Oral Feeding and Cardiorespiratory & Braescu, SaO 2 Medoff & Ray, 199 Daniel, Julie, & William, 2002 Ludwig 14 respiratory sinus arrhythmia, R

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1 早 產 兒 口 腔 餵 食 與 心 肺 功 能 調 節 之 關 係 張 雅 雯 張 瑩 如 * 由 於 早 產 兒 生 理 成 熟 及 疾 病 因 素, 導 致 其 在 學 習 口 腔 餵 食 時 心 肺 功 能 調 節 反 應 有 個 別 性 的 差 異, 因 而 影 響 其 餵 食 成 效 由 於 觀 察 餵 食 過 程 的 生 理 反 應 是 護 理 人 員 的 重 要 職 責, 故 本 文 統 整 文 獻 探 討 早 產 兒 口 腔 餵 食 與 其 心 肺 功 能 調 節 之 機 轉 及 關 係, 以 增 進 護 理 人 員 之 認 知 及 臨 床 觀 察 之 敏 感 度 本 文 統 整 四 個 重 要 概 念 :⑴ 早 產 兒 可 藉 由 成 熟 的 吸 吮 技 巧, 配 合 吸 吮 吞 嚥 和 呼 吸 間 的 協 調, 進 而 提 昇 口 腔 餵 食 成 效 ⑵ 早 產 兒 的 口 腔 餵 食 與 心 肺 功 能 調 節 具 有 絕 對 關 係, 心 肺 功 能 調 節 良 好, 餵 食 成 效 越 佳 ⑶ 早 產 兒 在 口 腔 餵 食 期 間 會 降 低 迷 走 神 經 反 應 使 心 跳 速 率 增 加, 以 平 衡 身 體 新 陳 代 謝 機 能, 在 餵 食 完 後 則 會 逐 漸 回 復 至 餵 食 前 之 速 率 ⑷ 早 產 兒 在 口 腔 餵 食 初 期 的 動 脈 血 氧 飽 和 濃 度 (arterial oxygen saturation, SaO 2 ) 持 續 低 下 情 況, 可 藉 由 經 驗 累 積 逐 漸 達 到 成 熟 的 口 腔 餵 食 動 作 來 改 善 這 些 概 念 可 提 供 臨 床 護 理 人 員 開 始 嘗 試 早 產 兒 口 腔 餵 食 時 機 的 依 據 或 參 考, 以 避 免 過 早 及 強 迫 口 腔 餵 食 而 導 致 心 肺 負 荷 早 產 兒 口 腔 餵 食 心 肺 功 能 調 節 餵 食 成 效 Thomas, arterial oxygen saturation, SaO 2 gestational age McGrath & Braescu, Pickler & Reyna, McGrath & Braescu, 2004; Pickler & Reyna, McGrath *

2 Oral Feeding and Cardiorespiratory & Braescu, SaO 2 Medoff & Ray, 199 Daniel, Julie, & William, 2002 Ludwig 14 respiratory sinus arrhythmia, RSAPorges, 19 Yasuma & Hayano, 2004 Brown, 200; Hill, 1992; Portales et al., 199; Suess et al., 2000 Portales et al., 199 Porges Lipsitt RSA nucleus ambiguous, NA Suess et al., 2000 RSA Veerappan feeding bradycardia (McCain, Fuller, & Gartside, 200 German, Crompton, McCluskey, & Thexton, 199 Medoff & Ray, 199 Simpson, Schanler, &

3 Lau, 2002 McGrath & Braescu, 2004 Medoff & Ray, 199 Shivpuri Martin Carlo Fanaroff 193 / Hill, 1992 Thoyre, S. M. & Carlson, J. R., 2003 Bu Lock, Woolridge, & Baum, 1990 Thoyre, S. M., & Carlson, J. R., 2003 SaO 2 oxyhemoglobin, HbO 2 Hb DiFiore, 2004 SaO 2 SaO 2 Chang, Anderson, Dowling, & Lin, 2002 SaO 2 SaO 2 McGrath & Braescu, 2004 Hill, 1992 SaO 2 SaO 2 Thoyre, S. M. & Carlson, J., 2003 SaO 2 Shiao, Brooker, & DiFiore, 199 Cheung, Barrington, Finer, & Robertson, 1999 SaO 2 Thoyre, S. M. & Carlson, J., 2003 Shiao et al., 199 Shiao 199 SaO 2 Thoyre, S. M. & Carlson, J. R., 2003 Chang et al., 2002

4 Oral Feeding and Cardiorespiratory Thoyre, S. M. Carlson, J very low birth weight, VLBW 20 SaO 2 90SaO 2 bottle-in-mouth 3. SaO 2 SaO 2 SaO 2 Medoff & Ray, 199 SaO 2 SaO 2 SaO 2 Hill, 1992 SaO 2 SaO 2 SaO 2 McGrath & Braescu, 2004 Brown, L. (2007). Heart rate variability in premature infants during feeding. Biological Research for Nursing, 8(4), Bu Lock, F., Woolridge, M. W., & Baum, J. D. (1990). Development of coordination of sucking, swallowing and breathing: Ultrasound study of term and preterm infants. Developmental Medicine and Child Neurology, 32(8), Chang, Y. J., Anderson, G. C., Dowling, D., & Lin, C. H. (2002). Decreased activity and oxygen desaturation in prone venti-

