發展性照護於早產兒視網膜病變檢查之臨床應用

The Clinical Application of Developmental Care in Retinopathy of Prematurity Eye Examinations

10.6224/JN.202010_67(5).11

莊玲如(Ling-Ju CHUANG)；黃美智(Mei-Chih HUANG)

發展性照護 ； 疼痛 ； 壓力 ； 早產兒視網膜病變 ； 早產兒 ； developmental care ； pain ； stress ； retinopathy of prematurity ； preterm infant

護理雜誌

67卷5期（2020 / 10 / 01）

82 - 88

繁體中文

早產兒視網膜病變（retinopathy of prematurity）是因早產兒的視網膜血管生長情形異常，透過視網膜檢查早期發現或治療是相當重要的。然而，研究已證實此項眼科檢查會導致疼痛、壓力和生理徵象變化。近幾十年，發展性照護廣泛地實施於新生兒照護，文獻亦顯示運用此照護於早產兒視網膜病變檢查可有效減少疼痛分數、壓力表現、生理徵象恢復時間。本文介紹發展性照護措施中之五層面：環境安排（如：提供安靜與避免光線刺激的環境）、擺位（如：以圍巢或捲軸支持物，協助早產兒維持促進神經運動發展之姿勢）、氧氣供給（如：依早產兒個別臨床情形及血氧濃度變化，提供足夠氧氣支持）、接觸早產兒與互動方式（如：檢查前以柔和聲音說話，以及溫暖的手碰觸早產兒）、以及依需求和暗示行為個別化照護（如：觀察暗示行為，視需求提供休息、非營養性吸吮或安撫）。經由發展性照護策略，以期能最大程度減少早產兒在視網膜病變檢查引起之疼痛、壓力與能量耗損，提供舒適、支持和促進早產兒發展之個別化照護。

Retinopathy of prematurity (ROP) is a disorder affecting the development of retinal blood vessels in preterm infants. Eye screening examinations are important to the early detection and treatment of ROP. However, several studies have associated eye examinations with pain, stress, and negative physiological effects. Developmental care has been provided as part of neonatal care in recent decades, and some studies indicate that this care positively affects pain scores, stress response, and recovery time during ROP eye screenings. In this article, five elements of developmental care that are applicable for preterm infants undergoing eye examinations for ROP are highlighted and described. These five elements include environmental modifications (e.g., provide a quite environment and dim room lighting), positioning (e.g., offer a nest or positing support and promote the infant to achieve neuromotor development), oxygen delivery (provide adequate oxygen support according to clinical conditions), approach and interaction (e.g., talk softly to infants and gently touch them before the eye examination), and cue-based individual care (e.g., soothe infants, give them a short break or soother based on observations of needs and cue-based behavior). Effectively addressing these five elements may minimize the pain, stress, and energy consumption during ROP eye screenings and provide individualized care that is comfortable, supportive, and promotes the healthy development of preterm infants.

