早産児の経口哺乳準備期間における口腔刺激プログラムの有効性に関する検討 <研究報告>

本研究は, 早産児の経口哺乳準備期間における口腔刺激プログラムが, 経管栄養から経口哺乳への移行において, その期間を短縮できるかなどの影響について検討することを目的とした. 在胎34週未満で出生した合併症のない早産児を対象に, 口腔刺激プログラムを行った群(以下, 口腔刺激群)とNon-Nutritive Suckingを行った群(以下, NNS群)の2群に分けた。両群の経口哺乳開始から経口哺乳成功・胃管抜去・コット移床・退院までの日数その時の日齢・修正週数・体重の有意差, および, 経口哺乳開始から7日目までの吸畷緩慢・むせ・飲みこぼし・努力呼吸・酸素飽和度の低下の症状が出現した回数の有意差を検討した. 8回/日の経口哺乳を成功するまでにかかった日数は, 口腔刺激群9±8日, NNS群6±2日, そのときの日齢は, 口腔刺激群24±6, NNS群33±12, 修正週数は口腔刺激群35週6日±1週0日, NNS群35週6日±0週3日, 体重は口腔刺激群1802±207g, NNS群1630±297gであり有意差は認められなかった. 他の項目においても2群間で有意差はなかった. 本研究の対象は在胎週数が比較的進んだ事例が多かったため, 出生時にある程度哺乳行動の準備が進んでいた可能性があり, 経管栄養から経口哺乳への移行において特別な援助を必要としなかったと考えられた.

The purpose of this study was to assess whether an oral stimulation program, during the preparation period for bottle feeding, enhances the bottle feeding performance of preterm infants. Preterm infants born at less than 34 weeks' gestational age were randomized into an experimental and a control group. Infants in the experimental group received an oral stimulation program (table 1.). Infants in the control group received non-nutritive sucking. We compared the number of days from starting bottle feeding, days of life, gestational age and weight between the two groups at successful bottle feeding as well as duration of nasogastric intubation, time in an incubator, and length of hospital stay. We also compared the groups with respect to inactive sucking, choking, spilling from the mouth, difficulty breathing, and low saturation of oxygen in the 7 days from starting bottle feeding. The number of days until 8 successful bottle feedings/day was 9 ± 8 days in the oral stimulation group and 6 ± 2 days in the non-nutritive sucking group, this difference was non-significant. There were no significant intergroup differences in days of life (24 ± 6 days in the oral stimulation group vs. 33 ± 12 days in the non-nutritive sucking group), gestational age (35 weeks 6days ± 1 week, vs. 35 weeks 6 days ± 3 days), and weight (1802 ± 207 g vs. 1630 ± 297 g) at successful bottle feeding. None of the other variable measured differed significantly between the two groups. Because the subjects had almost normal growth for gestational age, their bottle feeding behavior was relatively well developed, and it was not necessary to offer specific assistance in the transition from tube to bottle feeding.