Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710, United States of America; Duke University School of Medicine, Department of Pediatrics, Duke University Hospital, DUMC 2739, Durham, NC 27710, United States of America.
Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710, United States of America.
Early Hum Dev. 2022 Jan;164:105510. doi: 10.1016/j.earlhumdev.2021.105510. Epub 2021 Nov 20.
Bundling nurse caregiving interventions are promoted to minimize infant stress.
To evaluate impact of bundled nursing care and diaper change frequency on vital sign stability and skin health of preterm infants born ≤32 weeks gestation.
Stable preterm infants on a 3-hour feeding schedule were randomly assigned to 3- vs. 6-hour diaper changes. Diapers were changed prior to 6 h if stool was present. Direct observation of bundled care events (BCE) identify caregiving activities during each BCE. Skin pH, transepidermal water loss (TEWL), and neonatal skin condition scores (NSCS) were obtained. Vital sign data (HR, RR, O saturation) was downloaded from bedside monitors.
Forty-six infants contributed to 605 BCEs. BCEs lasted on average 28 min and included nine different activities (e.g., vital signs, feeding). Significant increases in heart rate during BCEs occurred in approximately half of the observations. Among observations with a diaper change increases in heart rate during diapering occurred in over 74% of observations Infants who were awake at the beginning of BCEs had 48% lower odds of having a change in heart rate than infants who were sleeping (p = .02). There were no group differences (3- vs. 6-hour diaper change) in skin health outcomes (TEWL, pH, NSCS).
Reducing diaper change frequency without stool present should be considered to minimize caregiving stress in preterm infants. Additional research should evaluate the intrusiveness and clusters of activities that significantly impact physiologic stability to better individualize the timing of routine yet intrusive activities. Clinicaltrials.gov registry # NCT03370757.
捆绑式护理干预措施被推广用于最大限度地减少婴儿的应激反应。
评估捆绑式护理和尿布更换频率对胎龄≤32 周的早产儿生命体征稳定性和皮肤健康的影响。
稳定的早产儿按照 3 小时喂养时间表进行随机分组，分别进行 3 小时和 6 小时的尿布更换。如果有粪便，尿布会在 6 小时前更换。直接观察捆绑护理事件（BCE），以识别每次 BCE 期间的护理活动。测量皮肤 pH 值、经皮水分丢失（TEWL）和新生儿皮肤状况评分（NSCS）。从床边监护仪下载生命体征数据（HR、RR、O 饱和度）。
46 名婴儿参与了 605 次 BCE。BCE 平均持续 28 分钟，包括九种不同的活动（如生命体征、喂养）。大约一半的观察中，BCE 期间心率显著增加。在有尿布更换的观察中，超过 74%的观察中，在换尿布期间心率增加。在 BCE 开始时清醒的婴儿比睡眠中的婴儿发生心率变化的可能性低 48%（p=0.02）。两组之间（3 小时与 6 小时尿布更换）皮肤健康结果（TEWL、pH 值、NSCS）没有差异。
应考虑减少无粪便的尿布更换频率，以尽量减少早产儿的护理应激。应进一步研究评估显著影响生理稳定性的侵入性和活动簇，以更好地个性化常规但侵入性活动的时间。Clinicaltrials.gov 注册号：NCT03370757。
