以质量求发展，以服务铸品牌

护理学报 ›› 2024, Vol. 31 ›› Issue (8): 37-42.doi: 10.16460/j.issn1008-9969.2024.08.037

• 循证护理 • 上一篇    下一篇

早产儿初乳口腔免疫疗法的最佳证据总结

纪锐婷1, 林丹娜1, 刘小成2, 李婷婷3a, 谢映梅3a, 胡冰3b, 应文娟1   

  1. 1.汕头大学医学院,广东 汕头 515000;
    2.深圳市龙华区妇幼保健院 护理部,广东 深圳 518000;
    3.深圳市龙岗区妇幼保健院 a.新生儿科;b.护理部,广东 深圳 518000
  • 收稿日期:2023-12-11 出版日期:2024-04-25 发布日期:2024-05-08
  • 通讯作者: 应文娟（1964-）,女,北京人,硕士,主任护师,副主任。E-mail: yingwenjuan@126.com
  • 作者简介:纪锐婷（1998-）,女,广东汕头人,本科学历,硕士研究生在读。
  • 基金资助:
    深圳市龙岗区经济与科技发展专项资金（LGKCYLWS2020150）

Best evidence for colostrum as oral immune therapy in premature infants

JI Rui-ting1, LIN Dan-na1, LIU Xiao-cheng2, LI Ting-ting3a, XIE Ying-mei3a, HU Bing3b, YING Wen-juan1   

  1. 1. Medical College, Shantou University, Shantou 515000, China;
    2. Dept. of Nursing Administration, Longhua Maternity and Child Healthcare Hospital, Shenzhen 518000, China;
    3a. Dept. of Neonatology; 3b. Dept. of Nursing Administration, Longgang Maternity and Child Healthcare Hospital, Shenzhen 518000, China
  • Received:2023-12-11 Online:2024-04-25 Published:2024-05-08

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摘要： 目的 检索、评价国内外早产儿行初乳口腔免疫疗法的证据,为开展早产儿初乳口腔免疫疗法提供临床实践依据。方法 根据“6S”证据模型,系统检索国内外数据库中关于早产儿运用初乳口腔免疫疗法的文献。由2名研究者独立对文献进行质量评价并提取整合证据。结果 共纳入11篇文献,其中指南3篇、专家共识1篇、临床决策1篇和系统评价6篇。从适宜对象、干预方法、初乳管理以及健康教育4个方面,共获得15条最佳证据。结论 本研究从适宜对象、干预方法、初乳管理及健康教育这4个方面归纳分析早产儿初乳口腔免疫疗法的最佳证据,医护人员可结合临床现有条件和患儿的实际情况开展初乳口腔免疫疗法,以促进患儿免疫系统的成熟及尽早达到出院标准。

关键词: 早产儿, 初乳口腔免疫疗法, 循证护理, 最佳证据

Abstract: Objective To retrieve and evaluate the best evidence for colostrum as oral immune therapy for premature infants at home and abroad, and to provide reference for clinical practice. Methods According to “6S” model, we systematically searched and collected the evidence regarding colostrum as oral immune therapy for premature infants. Two researchers evaluated the quality of the literature and extracted the data independently. Results Eleven pieces of literature were collected, including 3 guidelines, 1 evidence summary, 1 clinical decision, and 6 systematic reviews. Fifteen pieces of best evidence were obtained covering 4 aspects of suitable objects, intervention methods, management of colostrum and health education. Conclusion Colostrum as oral immune therapy could be delivered according to the best evidence. Clinical conditions and actual conditions of the preterm infants should be considered, so as to promote the maturity of the infants' immune system and reach the discharge standard as soon as possible.

Key words: premature infant, colostrum as oral immune therapy, evidence-based nursing, best evidence

中图分类号: 

