第 6 阶段和第 4-6 阶段）和身体运动（第 3-6 阶段）的发生率显著减少；然而，条件 2（BM-OT）的应激行为并没有明显减少。
BM-OT、HBs 和 NNS 的组合可作为预防和减轻静脉穿刺过程中行为压力的干预措施提供给早产儿，并促进疼痛恢复。
应教育临床医生如何识别早产儿的行为压力，并将各自母亲的 BM、HBs 和 NNS 的不同感官组合纳入疼痛程序，以帮助早产儿从痛苦中恢复。
