Chang Yu-Jung, Hao Grace, Ni Anpin, Layton Thomas, Huang Jing-Yang, Yang Shun-Fa, Chen Shiuan-Chih
Institute of Medicine, Chung Shan Medical University, No. 110, Section 1, Jianguo N. Rd., Taichung, 402367, Taiwan; Department of Speech Language Pathology and Audiology, Chung Shan Medical University, No. 110, Section 1, Jianguo N. Rd., Taichung, 402367, Taiwan; Speech and Language Therapy Room, Chung Shan Medical University Hospital, No. 110, Section 1, Jianguo N. Rd., Taichung, 402367, Taiwan.
Department of Communication Sciences and Disorders, North Carolina Central University, 1801 Fayetteville St, Durham, NC, 27707, USA.
Pediatr Neonatol. 2022 May;63(3):269-275. doi: 10.1016/j.pedneo.2021.12.008. Epub 2022 Feb 28.
The inconsistency in decisions to commence oral feeding indicates that health professionals require clearer guidelines to determine when to initiate oral feeding in preterm infants. This study applied the Taiwan version of Preterm Oral Feeding Readiness Assessment Scale (TW-POFRAS) to clinical decision-making, especially for preterm infants with a birth weight less than 1,500 g or gestational age (GA) less than 32 weeks.
This was a single-center observational cross-sectional study and 81 preterm infants were recruited. Lengths of stay from admission to initial one-meal oral feeding, to one-day all-meal oral feeding, and to discharge were analyzed. Scale scores, physician orders, and smooth oral intake of 5 mL of milk were analyzed. Kappa coefficients were examined to determine concordances within the results.
At least moderate concordance was evident (k = 0.492). Most preterm infants can begin to consume one meal of the least 5 mL of milk smoothly and proceed to consume a full day of meals with a week; they are typically discharged from the hospital within a month, except for those with a birth weight less than 1,500 g or a GA less than 32 weeks. For 17 of 81 participants, assessment results for physician orders, 5-mL milk consumption, and scale scores were inconsistent. Participants with a birth weight less than 1,500 g or GA less than 32 weeks were able to meet the 5-mL standard by the postmenstrual age of 35 weeks, at latest.
We recommend that TW-POFRAS should be used in conjunction with physicians' clinical decision-making for oral feeding readiness for preterm infants in the NICU.
开始经口喂养的决策存在不一致性，这表明卫生专业人员需要更明确的指导方针来确定何时开始对早产儿进行经口喂养。本研究将台湾版早产儿经口喂养准备度评估量表（TW-POFRAS）应用于临床决策，特别是对于出生体重小于1500g或胎龄（GA）小于32周的早产儿。
这是一项单中心观察性横断面研究，招募了81名早产儿。分析了从入院到首次一餐经口喂养、到一日全餐经口喂养以及到出院的住院时间。分析了量表评分、医生医嘱以及顺利经口摄入5mL牛奶的情况。检查kappa系数以确定结果之间的一致性。
至少有中等程度的一致性（k = 0.492）。大多数早产儿能够在一周内顺利开始摄入至少5mL的一餐奶，并进而摄入一整天的奶量；除了出生体重小于1500g或GA小于32周的早产儿外，他们通常在一个月内出院。在81名参与者中，有17名的医生医嘱、5mL牛奶摄入量和量表评分的评估结果不一致。出生体重小于1500g或GA小于32周的参与者最迟在孕龄35周时能够达到5mL的标准。
我们建议在新生儿重症监护病房（NICU）中，TW-POFRAS应与医生关于早产儿经口喂养准备度的临床决策结合使用。
