不同口腔涂抹剂对极低出生体重早产儿经口喂养能力及临床结局的影响

The effect of different oral applicators on oral feeding ability and clinical outcome of very low birth weight premature infants

目的探讨亲母初乳、捐献母乳、生理盐水3种口腔涂抹剂对提高极低出生体重早产儿经口喂养能力、缩短喂养进程及改善临床结局的效果。方法选取2018年6月-2019年11月在银川市妇幼保健院出生并入住NICU的极低出生体重早产儿为研究对象,采用随机化分组方法,每组各32例。3组均在早产儿发育支持护理的基础上,分别给予亲母初乳、捐献母乳、生理盐水口腔涂抹,记录3组极低出生体重早产儿开始经口喂养的时间和完全经口喂养的时间,计算喂养进程,并记录喂养不耐受、坏死性小肠结肠炎、高胆红素血症的发生情况。结果在出生后第7天,亲母初乳和捐献母乳口腔涂抹的极低出生体重早产儿口腔反射维度得分高于生理盐水口腔涂抹者(P<0.05),且其在出生后第14天,经口喂养能力总分及口腔反射、非营养性吸吮维度得分均高于生理盐水口腔涂抹者(P<0.05);亲母初乳口腔涂抹的极低出生体重早产儿开始经口喂养时间均短于捐献母乳和生理盐水口腔涂抹者(P<0.05),亲母初乳口腔涂抹的极低出生体重早产儿完全经口喂养的时间、喂养进程短于捐献母乳口腔涂抹者和生理盐水口腔涂抹者(P<0.05)。3组极低出生体重早产儿喂养不耐受、高胆红素血症的发生率差异均有统计学(P<0.05),坏死性小肠结肠炎的发生率差异无统计学意义(P>0.05)。结论亲母初乳和捐献母乳口腔涂抹均可提高极低出生体重早产儿经口喂养能力,缩短喂养进程;且亲母初乳口腔涂抹的效果优于捐献母乳口腔涂抹者;同时亲母初乳和捐献母乳口腔涂抹均可降低极低出生体重早产儿高胆红素血症、喂养不耐受的发生,且不增加坏死性小肠结肠炎的发生。

Objective To investigate and compare the effects of oral application of colostrum,donated human milk and normal saline on improving the oral feeding ability and clinical outcomes of very low birth weight premature infants.Methods Extremely low birth weight infants born and admitted to the NICU in Yinchuan maternal and child health hospital from June 2018 to November 2019 were selected as study subjects and randomized into 32 cases in each group,Three groups of very low birth weight preterm infants were given normal saline,donated human milk and colostrum oral smear on the basis of developmental support for preterm infants,record the beginning and complete oral feeding time of the three groups of very low birth weight preterm infants.The feeding process was calculated.The incidence of feeding intolerance,Necrotizing enterocolitis and hyperbilirubinemia.Results On the 7th day after birth,the oral reflexes of very low birth weight preterm infants with colostrum and donated breast milk oral smear were higher than those with saline oral smear(P<0.05).On the 14th day after birth,the total score of oral feeding ability,oral reflex and non-nutritive sucking dimension were higher than those of saline mouth applicator(P<0.05).The duration of oral feeding for very low birth weight infants in the own mother's colostrum group was less than that of the donated human milk group and the normal saline group(P<0.05),while total oral feeding time and Feeding process of very low birth weight preterm infants with own mother's colostrum application was all shorter than those with oral milk donation and which were also shorter than those with oral saline application.There were statistically significant differences in the incidence of feeding intolerance and HB among the three groups of very low birth weight premature infants(P<0.05),while there was no statistically significant difference in the incidence of NEC(P<0.05).Conclusion Both own mother's colostrum and the donated human milk application can improve the oral feeding ability and shorten the feeding process of very low birth weight preterm infants.The oral smear of colostrum was better than that of breast milk donor.The colostrum oral application and the donor human milk oral application of the very low birth weight premature infants can reduce the incidence of hyperbilirubinemia and feeding intolerance,no increase the incidence of Necrotizing enterocolitis.