嚥下運動と非栄養性吸啜運動が早産児の経口栄養摂取準備に及ぼす影響。無作為化比較試験

The effects of swallowing exercise and non-nutritive sucking exercise on oral feeding readiness in preterm infants: A randomized controlled trial.

抄録

はじめに:

早産児は、吸啜の問題に加えて、咽頭嚥下の問題を示す。早産児の経口摂食能力を促進するために、口腔運動介入と無栄養性吸啜（NNS）が導入された。しかし，NNSは経口摂取のすべての要素をカバーすることはできません．一方，嚥下訓練（SE）は，早産児の自立的な経口栄養摂取の達成を促進することができる．本研究では、NNSとSEを組み合わせたプログラムが、NNSのみのプログラムと比較して、早産児の経口摂食準備に効果的であるかどうかを検討することを目的とした。

INTRODUCTION: Preterm infants demonstrate problems with pharyngeal swallowing in addition to sucking problems. Oral motor intervention and nonnutritive sucking (NNS) were introduced for promoting oral feeding skills in preterm infants. NNS cannot cover all the components of oral feeding. In another hand, the swallowing exercise (SE) can accelerate the attainment of independent oral feeding in the preterm infants. The current study sought to examine if a combined program of NNS and SE compared with a program that only involves NNS would be more effective on oral feeding readiness of premature infants.

材料および方法:

この無作為化比較試験は、新生児集中治療室（NICU）で実施された。45名の早産児を3群に分け募集した。I群では、乳児は1日2回NNSを投与された。グループIIでは、1日15分のNNSと15分のSEを行うプログラムを実施した。両群とも2週間連続の10日間である。対照群であるIII群は、通常のNICUケアを受けただけであった。すべての乳児は、経口栄養開始時の月経後年齢（PMA）、完全経口栄養時のPMA、移行時間（開始から完全経口栄養までの日数）、退院時のPMA、さらに介入後の退院時の乳児の経管栄養への依存度を含む経口栄養機能評価指標で評価された。また、介入前後にPreterm Oral Feeding Readiness Scale（POFRAS）を用いて全児童の評価を行った。

MATERIAL AND METHODS: This randomized controlled trial was conducted in a neonatal intensive care unit (NICU). 45 preterm infants were recruited in three groups. In the group I, infants were provided with NNS twice a day. The group II received a program that involved 15 min of NNS and 15 min of SE, daily. Both interventions were provided 10 days during two consecutive weeks. The group III, control group, just received the routine NICU care. All infants were assessed by functional oral feeding outcome measures including postmenstrual age (PMA) at the start of oral feeding, PMA at full oral feeding, transition time (days from start to full oral feeding), PMA at discharge time and also the infant's dependency on tube-feeding at discharge time after interventions. Also, all infants were assessed via Preterm Oral Feeding Readiness Scale (POFRAS) before and after intervention.

結果:

経口栄養開始時（P=0.29）、完全経口栄養時（P=0.13）、退院時（P=0.45）、移行時（P=0.14）のPMA平均値に有意差を認めなかった。対照群に比べ，II群では経管栄養を行わずに退院した乳児が多かった（P＝0.01）．POFRASの平均値は，III群に比べ，I，II両群で有意に高かった（それぞれP＝0.02，P＝0.01）．しかし，このスコアはI群とII群の間で統計的な差はなかった（P=0.98）．

RESULTS: No significant differences were observed in the PMA mean at start of oral-feeding (P = 0.29), full oral-feeding (P = 0.13), discharge time (P = 0.45) and the mean of transition time (P = 0.14). Compared to the control group, more infants in the group II were discharged without tube-feeding (P = 0.01). The mean of POFRAS was significantly higher in both groups I and II compared to the group III (P = 0.02 and P = 0.01, respectively). This score was, however, not statistically different between the groups I and II (P = 0.98).

結論:

POFRASスコアに基づく早産児の経口摂取準備の向上において，研究された両方の介入は通常のNICUケアよりも優れていた．また，NNSではなく，NNSとSEの併用プログラムでは，対照群に比べ，経管栄養を行わずに退院する乳児の数を有意に増加させることが可能であった．

CONCLUSIONS: Both studied interventions were superior to routine NICU care in enhancing the oral feeding readiness of preterm infants based on the POFRAS score. The studied combined program of NNS and SE, and not NNS program, could significantly increase the number of discharged infants without tube-feeding compared to control group.