极低出生体重儿初乳口腔涂抹安全性和可行性的研究

Study on safety and feasibility of colostrum oropharyngeal administration for very low birth weight infants

[目的]探究使用初乳对极低出生体重儿进行口腔涂抹的安全性及临床推广的可行性。[方法]采用便利抽样法,对2015年3月—8月入住复旦大学附属儿科医院新生儿重症监护病房(NICU)的新生极低出生体重儿家属进行健康宣教,获取新鲜初乳。使用获得的初乳对患儿进行口腔涂抹,每次0.2mL,4h涂抹1次,连续7d。观察涂抹开始前、涂抹过程中及涂抹后患儿心率、血氧饱和度、呼吸等基本生命体征,同时记录患儿开始初乳口腔涂抹、管饲喂养、母乳喂养的时间以及目标人群完成初乳口腔涂抹的比例。[结果]共观察205例极低出生体重儿,其中130例符合纳入标准,其中104例患儿家属表示愿意前7d每日送初乳进行口腔涂抹,结果77例(59.23%)患儿家属坚持每日送新鲜母乳来院,顺利完成为期7d的初乳口腔涂抹干预,即74.04%(77/104)的志愿人群顺利完成初乳口腔涂抹。在涂抹过程中患儿心率、血氧饱和度平稳,有7例9次在操作过程中出现呼吸暂停。[结论]对入住NICU病情危重的极低出生体重儿在合理宣教的基础上进行初乳口腔涂抹是安全的,新鲜初乳的获得较为方便,初乳口腔涂抹具有较高的可行性。

Objective:To explore the safety and clinical feasibility of colostrum oropharyngeal administration for very low birth weight infants.Methods:The convenience sampling method was adopted to carry out health education on the families of very low birth weight infants who were admitted to the neonatal intensive care unit(NICU)of Fudan University Pediatric Hospital from March to August in 2015 to obtain fresh colostrum.The obtained colostrum was smeared with 0.2mL,once every 4hfor 7days.The vital signs such as heart rate,blood oxygen saturation and respiration were observed before,during and after the smearing.At the same time to record the beginning time of colostrum oropharyngeal administration,tube feeding,breastfeeding and the proportion of colostrum oropharyngeal administration.Results:A total of 205 cases of very low birth weight infants were observed,130 cases met the inclusion criteria,and 104 cases of family members expressed willingness to send the colostrum for oral daub every day during the first 7days.A total of 77cases(59.23%)persisted in sending fresh colostrum to the hospital,and successfully finished a period of 7days of colostrum oropharyngeal administration intervention,in the same means that 74.04%(77/104)of the volunteers successfully completed colostrum oropharyngeal administration.durins the smear,the children's heart rate,blood oxygen saturation were stable,there were 9Apnea occured in 7cases during the smear.Conclusion:It was safe to apply colostrum oropharyngeal administration for NICU infants with very low birth weight based on the reasonable education.It was convenient to obtain fresh colostrum and the colostrum oropharyngeal administration had higher feasibility.