Leslie A. Parker is a professor in the University of Florida College of Nursing and a nurse practitioner in the neonatal intensive care unit, UF Health, Gainesville, Florida.
Jennifer Pruitt is the clinical leader of the postpartum unit at UF Health and a PhD student at the University of Florida College of Nursing.
Crit Care Nurse. 2023 Aug 1;43(4):39-50. doi: 10.4037/ccn2023902.
Critically ill infants admitted to the neonatal intensive care unit are at risk for ventilator-associated pneumonia and abnormal oral colonization. Adherence to evidence-based guidelines for oral care in critically ill adults is associated with improved short- and long-term health outcomes. However, oral care guidelines for critically ill infants admitted to the neonatal intensive care unit have not been established, possibly increasing their risk of ventilator-associated pneumonia and other health complications.
To describe and summarize the evidence regarding oral care for critically ill infants admitted to the neonatal intensive care unit and to identify gaps needing further investigation.
The MEDLINE (through PubMed) and CINAHL databases were searched for observational studies and randomized controlled trials investigating the effect of oral care on oral colonization, ventilator-associated pneumonia, and health outcomes of infants in the neonatal intensive care unit.
This review of 5 studies yielded evidence that oral care may promote a more commensal oral and endotracheal tube aspirate microbiome. It may also reduce the risk of ventilator-associated pneumonia and length of stay in the neonatal intensive care unit. However, the paucity of research regarding oral care in this population and differences in oral care procedures, elements used, and timing greatly limit any possible conclusions.
Oral care in critically ill infants may be especially important because of their suppressed immunity and physiological immaturity. Further appropriately powered studies that control for potential covariates, monitor for adverse events, and use recommended definitions of ventilator-associated pneumonia are needed to make clinical recommendations.
入住新生儿重症监护病房的危重症婴儿存在呼吸机相关性肺炎和口腔定植异常的风险。在危重症成人中遵循口腔护理循证指南与改善短期和长期健康结果相关。然而，尚未为入住新生儿重症监护病房的危重症婴儿制定口腔护理指南，这可能增加了他们患呼吸机相关性肺炎和其他健康并发症的风险。
描述和总结关于入住新生儿重症监护病房的危重症婴儿口腔护理的证据，并确定需要进一步研究的差距。
通过 PubMed 检索 MEDLINE 和 CINAHL 数据库，以查找关于口腔护理对口腔定植、呼吸机相关性肺炎和新生儿重症监护病房婴儿健康结果影响的观察性研究和随机对照试验。
对 5 项研究的综述表明，口腔护理可能会促进更共生的口腔和气管内抽吸物微生物组。它还可能降低呼吸机相关性肺炎的风险和新生儿重症监护病房的住院时间。然而，由于该人群中关于口腔护理的研究匮乏，以及口腔护理程序、使用的要素和时间存在差异，因此极大地限制了任何可能的结论。
由于危重症婴儿的免疫功能受到抑制和生理不成熟，因此对他们进行口腔护理可能尤为重要。需要进一步进行适当的、有影响力的研究，以控制潜在的混杂因素、监测不良事件，并使用推荐的呼吸机相关性肺炎定义，从而提出临床建议。
