预喂食口腔刺激方案对早产儿首次尝试喂养的影响：双盲对照临床试验。
Impact of a pre-feeding oral stimulation program on first feed attempt in preterm infants: Double-blind controlled clinical trial.
机构信息
Department of Speech-Language Pathology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
Department of Health and Communication, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
出版信息
PLoS One. 2020 Sep 9;15(9):e0237915. doi: 10.1371/journal.pone.0237915. eCollection 2020.
OBJECTIVE
To evaluate the effect of an oral stimulation program in preterm on the performance in the first oral feeding, oral feeding skills and transition time from tube to total oral intake.
STUDY DESIGNER
Double-blind randomized clinical trial including very preterm newborns. Congenital malformations, intracranial hemorrhage grade III or IV, bronchopulmonary dysplasia, and necrotizing enterocolitis were excluded. Intervention group (GI) received an oral stimulation program of tactile extra-, peri-, and intraoral tactile manipulation once a day for 15 minutes, during a 10-day period. Control group (GII) received sham procedure with same duration of time. Feeding ability was assessed by a speech-language pathologist blinded to group assignment. The classification of infants' oral performance was determined by Oral Feeding Skills (OFS). Neonates were monitored until hospital discharge.
RESULTS
Seventy-four (37 in each group) were randomized. Mean gestational ages and birth weights were 30±1.4 and 30±1.5 weeks, and 1,452±330g and 1,457±353g for intervention and control groups, respectively. Infants in the intervention group had significantly better rates than infants in the control group on: mean proficiency (PRO) (41.5%±18.3 vs. 19.9%±11.6 (p<0.001)), transfer rate (RT) (2.3 mL/min and 1.1 mL/min (p<0.001)) and overall transfer (OT) (57.2%±19.7 and 35.0%±15.7 (p<0.001)). Median transition time from tube to oral feeding was 4 (3-11) and 8 (7-13) days in intervention and control groups, respectively (p = 0.003). Intake of breast milk was found to reduce transition time from tube feeds to exclusive oral feeding (p<0.001, HR 1.01, 95%CI 1.005-1.019), but the impact of the study intervention remained significant (p = 0.007, HR 1.97, 95%CI 1.2-3.2).
CONCLUSION
Infants who were breast-fed and an oral stimulation program proved beneficial in reducing transition time from tube feeding to oral feeding.
TRIAL REGISTRATION
ClinicalTrials.gov number NCT03025815.
目的
评估早产儿口腔刺激方案对首次经口喂养表现、经口喂养技能和从管饲到完全经口喂养的过渡时间的影响。
研究设计
这是一项包括极早产儿的双盲随机临床试验。排除先天性畸形、颅内出血 III 或 IV 级、支气管肺发育不良和坏死性小肠结肠炎。干预组（GI）每天接受 15 分钟的口腔外、口腔周和口腔内触觉操作的口腔刺激方案，持续 10 天。对照组（GII）接受相同时间的假处理。由一名语言病理学家对喂养能力进行盲法评估，该语言病理学家不知道分组情况。通过 Oral Feeding Skills（OFS）确定婴儿口腔表现的分类。监测新生儿直至出院。
结果
74 名（每组 37 名）随机分组。干预组和对照组的平均胎龄和出生体重分别为 30±1.4 周和 30±1.5 周，1452±330g 和 1457±353g。干预组婴儿的经口喂养能力明显优于对照组：平均熟练程度（PRO）（41.5%±18.3 比 19.9%±11.6（p<0.001））、转移率（RT）（2.3 毫升/分钟和 1.1 毫升/分钟（p<0.001））和总体转移（OT）（57.2%±19.7 比 35.0%±15.7（p<0.001））。干预组和对照组从管饲到经口喂养的中位过渡时间分别为 4（3-11）天和 8（7-13）天（p=0.003）。发现母乳喂养可缩短从管饲到完全经口喂养的过渡时间（p<0.001，HR 1.01，95%CI 1.005-1.019），但研究干预的影响仍然显著（p=0.007，HR 1.97，95%CI 1.2-3.2）。
结论
母乳喂养和口腔刺激方案可缩短从管饲到经口喂养的过渡时间。
试验注册
ClinicalTrials.gov 编号 NCT03025815。
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