超・早産児の吸啜運動とDevelopmental Careに関する検討 <報告>

1事例の超・早産児と4事例の早産児の行動観察記録の分析結果から,哺乳機能に関するDevelopmentalCareとして,ケア提供者が対象児とのかかわりの中で,どのように空乳首を扱うことが適切であるかを検討するための基礎資料を得た.その結果は以下のとおりであった.1.タッチケア実施後「ストレス」のシグナル表現がみられ「不快」反応があったのは,5事例いずれも10%未満であった.2.「微笑み」を最初に認めたのは,事例5が日齢10日であり,5事例とも出生後1か月以内に観察された.3.「注視」は,日齢15日以降に出現し,3事例は既に空乳首の吸暇を始めていた.事例4は,超早産児であり,少し遅れて出現し,日齢41日に観察された.4.5事例全例が「微笑み」が出現してから,5～21日以降に「注視」がみられた.5.「吸啜運動」は事例1が日齢3日にみられ,全事例いずれも「微笑み」や「注視」に先立って観察された.修正週数で最も早かった事例4は,28週4日であった.6.「吸啜運動」は,ミルク注入開始後数日して始まり,出生後しばらく続いた生理的体重減少が横ばいになり,体重増加に向かう転換期であった.

The aim of this study is to examine the appropriate developmental care when caregivers using nipples in the relationships with preterm infants through qualitative analysis of observation records for sucking, facial expression and behavior of 5 preterm infant cases. We herein report the results as follows. 1. After the touch care was performed, signal expression of "stress" was observed. "Discomfort" response was found less than 10% in all 5 cases. 2 . "Smiling" was f i r s t observed when the case 5 was 10 days old. In all 5 cases, i t first appeared within 1 month after the birth. 3 . "Gaze" appeared after the subjects became 15-days old and a t that time, 3 cases already started sucking with nipples. The case 4 was an extreme preterm infant and presented slightly delayed "gaze" of 41st days. 4 . In all of 5 cases, "gaze" was observed 5-21 days a f t e r "smiling" appeared. 5 . "Sucking" was observed in case 1 when the subject was 3 days old, and i t was observed always before "smiling" or "gaze" appeared in all coses. The shortest gestational age was found in case 4, which was a t 28 weeks and 4 days. 6 . "Sucking" started a few days after the biginning of tube feeding, when initial neonatal weight loss, which lasted for a while, leveled off and moved toward the turning point for weight gain.