[Development of evidence-based clinical practice guidelines for endotracheal suction in premature infants].

BACKGROUND: Endotracheal suctioning (ETS) for mechanically ventilated premature infants is a routine practice in neonatal intensive care. However, ETS is associated with hypoxemia and bradycardia, which may cause brain damage and negatively affect neurodevelopmental outcomes. PURPOSE: This study develops a set of evidence-based clinical-practice ETS guidelines for premature infants. METHODS: A multidisciplinary task group at a medical center in southern Taiwan was established. Team members analyzed current ETS practice guidelines, constructed foreground questions, reviewed each question systemically, drafted a new set of guidelines, established expert consensus, disseminated the developed guidelines within a hospital setting, and evaluated their efficacy in practice. RESULTS: The developed ETS guidelines address 13 issues with 39 recommendations. The Delphi method found that 75% of experts agreed with all of the recommendations. Issues addressed in the ETS included pre-assessment, frequency of suctioning, pre-oxygenation, suction-tube selection, infection control, suction pressure and depth decision making, humidity with normal saline, suction duration and number, containment and comforting, assessment during and after suctioning, recovery time, and documentation. The panel of clinical and methodological experts recommended that ETS be used in practice and nurses in the neonatal intensive care unit evaluated the ETS as applicable and accessible. The cardiorespiratory responses to ETS of 5 premature infants were within normal ranges without episodes of hypoxemia (oxygen saturation < 85%) or bradycardia (heart rate < 100 beat/min). CONCLUSIONS: This set of evidence-based ETS guidelines for premature infants integrated recommendations from the best available literature and obtained a high consensus among clinical experts. Thus, these guidelines are recommended for clinical application.

Factors affecting early feeding performance in preterm infants below 32 weeks gestation.

OBJECTIVE: To identify the influence of various physiological and behavioral factors on feeding performance of preterm infants in the transition to full oral feeding. METHODS: We retrospectively reviewed data from a feeding assessment conducted on 24 preterm infants born at 25-31 weeks without severe brain complications. RESULTS: Prolonged oxygen use and low current weight are two adverse factors for feeding efficiency (volume of milk ingested orally per minute in the initial 5 min of feeding) and proficiency (percentage of prescribed volume ingested orally over the entire feeding). Young post-menstrual age, low baseline oxygen saturation and high feeding efficiency were risk factors for oxygen desaturation during the initial feeding. CONCLUSION: Proper feeding strategies are needed for preterm infants with those disadvantageous factors to improve their early feeding performance.

Feeding with cross-cut teats has better sucking effects and oxygenation in preterm infants with chronic lung disease.

AIM: To compare effects of single-hole and cross-cut teats on feeding performance, oral movement and cardiorespiratory parameters in preterm infants with chronic lung disease. BACKGROUND: Infants' feeding performance and physiological stability are affected by the shape and hole size of teats because of varied milk flow. The single-hole teat could facilitate efficient milk intake in healthy preterm infants. In preterm infants with chronic lung disease, few studies have determined which type of teat is suitable for feeding. DESIGN: A crossover study design was conducted. METHODS: Twenty preterm infants with chronic lung disease were studied in a neonatal intensive care unit. During the early stage in transitional period of oral feeding, each infant was provided with a small single-hole, an intermediate single-hole and a cross-cut teat with diameters of 0.45-0.5 mm, 0.7-0.8 mm and 2.0 mm, respectively, for three consecutive feeds in a random order. Feeding performance, oral movement, heart rate, respiratory rate and oxygen saturation (SpO(2)) were measured. RESULTS: Infants fed with single-hole teats had a shorter duration of feeding time (p < 0.001) and higher feeding efficiency (p < 0.001) compared with the cross-cut teats. However, infants fed with cross-cut teats had a higher sucking pressure (p < 0.001), more sucks (p < 0.001) and bursts (p < 0.001), longer sucking duration (p = 0.002) and higher respiratory rate (p = 0.005) and SpO(2) (p = 0.014) than infants fed with single-hole teats. CONCLUSIONS: For preterm infants with chronic lung disease, cross-cut teats facilitate feeding coordination and physiological stability during the early stage of the transition from tube to oral feeding. RELEVANCE TO CLINICAL PRACTICE: Cross-cut teat can be considered for preterm infants with chronic lung disease to increase safety and self-regulation in the early stage of the transition from tube to oral feeding.