Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
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Feeding Desaturation and Effects of Orocutaneous Stimulation in Extremely Low Birth Weight Infants

초극소 저체중 출생아에서 수유 시 산소포화도 저하와 구강자극 요법의 효과

  • Choi, Hae-Won (Division of Neonatology, Department of Pediatrics, University of Ulsan College of Medicine, Children’s Hospital, Asan Medical Center) ;
  • Park, Hye-Won (Division of Neonatology, Department of Pediatrics, University of Ulsan College of Medicine, Children’s Hospital, Asan Medical Center) ;
  • Kim, Hee-Young (Division of Neonatology, Department of Pediatrics, University of Ulsan College of Medicine, Children’s Hospital, Asan Medical Center) ;
  • Lim, Gi-Na (Division of Neonatology, Department of Pediatrics, University of Ulsan College of Medicine, Children’s Hospital, Asan Medical Center) ;
  • Koo, So-Eun (Division of Neonatology, Department of Pediatrics, University of Ulsan College of Medicine, Children’s Hospital, Asan Medical Center) ;
  • Lee, Byong-Sop (Division of Neonatology, Department of Pediatrics, University of Ulsan College of Medicine, Children’s Hospital, Asan Medical Center) ;
  • Kim, Ai-Rhan (Division of Neonatology, Department of Pediatrics, University of Ulsan College of Medicine, Children’s Hospital, Asan Medical Center) ;
  • Kim, Ki-Soo (Division of Neonatology, Department of Pediatrics, University of Ulsan College of Medicine, Children’s Hospital, Asan Medical Center) ;
  • Pi, Soo-Young (Division of Neonatology, Department of Pediatrics, University of Ulsan College of Medicine, Children’s Hospital, Asan Medical Center)
  • 최해원 (울산대학교 의과대학 서울아산병원 소아청소년병원 신생아분과) ;
  • 박혜원 (울산대학교 의과대학 서울아산병원 소아청소년병원 신생아분과) ;
  • 김희영 (울산대학교 의과대학 서울아산병원 소아청소년병원 신생아분과) ;
  • 임진아 (울산대학교 의과대학 서울아산병원 소아청소년병원 신생아분과) ;
  • 구소은 (울산대학교 의과대학 서울아산병원 소아청소년병원 신생아분과) ;
  • 이병섭 (울산대학교 의과대학 서울아산병원 소아청소년병원 신생아분과) ;
  • 김애란 (울산대학교 의과대학 서울아산병원 소아청소년병원 신생아분과) ;
  • 김기수 (울산대학교 의과대학 서울아산병원 소아청소년병원 신생아분과) ;
  • 피수영 (울산대학교 의과대학 서울아산병원 소아청소년병원 신생아분과)
  • Published : 2010.11.30
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Abstract

Purpose: Feeding desaturation is a common problem among preterm infants which can result in prolonged hospital stays, longterm feeding difficulties and growth delay. The purpose of this study was to identify the characteristics of premature infants with feeding desaturation and to examine the effect of orocutaneous stimulation on oral feeding. Methods: During the first phase of this study, 125 extremely low birth weight infants were reviewed retrospectively. Characteristics between infants with feeding desaturation (n=34) and those without feeding desaturation (n=91) were examined. During the second phase, 29 infants recruited from March, 2009 to May, 2010 were subjected to orocutaneous stimulation. The results of orocutaneous stimulation were compared to a control group (n=81). Results: The first phase of the study revealed that extremely low birth weight infants with feeding desaturation were significantly lower in gestational ages at birth, and had lower 5 minute apgar scores, more gastroesophageal refluxes and bronchopulmonary dysplasia. Infants without feeding desaturation reached full enteral feeding significantly earlier and showed shorter duration of hospital stay. At the second phase, infants in the intervention group showed shorter days to achieve initiation of bottle feeding, shorter days in achievement of full bottle feeding, last episodes of feeding desaturation and length of hospital stay compared to the control group of similar characteristics. Conclusion: Orocutaneous stimulation among extremely low birth weight infants results in earlier achievement of full bottle feedings without episodes of feeding desaturation hence shortens the length of hospital stay.

