降低新生兒加護病房早產兒餵食不耐受之發生率

Reducing the Incidence of Feeding Intolerance in Premature Infants in the Neonatal Intensive Care Unit

10.6224/JN.202206_69(3).11

黃鈺婷(Yu-Ting HUANG)；曾詩方(Shi-Fang TSENG)；邱昱婷(Yu-Ting CHIU)；李銘櫻(Ming-Ying LEE)；陳麗貞(Li-Chen CHEN)

餵食不耐受 ； 早產兒 ； 胃殘餘量 ； 管灌餵食 ； 新生兒加護病房 ； feeding intolerance ； premature ； gastric residual volumes ； tube feeding ； neonatal intensive care unit

護理雜誌

69卷3期（2022 / 06 / 01）

77 - 84

繁體中文

背景：營養對於早產兒至關重要，經現況調查發現單位護理人員對灌食照護認知正確率為74.8%，執行灌食照護流程完整率為74.3%，對胃殘餘量處理方式不一致，缺乏客觀評估胃殘餘量相關工具，專科照護指引未修定，以及無定期查核制度。目的：提升護理人員灌食照護認知正確率及照護流程完整率，以及降低早產兒餵食不耐受發生率。解決方案：制作「灌食標準作業流程手冊」及「胃殘餘色卡」以利護理人員在照護過程有所依循。舉辦灌食照護教育訓練，並透過臨床專科評核，以減少早產兒餵食不耐受發生率。結果：新生兒加護病房護理人員灌食照護認知正確率由74.8%提升至93.7%，執行灌食照護流程完整率由74.3%提升至95.5%，以及早產兒餵食不耐受發生率從71.8%下降至39.0%。結論：藉由此專案結果作為新生兒加護病房現行早產兒餵食照護模式之參考，改善了早產兒腸道營養的建立，提升照護品質，也使早產兒能獲得更完善及安全的照護。

Background & Problems: Nutrition is very important for premature infants. Our recent research showed that the accuracy of recognition related to tube feeding was 74.8%, and the completeness of tube feeding was 74.3%. After analyzing this situation, the reasons found to be significantly associated with the low rates of tube-feeding recognition accuracy and completion included: inconsistent treatment of gastric residual by nurses in the neonatal intensive care unit (NICU), lack of sufficient assessment tools in the NICU, out-of-date specialist care guidelines, and lack of a regular inspection system. Purpose: Our aim was to improve tube-feeding-related recognition accuracy and completion to reduce the incidence of feeding intolerance. Resolutions: The intervention included developing a guideline manual for feeding procedures and making a gastric residual color card as a clinical-care reference. Holding on-the-job training and monitoring the quality of nursing care can reduce the incidence of feeding intolerance in preterm. Results: The accuracy of tube-feeding recognition increased from 74.8% to 93.7%. The completion of tube feeding increased from 74.3% to 95.5%. The incidence of feeding intolerance in premature infants decreased from 71.8% to 39.0%. Conclusions: The results and process of this project provides a reference for improving the clinical care model for preterm infants in the NICU and for improving the enteral nutrition of preterm infants. The implementation of this project may improve the quality of nursing care and enable preterm infants to receive safer and more-complete care.

1. 葉奕廷, Y.-T.(2018)。新生兒壞死性腸炎（一）：流行病學及病生理。臨床醫學月刊，82(6)，713-715。
   連結：
2. Barr, P. A.,Mally, P. V.,Caprio, M. C.(2019).Standardized nutrition protocol for very low-birth-weight infants resulted in less use of parenteral nutrition and associated complications, better growth, and lower rates of necrotizing enterocolitis.Journal of Parenteral and Enteral Nutrition,43(4),540-549.
3. Binchy, Á.,Moore, Z.,Patton, D.(2018).Feeding intervals in premature infants ≤ 1750 g: An integrative review.Advances in Neonatal Care,18(3),168-178.
4. Foster, J. P.,Psaila, K.,Patterson, T.(2016).Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants.Cochrane Database of Systematic Reviews
5. Khatony, A.,Abdi, A.,Karimi, B.,Aghaei, A.,Brojeni, H. S.(2019).The effects of position on gastric residual volume of premature infants in NICU.Italian Journal of Pediatrics,45(1),Article 6.
6. Kumar, R. K.,Singhal, A.,Vaidya, U.,Banerjee, S.,Anwar, F.,Rao, S.(2017).Optimizing nutrition in preterm low birth weight infants - Consensus summary.Frontiers in Nutrition,4,Article 20.
7. Parker, L. A.,Weaver, M.,Torrazza, R. J. M.,Shuster, J.,Li, N.,Krueger, C.,Neu, J.(2020).Effect of aspiration and evaluation of gastric residuals on intestinal inflammation, bleeding, and gastrointestinal peptide level.The Journal of Pediatrics,217,165-171.e2.
8. Riskin, A.,Cohen, K.,Kugelman, A.,Toropine, A.,Said, W.,Bader, D.(2017).The impact of routine evaluation of gastric residual volumes on the time to achieve full enteral feeding in preterm infants.The Journal of Pediatrics,189,128-134.
9. Tume, L. N.,Bickerdike, A.,Latten, L.,Davies, S.,Lefè, M. H.,Nicolas, G. W.,Valla, F. V.(2017).Routine gastric residual volume measurement and energy target achievement in the PICU: A comparison study.European Journal of Pediatrics,176(12),1637-1644.
10. Wang, Y.,Zhu, W.,Luo, B.-R.(2020).Continuous feeding versus intermittent bolus feeding for premature infants with low birth weight: A meta-analysis of randomized controlled trials.European Journal of Clinical Nutrition,74(5),775-783.
11. 林鈺珊, Y.-S.,江明洲, M.-C.(2020)。不同母乳添加劑劑型對於早產兒臨床預後差異之比較。台灣營養學會雜誌，44(1)，18-25。
12. 衛生福利部國民健康署（2021，10月25日）．109年出生通報統計年報。https://www.hpa.gov.tw/Pages/ashx/File.ashx?FilePath=~/File/Attach/14674/File_17440.pdf [Health Promotion Administration, Ministry of Health and Welfare, Taiwan, ROC. (2021, October 25). 2020 statistics of birth reporting system. https://www.hpa.gov.tw/Pages/ashx/File.ashx?FilePath=~/File/Attach/14674/File_17440.pdf]