  • R473.72
[1] Sudeep KC, Kumar J, Ray S,et al.Oral application of colostrum and mother's own milk in preterm infants-a randomized, controlled trial[J]. Indian J Pediatr, 2022 ,89(6):579-586. DOI: 10.1007/s12098-021-03982-4.
[2] Colonetti T, de Carvalho Florêncio I, Figueiredo P, et al. Colostrum use and the immune system of premature newborns:a systematic review and Meta-analysis[J].J Hum Lact,2022,38(3):487-500.DOI:10.1177/08903344221087967.
[3] Lee J, Kim HS, Jung YH, et al.Oropharyngeal colostrum administration in extremely premature infants: an RCT[J]. Pediatrics,2015,135(2):e357-366. DOI:10.1542/peds.2014-2004.
[4] 胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018.
[5] Alper BS, Haynes RB.EBHC pyramid 5.0 for accessing preappraised evidence and guidance[J]. Evid Based Med,2016,21(4):123-125. DOI: 10.1136/ebmed-2016-110447.
[6] Brouwers MC, Kho ME, Browman GP, et al.AGREE II: advancing guideline development, reporting and evaluation in health care[J]. CMAJ, 2010,182(18):E839-842. DOI:10.1503/cmaj.090449.
[7] Jordan Z, Lockwood C, Munn Z, et al.The updated Joanna Briggs Institute model of evidence-based healthcare[J]. Int J Evid Based Healthc,2019,17(1):58-71. DOI: 10.1097/XEB.0000000000000155.
[8] Foster MJ, Shurtz S.Making the critical appraisal for summaries of evidence (CASE) for evidence-based medicine (EBM): critical appraisal of summaries of evidence[J].J Med Libr Assoc,2013,101(3):192-198. DOI: 10.3163/1536-5050.101.3.008.
[9] 顾莺,张慧文,周英凤,等. JBI循证卫生保健中心关于不同类型研究的质量评价工具——系统评价的方法学质量评价[J]. 护士进修杂志,2018,33(8):701-703. DOI:10.16821/j.cnki.hsjx.2018.08.008.
[10] 王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967.DOI:10.16821/j.cnki.hsjx.2015.11.002.
[11] 林穗仪,何家欣,纪翠红,等. 胆管癌患者光动力治疗避光管理的最佳证据总结[J]. 护理学报,2022,29(23):39-44. DOI:10.16460/j.issn1008-9969.2022.23.039.
[12] 罗黎,何娇,张娟,等. 新生儿尿布皮炎预防及管理的最佳证据总结[J]. 护理学报,2023,30(6):42-46. DOI:10.16460/j.issn1008-9969.2023.06.042.
[13] Fenton TR, Griffin IJ, Groh-Wargo S, et al.Very low birthweight preterm infants: a 2020 evidence analysis center evidence-based nutrition practice guideline[J].J Acad Nutr Diet, 2022,122(1):182-206. DOI: 10.1016/j.jand.2021.02.027.
[14] 中国医师协会新生儿科医师分会循证专业委员会. 早产儿喂养不耐受临床诊疗指南(2020)[J]. 中国当代儿科杂志,2020,22(10):1047-1055. DOI:10.7499/j.issn.1008-8830.2008132.
[15] 中国医师协会新生儿科医师分会营养专业委员会,中国医师协会儿童健康专业委员会母乳库学组,《中华儿科杂志》编辑委员会. 新生儿重症监护病房推行早产儿母乳喂养的建议[J]. 中华儿科杂志,2016,54(1):13-16. DOI:10.3760/cma.j.issn.0578-1310.2016.01.004.
[16] 曹云,李正红,韩树萍,等. 新生儿重症监护室母乳使用专家共识[J]. 中国循证儿科杂志,2021,16(3):171-178. DOI:10.3969/j.issn.1673?5501.2021.03.001.
[17] Hair AB, Abrams SA, Hoppin AG. 早产儿肠内营养策略[EB/OL].(2022-06-29)[2022-09-13].https://www.uptodate.cn/contents/approach-to-enteral-nutrition-in-the-premature-infant.
[18] Nasuf AWA, Ojha S, Dorling J. Oropharyngeal colostrum in preventing mortality and morbidity in preterm infants[J]. Cochrane Database Syst Rev,2018,9(9):CD011921. DOI:10.1002/14651858.CD011921.pub2.
[19] Panchal H, Athalye-Jape G, Patole S.Oropharyngeal colostrum for preterm infants: a systematic review and Meta-analysis[J]. Adv Nutr, 2019, 10(6):1152-1162. DOI:10.1093/advances/nmz033.
[20] 李媛媛,赵旭,历广招,等. 应用初乳对早产儿进行口腔护理干预效果的系统评价[J].中华护理杂志,2019,54(5):753-759. DOI:10.3761/j.issn.0254-1769.2019.05.027.
[21] Ma A, Yang J, Li Y, et al.Oropharyngeal colostrum therapy reduces the incidence of ventilator-associated pneumonia in very low birth weight infants: a systematic review and meta-analysis[J]. Pediatr Res,2021,89(1):54-62. DOI: 10.1038/s41390-020-0854-1.
[22] 王璐,张枭霄,黎李,等. 应用母乳对机械通气新生儿进行口腔护理干预效果的系统评价[J].全科护理,2021,19(22):3037-3043. DOI:10.12104/j.issn.1674-4748.2021.22.004.
[23] Cai M, Lin L, Peng Y, et al.Effect of breast milk oral care on mechanically ventilated preterm infants: a systematic review and Meta-analysis of randomized controlled trials[J]. Front Pediatr,2022,10:899193.DOI:10.3389/fped.2022.899193.