목적: 초극소 저체중 출생아는 경구수유를 진행하는데 여러가지 어려움을 겪어, 경구수유로의 이행이 늦어진다. 본 연구에 서는 초극소 저체중 출생아 중, 수유 시 산소포화도 저하가 발생하는 군과 산소포화도 저하가 없는 군 사이의 특징을 비교하고, 초극소 저체중 출생아의 경구수유 이행 및 입원기간에 미치는 영향에 대해 알아보았다. 또한 초극소 저체중 출생아에서 구강자극요법을 시행하는 경우, 수유 시 산소포화도 저하와 경구수유 능력의 발달, 입원기간에 미치는 효과를 알아보았다. 방법: 제 1상 연구에서는 2003년 10월부터 2009년 1월까지 서울아산병원 신생아 중환자실에 입원한 125명의 초극소 저체중 출생아를 대상으로 차트 분석을 통한 후향적 연구를 실시하여, 수유 시 산소포화도 저하 여부에 따른 특성, 산소포화도 저하가 경구수유 능력 발달 및 입원기간에 미치는 영향에 대해 알아보았다. 제 2상 연구에서는 2009년 3월부터 2010년 5월까지 29명의 초극소 저체중 출생아에게 구강자극요법을 시행하며 전향적으로 자료를 수집하였고, 81명의 초극소 저체중 출생아에서 후향적 코호트 연구를 통해 두 그룹을 비교 분석하였다. 결과: 초극소 저체중 출생아의 72.8%에서 수유 시 산소포화도 저하를 보였고. 그 중 37.4%에서 서맥을 동반하였다. 수유 시산소포화도 저하가 발생하는 시점은 평균 58.2일이었고, 당시 평균 175.4 mL의 수유를 하고 있었으며, 대부분 위관영양과 경구수유를 병행하고 있었지만, 36.3%에서는 위관영양만 시행하고 있었다. 수유 시 산소포화도 저하가 발생한 군은 정상군 보다 출생 시 재태연령이 낮고, 5분 아프가 점수가 낮았으며, 위식도 역류 및 상인두 부조화가 유의하게 많았다. 또한 기관지폐이형성이 있는 초극소 저체중 출생아에서 수유 시 산소포화도의 저하가 발생할 확률은 19배 증가하였다. 수유 시 산소포화도 저하가 있는 군은 경구수유로 완전히 이행하는 시기가 늦었으며, 입원기간도 길었다. 위 결과를 토대로, 초극소 저체중 출생아에서 구강자극요법을 시행하였을 때 대조군에 비해 경구수유 시작시기 및 경구수유로 완전히 이행한 시기가 빨랐으며, 입원기간이 단축되었다. 결론: 초극소 저체중 출생아에서 구강자극요법은 경구수유능력 발달에 긍정적인 효과가 있으며 입원기간을 단축하는데 도움이 된다.