1. Als, H.(1982).Toward a synactive theory of development: Promise for the assessment and support of infant individuality.Infant Mental Health Journal,3(4),229-243.
2. Als, H.,Lawhon, G.,Brown, E.,Gibes, R.,Duffy, F. H.,McAnulty, G.,Blickman, J. G.(1986).Individualized behavioral and environmental care for the very low birth weight preterm infant at high risk for bronchopulmonary dysplasia: Neonatal intensive care unit and developmental outcome.Pediatrics,78(6),1123-1132.
3. Als, H.,McAnulty, G. B.(2011).The newborn individualized developmental care and assessment program (NIDCAP) with kangaroo mother care (KMC): Comprehensive care for preterm infants.Current Women`s Health Reviews,7(3),288-301.
4. American Academy of Pediatrics Committee on Fetus and Newborn & Section on Anesthesiology and Pain Medicine(2016).Prevention and management of procedural pain in the neonate: An update.Pediatrics,137(2),Article e20154271.
5. Binenbaum, G.,Tomlinson, L. A.,de Alba Campomanes, A. G.,Bell, E. F.,Donohue, P.,Morrison, D.,Quinn, G. E.,Repka, M. X.,Rogers, D.,Yang, M. B.,Yu, Y.,Ying, G.(2020).Validation of the postnatal growth and retinopathy of prematurity screening criteria.JAMA Ophthalmology,138(1),31-37.
6. Cao, J. H.,Wagner, B. D.,Cerda, A.,McCourt, E. A.,Palestine, A.,Enzenauer, R. W.,Braverman, R. S.,Wong, R. K.,Tsui, I.,Gore, C.,Robbins, S. L.,Puente, M. A., Jr.,Kauffman, L.,Kong, L.,Morrison, D. G., Lynch, A. M.(2016).Colorado retinopathy of prematurity model: A multi-institutional validation study.Journal of American Association for Pediatric Ophthalmology and Strabismus,20(3),220-225.
7. Chuang, L.-J.,Wang, S.-H.,Ma, M.-C.,Lin, C.-N.,Chen, C.-L.,Huang, M.-C.(2019).A modified developmental care bundle reduces pain and stress in preterm infants undergoing examinations for retinopathy of prematurity: A randomised controlled trial.Journal of Clinical Nursing,28(3-4),545-559.
8. Cong, X.,Wu, J.,Vittner, D.,Xu, W.,Hussain, N.,Galvin, S.,Fitzsimons, M.,McGrath, J. M.,Henderson, W. A.(2017).The impact of cumulative pain/stress on neurobehavioral development of preterm infants in the NICU.Early Human Development,108,9-16.
9. Cummings, J. J.,Polin, R. A.,American Academy of Pediatrics Committee on Fetus and Newborn(2016).Oxygen targeting in extremely low birth weight infants.Pediatrics,138(2),Article e20161576.
10. Fierson, W. M.,American Academy of Pediatrics Section on Ophthalmology,American Academy of Ophthalmology,American Association for Pediatric Ophthalmology and Strabismus,American Association of Certified Orthoptists(2018).Screening examination of premature infants for retinopathy of prematurity.Pediatrics,142(6),Article e20183061.
11. Francis, K.(2016).What is best practice for providing pain relief during retinopathy of prematurity eye examinations?.Advances in Neonatal Care,16(3),220-228.
12. Gaspardo, C. M.,Cassiano, R. G. M.,Gracioli, S. M. A.,Furini, G. C. B.,Linhares, M. B. M.(2018).Effects of neonatal pain and temperament on attention problems in toddlers born preterm.Journal of Pediatric Psychology,43(3),342-351.
13. Hartley, K. A.,Miller, C. S.,Gephart, S. M.(2015).Facilitated tucking to reduce pain in neonates: Evidence for best practice.Advances in Neonatal Care,15(3),201-208.
14. Kenner, C.(Ed.),McGrath, J. M.(Ed.)(2010).Developmental care of newborns and infant: A guide for health professionals.National Association of Neonatal Nurses.
15. Kim, S. J.,Port, A. D.,Swan, R.,Campbell, J. P.,Chan, R. V. P.,Chiang, M. F.(2018).Retinopathy of prematurity: A review of risk factors and their clinical significance.Survey of Ophthalmology,63(5),618-637.
16. Kleberg, A.,Warren, I.,Norman, E.,Mörelius, E.,Berg, A.-C.,Mat-Ali, E.,Holm, K.,Fielder, A.,Nelson, N.,Hellström-Westas, L.(2008).Lower stress responses after newborn individualized developmental care and assessment program care during eye screening examinations for retinopathy of prematurity: A randomized study.Pediatrics,121(5),e1267-e1278.
17. Liaw, J.-J.,Yang, L.,Wang, K.-W.,Chen, C.-M.,Chang, Y.-C.,Yin, T.(2012).Non-nutritive sucking and facilitated tucking relieve preterm infant pain during heel-stick procedures: A prospective, randomised controlled crossover trial.International Journal of Nursing Studies,49(3),300-309.
18. Lin, C.-N.(2015).National Cheng Kung University.
19. Metreş, Ö.,Yıldız, S.(2019).Pain management with ROP position in Turkish preterm infants during eye examinations: A randomized controlled trial.Journal of Pediatric Nursing,49,E81-E89.
20. O’Sullivan, A.,O’Connor, M.,Brosnahan, D.,McCreery, K.,Dempsey, E. M.(2010).Sweeten, soother and swaddle for retinopathy of prematurity screening: A randomised placebo controlled trial.Archives of Disease in Childhood - Fetal & Neonatal Edition,95(6),F419-F422.
21. Peng, N.-H.,Bachman, J.,Chen, C.-H.,Huang, L.-C.,Lin, H.-C.,Li, T.-C.(2014).Energy expenditure in preterm infants during periods of environmental stress in the neonatal intensive care unit.Japan Journal of Nursing Science,11(4),241-247.
22. Pillai Riddell, R. R.,Racine, N. M.,Gennis, H. G.,Turcotte, K.,Uman, L. S.,Horton, R. E.,Kohut, S. A.,Stuart, J. H.,Stevens, B.,Lisi, D. M.(2015).Non-pharmacological management of infant and young child procedural pain.Cochrane Database of Systematic Reviews
23. Rasoulinejad, S. A.,Montazeri, M.(2016).Retinopathy of prematurity in neonates and its risk factors: A seven year study in northern Iran.The Open Ophthalmology Journal,10,17-21.
24. Tan, J. B. C.,Boskovic, D. S.,Angeles, D. M.(2018).The energy costs of prematurity and the neonatal intensive care unit (NICU) experience.Antioxidants,7(3),Article 37.
25. 武蕙蘭, H.-L.(2017)。國立成功大學=National Cheng Kung University。
26. 食品藥物管理署（2015，9月23日）．衛署藥輸字第005728號。https://info.fda.gov.tw/MLMS/H0001D3.aspx?LicId=02005728 [Food and Drug Administration, Taiwan, ROC. (2015, September 23). DOH Announcement (Yaoshu No. 005728). https://info.fda.gov.tw/MLMS/H0001D3.aspx?LicId=02005728]

1. 葉廷薇,張鈞竹,林凱慧(2022)。照顧一位斑色魚鱗癬早產兒之護理經驗。助產雜誌，62，33-41。