NICU早产儿住院期间经口喂养能力变化轨迹及影响因素研究

Trajectories and the influencing factors of oral feeding performance of preterm infants during hospitalization in the NICU

目的探讨NICU早产儿住院期间经口喂养能力的纵向变化轨迹及其影响因素,为早产儿早期经口喂养的个体化管理提供依据。方法采用便利抽样法选取158例NICU早产儿作为研究对象,分别于早产儿入院24 h内、开始肠道喂养、完全肠道喂养、初次经口喂养、初次一半喂养、完全经口喂养和出院时,采用早产儿准备经口喂养评估量表对其经口喂养能力进行纵向追踪测评。使用潜变量增长混合模型分析其经口喂养能力变化轨迹,采用logistic回归分析其影响因素。结果早产儿经口喂养能力变化轨迹可分为高水平缓升组(32.9%)、中水平缓升组(47.5%)、低水平先降后升组(19.6%);出生胎龄、出生体质量、开始经口喂养纠正胎龄、疾病严重程度和喂养前的行为状态是早产儿经口喂养能力变化轨迹的影响因素(均P<0.05)。结论早产儿经口喂养能力水平总体呈逐渐上升趋势,其变化轨迹具有异质性;NICU医护人员可通过早产儿经口喂养能力变化轨迹对其进行针对性评估和干预,实现精准护理。

Objective To characterize longitudinal trajectories of oral feeding performance of preterm infants during hospitalization in the NICU,to describe the influencing factors,and to provide reference for individualized management of oral feeding in preterm infants.Methods A convenience sample of 158 preterm infants were recruited and their oral feeding performance was assessed by using the Preterm Infant Oral Feeding Readiness Assessment Scale within 24 h of admission,at five milestones:first enteral fee-ding,complete enteral feeding,first oral feeding,half oral feeding,and full oral feeding,and also at discharge.The trajectories of oral feeding performance were analyzed using latent growth mixture modeling,and the influencing factors were identified through logistic regression.Results Three trajectory groups were identified:high-level and rising group(32.9%),medium-level and rising group(47.5%)and low-level and falling then rising group(19.6%).The logistic regression showed that,gestational age,birth weight,corrected gestational age at first oral feeding,severity of the disease and pre-feeding behavioral state were factors influencing trajectories(all P<0.05).Conclusion The oral feeding performance of preterm infants generally shows a gradual rising trend,with heterogeneous patterns of change.NICU healthcare professionals can perform targeted assessment and intervention based on the oral feeding performance trajectories in preterm infants to achieve precise care.