Keywords

References

  1. Bragdon DB. A basis for the nursing management of feeding the premature infant. JOGN Nurs 1983;12(3 Suppl):51s-7s. https://doi.org/10.1111/j.1552-6909.1983.tb01101.x
  2. Gryboski JD. Suck and swallow in the premature infant. Pediatrics 1969;43:96-102.
  3. Krauss AN, Brown J, Waldman S, Gottlieb G, Auld PA. Pulmonary function following feeding in low-birth-weight infants. Am J Dis Child 1978;132:139-42.
  4. Lau C, Sheena HR, Shulman RJ, Schanler RJ. Oral feeding in low birth weight infants. J Pediatr 1997;130:561-9. https://doi.org/10.1016/S0022-3476(97)70240-3
  5. Gardner SL, Hagedorn MI. Physiologic sequelae of prematurity: the nurse practitioner's role. Part V. Feeding difficulties and growth failure (pathophysiology, cause, and data collection. J Pediatr Health Care 1991;5:122-34. https://doi.org/10.1016/0891-5245(91)90022-I
  6. BuLock F, Woolridge MW, Baum JD. Development of coordination of sucking, swallowing and breathing: ultrasound study of term and preterm infants. Dev Med Child Neurol 1990;32:669- 78.
  7. Hack M, Estabrook MM, Robertson SS. Development of sucking rhythm in preterm infants. Early Hum Dev 1985;11:133-40. https://doi.org/10.1016/0378-3782(85)90100-8
  8. Garg M, Kurzner SI, Bautista DB, Keens TG. Clinically unsuspected hypoxia during sleep and feeding in infants with bronchopulmonary dysplasia. Pediatrics 1988;81:635-42.
  9. Poets CF, Langner MU, Bohnhorst B. Effects of bottle feeding and two different methods of gavage feeding on oxygenation and breathing patterns in preterm infants. Acta Paediatr 1997;86:419-23. https://doi.org/10.1111/j.1651-2227.1997.tb09034.x
  10. Rosen CL, Glaze DG, Frost JD Jr. Hypoxemia associated with feeding in the preterm infant and full-term neonate. Am J Dis Child 1984;138:623-8.
  11. Shiao SY, Brooker J, DiFiore T. Desaturation events during oral feedings with and without a nasogastric tube in very low birth weight infants. Heart Lung 1996;25:236-45. https://doi.org/10.1016/S0147-9563(96)80034-3
  12. Shivpuri CR, Martin RJ, Carlo WA, Fanaroff AA. Decreased ventilation in preterm infants during oral feeding. J Pediatr 1983;103: 285-9. https://doi.org/10.1016/S0022-3476(83)80368-0
  13. Groothuis JR, Rosenberg AA. Home oxygen promotes weight gain in infants with bronchopulmonary dysplasia. Am J Dis Child 1987; 141:992-5.
  14. Jenni OG, Wolf M, Hengartner M, Siebenthal K, Keel M, Bucher HU. Impact of central, obstructive and mixed apnea on cerebral hemodynamics in preterm infants. Biol Neonate 1996;70:91-100. https://doi.org/10.1159/000244353
  15. Perlman JM, Volpe JJ. Episodes of apnea and bradycardia in the preterm newborn: impact on cerebral circulation. Pediatrics 1985; 76:333-8.
  16. Samuels MP, Poets CF, Southall DP. Abnormal hypoxemia after lifethreatening events in infants born before term. J Pediatr 1994; 125:441-6. https://doi.org/10.1016/S0022-3476(05)83292-5
  17. Urlesberger B, Kaspirek A, Pichler G, Muller W. Apnoea of prematurity and changes in cerebral oxygenation and cerebral blood volume. Neuropediatrics 1999;30:29-33. https://doi.org/10.1055/s-2007-973453
  18. American Academy of Pediatrics, Committee on Fetus and Newborn. Hospital discharge of the high-risk neonate--proposed guidelines. Pediatrics 1998;102:411-7. https://doi.org/10.1542/peds.102.2.411
  19. Leonard EL, Trykowski LE, Kirkpatrick BV. Nutritive sucking in high-risk neonates after perioral stimulation. Phys Ther 1980;60: 299-302. https://doi.org/10.1093/ptj/60.3.299
  20. Einarsson-Backes LM, Deitz J, Price R, Glass R, Hays R. The effect of oral support on sucking efficiency in preterm infants. Am J Occup Ther 1994;48:490-8. https://doi.org/10.5014/ajot.48.6.490