5 9 lated preterm infants during the first postnatal week. Heart & Lung, 31(1), Cheung, P. Y., Barrington, K. J., Finer, N. N., & Robertson, C. M. (1999). Early childhood neurodevelopment in very low birth weight infants with predischarge apnea. Pediatric Pulmonology, 27(1), Daniel, J. S., Julie, A. A., & William, T. (2002). Heart rate and gender: Neurohumoral basis and clinical implications. Philippine Journal of Cardiology, 30(1), 1 5. DiFiore, J. M. (2004). Neonatal cardiorespiratory monitoring techniques. Seminars in Neonatology, 9(3), German, R. Z., Crompton, A. W., McCluskey, C., & Thexton, A. J. (1996). Coordination between respiration and deglutition in a preterm infant mammal, Sus scrofa. Archives of Oral Biology, 41(6), Hill, A. S. (1992). Preliminary finding: A maximum oral feeding time for premature infants, the relationship to physiological indicator. Maternal Child Nursing Journal, 20(2), McCain, G. C., Fuller, E. O., & Gartside, P. S. (2005). Heart rate variability and feeding bradycardia in healthy preterm infants during transition from gavage to oral feeding. Newborn and Infant Nursing Reviews, 5(3), McGrath, J. M., & Braescu, A. V. (2004). State of the science: Feeding readiness in the preterm infant. Journal of Perinatal and Neonatal Nursing, 18(4), Medoff, C. B., & Ray, W. (1995). Neonatal sucking behaviors. The Journal of Nursing Scholarship, 27(3), Pickler, R. H., & Reyna, B. A. (2004). Effects of non-nutritive sucking on nutritive sucking, breathing, and behavior during bottle feedings of preterm infants. Advances in Neonatal Care, 4(4), Porges, S. W. (1986). Respiratory sinus arrhythmia: Physiological basis, quantitative methods, and clinical implications. In P. Grossman, K. Janssen, & D. Vaitl (Eds.), Cardiorespiratory and cardiosomatic psychophysiology (pp ). New York: Plenum. Porges, S. W., & Lipsitt, L. P. (1993). Neonatal responsivity to gustatory stimulation: The gustatory-vagal hypothesis. Infant Behavior and Development, 16, Portales, A. L., Porges, S. W., Doussard-Roosevelt, J. A., Abedin, M., Lopez, R., Young, M. A., et al. (1997). Vagal regulation during bottle feeding in low-birthweight neonates: Support for the gustatory-vagal hypothesis. Developmental Psychobiology, 30(3), Shiao, S. Y., Brooker, J., & DiFiore, T. (1996). Desaturation events during oral feedings with and without a nasogastric tube in very low birth weight infants. Heart & Lung, 25(3), Shivpuri, C. R., Martin, R. J., Carlo, W. A., & Fanaroff, A. A. (1983). Decreased ventilation in preterm infants during oral feeding. The Journal of Pediatrics, 103(2), Simpson, C., Schanler, R. J., & Lau, C. (2002). Early introduction of oral feeding in preterm infants. Pediatrics, 110(3), Suess, P. E., Alpan, G., Dulkerian, S. J., Doussard-Roosevelt, J. A., Porges, S. W., & Gewolb, I. H. (2000). Respiratory sinus arrhythmia during feeding: A measure of vagal regulation of metabolism, ingestion, and digestion in premature infants. Developmental Medicine and Child Neurology, 42(3), Thomas, J. A. (2007). Guidelines for bottle feeding your premature baby. Advances in Neonatal Care, 7(6), Thoyre, S. M., & Carlson, J. (2003). Occurrence of oxygen desaturation events during preterm infant bottle feeding near discharge. Early Human Development, 72(1), Thoyre, S. M., & Carlson, J. R. (2003). Preterm infants behavioural indicators of oxygen decline during bottle feeding. Journal of Advanced Nursing, 43(6), Veerappan, S., Rosen, H., Craelius, W., Curcie, D., Hiatt, M., & Hegyi, T. (2000). Spectral analysis of heart rate variability in premature infants with feeding bradycardia. Pediatric Research, 47(5), Yasuma, F., & Hayano, J. I. (2004). Respiratory sinus arrhythmia: Why does the heartbeat synchronize with respiratory rhythm? Chest, 125(2),

6 10 Oral Feeding and Cardiorespiratory The Relationship Between Oral Feeding and Cardiorespiratory Regulation of Premature Infants Ya-Wen Chang Ying-Ju Chang * Abstract: Levels of maturity and diseases of premature infants are factors that produce individual differences in cardiorespiratory responses to oral feeding and feeding performances. Recognition of mechanisms and cardiorespiratory regulation of oral feeding may increase sensitivity of clinical observation of nurses and facilitate safe and comfort feeding experiences for premature infants. Four major concepts of this integrated literature review are: (a) The maturation of sucking skills and coordination of sucking, swallowing, and breathing play an important role in successful oral feeding. (b) There are significant relationships between the feeding performances and cardiorespiratory stability of premature infants in the early period of oral feeding. (c) During the oral feeding period, the reduction of vagal tone will increase the heart rate of premature infants in order to balance physiological metastasis. (d) During the early period of oral feeding, the SaO 2 of premature infants might decrease continually. This condition can be improved gradually with experience of oral feeding. These concepts provide knowledge for assessing feeding readiness and facilitate protocols for safe feeding by reducing the cardiorespiratory workload of premature infants. Key Words: premature infants, oral feeding, cardiorespiratory regulation, feeding performance. RN, MSN, Instructor, Department of Nursing, National Tainan Institute of Nursing; *RN, PhD, Associate Professor, Department of Nursing & Institute of Allied Health, College of Medicine, National Cheng Kung University. Received: March 13, 2008 Revised: March 31, 2008 Accepted: May 13, 2008 Address correspondence to: Ying-Ju Chang, No. 1, Ta-Hsueh Rd., Tainan 70101, Taiwan, ROC. Tel: +886 (6) ext. 5854; yxc2@mail.ncku.edu.tw