[24] Lee JK, Hern Tan LT, Ramadas A, et al.Exploring the role of gut bacteria in health and disease in preterm neonates[J]. Int J Environ Res Public Health, 2020,17(19):6963. DOI: 10.3390/ijerph17196963.
[25] Rasmussen SO, Martin L, Østergaard MV, et al.Bovine colostrum improves neonatal growth, digestive function, and gut immunity relative to donor human milk and infant formula in preterm pigs[J]. Am J Physiol Gastrointest Liver Physiol,2016,311(3):G480-491. DOI: 10.1152/ajpgi.00139.2016.
[26] Rodriguez NA, Meier PP, Groer MW, et al.Oropharyngeal administration of colostrum to extremely low birth weight infants: theoretical perspectives[J]. J Perinatol,2009 ,29(1):1-7. DOI: 10.1038/jp.2008.130.
[27] Chen LL, Liu J, Mu XH, et al.Oropharyngeal administration of mother's own milk influences levels of salivary sIgA in preterm infants fed by gastric tube[J]. Sci Rep,2022,12(1):2233. DOI: 10.1038/s41598-022-06243-2.
[28] Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services[J]. Geneva: World Health Organization, 2017.
[29] Manerkar S, Kalamdani P, Patra S, et al.Improving early colostrum feeding in a tertiary neonatal intensive care unit: a quality improvement initiative[J]. Breastfeed Med,2022,17(2):143-148. DOI: 10.1089/bfm.2021.0173.
[30] Wang H, Li QF, Xu XF, et al.Study on improving collection feeding safety and quality of colostrum for very (extremely) low birth weight infants[J]. Front Pediatr,2023,10:1069719. DOI: 10.3389/fped.2022.1069719.
[31] Dong D, Ru X, Huang X, et al.A prospective cohort study on lactation status and breastfeeding challenges in mothers giving birth to preterm infants[J]. Int Breastfeed J,2022,17(1):6. DOI: 10.1186/s13006-021-00447-4.
[32] Tao J, Mao J, Yang J, et al.Effects of oropharyngeal administration of colostrum on the incidence of necrotizing enterocolitis, late-onset sepsis, and death in preterm infants: a Meta-analysis of RCTs[J]. Eur J Clin Nutr,2020,74(8):1122-1131. DOI: 10.1038/s41430-019-0552-4.
[33] Bashir T, Reddy KV, Kiran S, et al.Effect of colostrum given within the 12 hours after birth on feeding outcome, morbidity and mortality in very low birth weight infants: a prospective cohort study[J]. Sudan J Paediatr,2019,19(1):19-24. DOI: 10.24911/SJP.106-1540825552.
[34] 许素环,张巧梅,但鑫,等. 口腔免疫疗法对早产儿干预效果的Meta分析[J].中国护理管理,2018,18(10):1340-1346. DOI:10.3969/j.issn.1672-1756.2018.10.009.
[35] 张西洋,刘杰,穆晓和,等. 初乳口腔免疫疗法改善早产儿胃肠道喂养效果的Meta分析[J]. 循证护理,2022,8(14):1847-1853. DOI:10.12102/j.issn.2095-8668.2022.14.001.
[36] 涂满梅,王丽丽,李翠,等. 不同持续时间初乳口腔涂抹对极低出生体质量儿喂养状况的影响[J]. 中国妇幼保健,2021,36(17):3975-3978. DOI:10.19829/j.zgfybj.issn.1001-4411.2021.17.024.
[37] Rodriguez NA, Meier PP, Groer MW, et al.A pilot study to determine the safety and feasibility of oropharyngeal administration of own mother's colostrum to extremely low-birth-weight infants[J].Adv Neonatal Care,2010,10(4):206-212. DOI: 10.1097/ANC.0b013e3181e94133.
[38] 季福婷,张玉侠. 极低出生体重儿初乳口腔涂抹安全性和可行性的研究[J].护理研究,2016,30(31):3882-3886. DOI:10.3969/j.issn.1009-6493.2016.31.011.
[39] Le Q, Zheng SH, Zhang L, et al.Effects of oral stimulation with breast milk in preterm infants oral feeding: a randomized clinical trial[J]. J Perinat Med,2021,50(4):486-492. DOI: 10.1515/jpm-2020-0282.
[40] 蔡会文,马月兰,刘永戍,等. 口腔免疫疗法对预防早产儿呼吸机相关性肺炎的Meta分析[J]. 中华现代护理杂志,2021,27(19):2563-2569.DOI:10.3760/cma.j.cn115682-20201125-06389.
[41] 张玉玲,李敬风,蒋丽,等. 口腔护理使用母乳预防新生儿呼吸机相关性肺炎的效果[J]. 中华现代护理杂志,2015(15):1805-1807. DOI:10.3760/cma.j.issn.1674-2907.2015.15.021.
[42] Seigel JK, Smith PB, Ashley PL, et al.Early administration of oropharyngeal colostrum to extremely low birth weight infants[J]. Breastfeed Med,2013,8(6):491-495. DOI:10.1089/bfm.2013.0025.
[43] 王琪,黄辉,林卓琛,等. 区域人口健康信息平台上的网络健康教育需求初探[J]. 中国健康教育,2017,33(8):693-697. DOI:10.16168/j.cnki.issn.1002-9982.2017.08.005.
[44] 张贵清,刘俊俐,李雪,等. 全媒体健康教育对初产妇母乳喂养自信心及主观幸福感的影响[J].中国健康教育,2020,36(2):163-166. DOI:10.16168/j.cnki.issn.1002-9982.2020.02.015.
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