  21. Bernbaum JC, Pereira GR, Watkins JB, Peckham GJ. Nonnutritive sucking during gavage feeding enhances growth and maturation in premature infants. Pediatrics 1983;71:41-5.
  22. Field T, Ignatoff E, Stringer S, Brennan J, Greenberg R, Widmayer S, et al. Nonnutritive sucking during tube feedings: effects on preterm neonates in an intensive care unit. Pediatrics 1982;70:381-4.
  23. Gaebler CP, Hanzlik JR. The effects of a prefeeding stimulation program on preterm infants. Am J Occup Ther 1996;50:184-92. https://doi.org/10.5014/ajot.50.3.184
  24. Fucile S, Gisel E, Lau C. Oral stimulation accelerates the transition from tube to oral feeding in preterm infants. J Pediatr 2002;141:230- 6. https://doi.org/10.1067/mpd.2002.125731
  25. Kim J. The effects of oral stimulation program on oral feeding of premature infants [dissertation]. [Seoul]: Seoul National University; 2007.
  26. Beckman D. Oral motor assessment and intervention. Dallas: Easter Seal Society, 1998.
  27. Chen CH, Wang TM, Chang HM, Chi CS. The effect of breast- and bottle-feeding on oxygen saturation and body temperature in preterm infants. J Hum Lact 2000;16:21-7. https://doi.org/10.1177/089033440001600105
  28. Meier P. Bottle- and breast-feeding: effects on transcutaneous oxygen pressure and temperature in preterm infants. Nurs Res 1988;37:36- 41.
  29. Shiao SY. Comparison of continuous versus intermittent sucking in very-low-birth-weight infants. J Obstet Gynecol Neonatal Nurs 1997;26:313-9. https://doi.org/10.1111/j.1552-6909.1997.tb02147.x
  30. Shiao SY, Youngblut JM, Anderson GC, DiFiore JM, Martin RJ. Nasogastric tube placement: effects on breathing and sucking in very-low-birth-weight infants. Nurs Res 1995;44:82-8.
  31. Herbst JJ, Minton SD, Book LS. Gastroesophageal reflux causing respiratory distress and apnea in newborn infants. J Pediatr 1979;95:763-8. https://doi.org/10.1016/S0022-3476(79)80733-7
  32. Peter CS, Sprodowski N, Bohnhorst B, Silny J, Poets CF. Gastroesophageal reflux and apnea of prematurity: no temporal relationship. Pediatrics 2002;109:8-11. https://doi.org/10.1542/peds.109.1.8
  33. Wenzl TG, Schenke S, Peschgens T, Silny J, Heimann G, Skopnik H. Association of apnea and nonacid gastroesophageal reflux in infants: Investigations with the intraluminal impedance technique. Pediatr Pulmonol 2001;31:144-9. https://doi.org/10.1002/1099-0496(200102)31:2<144::AID-PPUL1023>3.0.CO;2-Z
  34. Slocum C, Arko M, Di Fiore J, Martin RJ, Hibbs AM. Apnea, bradycardia and desaturation in preterm infants before and after feeding. J Perinatol 2009;29:209-12. https://doi.org/10.1038/jp.2008.226
  35. S. Co-regulation in preterm infant feeding [dissertation]. [Madison]: University of Wisconsin; 1997.
  36. Sekar KC, Duke JC. Sleep apnea and hypoxemia in recently weaned premature infants with and without bronchopulmonary dysplasia. Pediatr Pulmonol 1991;10:112-6. https://doi.org/10.1002/ppul.1950100213
  37. Adams JA, Zabaleta IA, Sackner MA. Hypoxemic events in spontaneously breathing premature infants: etiologic basis. Pediatr Res 1997;42:463-71. https://doi.org/10.1203/00006450-199710000-00007
  38. Kessen W, Leutzendorff AM. The effect of nonnutritive sucking on movement in the human newborn. J Comp Physiol Psychol 1963;56:69-72. https://doi.org/10.1037/h0040802
  39. Joung KH, Yoo IY, Cho SC. Effect of non-nutritive sucking on the oxygen saturation level and behavioral state of preterm infants during tube feeding. J Korean Soc Neonatol 2006;13:75-82.

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