Razi Journal of Medical Sciences

fa مقایسه روش شیردهی تغذیه با انگشت و با فنجان در نوزادان نارس در زمان رسیدن به دریافت مستقیم شیر مادر در بیمارستان اکبرآبادی 1398 Comparison of Finger-Feeding and Cup-Feeding in Preterm Infants at the Time of Exclusive Breast Feeding in Akbarabadi Hospital 2020 نوزادان Neonatology پژوهشي Research <div style="text-align: justify;">زمینه و هدف: تغذیه نوزادان نارس از جمله چالش‌های همیشگی تیم پزشکی و پرستاری می‌باشد. در این تحقیق به مقایسه دو روش شیردهی  تغذیه با انگشت و تغذیه با فنجان در نوزادان نارس از نظر زمان رسیدن به دریافت مستقیم شیر مادر پرداخته شده است. روش کار: این مطالعه مشاهده‌ای-مقطعی می‌باشد و به پرونده‌های نوزادان نارس کمتر از 36 هفته و 6 روز متولد شده در بیمارستان اکبرآبادی در سال 1398 مراجعه شده و 30 نوزاد در گروه تغذیه با انگشت و 35 نوزاد در گروه تغذیه با فنجان از نظر جنس، نوع تولد، سن حاملگی همسان سازی شدند. در دو گروه زمان لازم تا شروع تغذیه با هریک از روش‌ها بدون نیاز به گاواژ گاستریک، تعداد دفعات گاواژ موفقیت آمیز و حجم شیر دریافتی در 10 روز اول، مدت زمان بستری در NICU و زمان لازم تا دریافت مستقیم شیر مادر مقایسه گردید. یافته‌ها: با توجه به عوامل مورد بررسی در این مطالعه مشخص گردید که مدت زمان لازم تا شروع تغذیه در دو گروه تفاوت معناداری داشت. بدین معنی که گروه Cup  feeding زودتر می‌توانستند از این روش نسبت به گروه Finger استفاده کنند ولی  در مورد سایر متغیرها چنین ارتباط معناداری یافت نشد. نتیجه‌گیری:  نتایج این پژوهش نشان داد که مدت زمان لازم تا دریافت مستقیم شیر مادر و متغیرهای مربوط به تغذیه موفقیت آمیز در دو گروه تفاوتی نداشت.</div> Background & Aims: The rate or prevalence of preterm neonates in 5-15% of pregnancies and with the probability of neonatal mortality rates 40 times higher than normal neonate’s weight, due to their inability has caused the feeding of this group of neonates for directly receiving breast milk becomes one of the serious and important challenges of the medical and nursing team. Lack of neural development, abnormal muscle tone, lack of integration of muscle activity and oral reflexes weakness are among the effective factors that they have caused premature babies to be deprived of the immunological and antiseptic properties of breast milk. Considering these factors that mentioned before and with the aim of reducing the mortality rate of premature babies, finding suitable alternative solutions for breastfeeding always has been considered of medical community interest until reaching the maturity stage to receive breast milk. Currently, several breastfeeding methods including cup method, syringe suction method, translactation, finger feeding method, paladai, and bottle-feeding method are available for premature babies. Scientific research shows that breastfeeding with bottles and cups have been studied more than other methods. With considering these cases, it is essential to study and compare different methods in order to choose the best technique led to increase and improve the suction process and, as a result, the capacity of premature babies to receive breast milk. In various surveys and studies that have been conducted in the world, it has been pointed out that the two methods of finger feeding and cup feeding are more useful in feeding premature babies in different societies. Therefore, in this research, two methods of finger feeding and cup feeding have been compared in premature babies in terms of the time to directly receive breast milk. Methods: This retrospective study is a cross-sectional study. In attention to Akbarabadi Hospital is equipped with a milk bank and feeding babies with two methods of finger feeding and cup feeding, therefore premature babies born in this hospital in 2020, with the age of less than 36 weeks and 6 days, were considered as the statistical population of this study research. 30 babies in the finger-feeding group and 35 babies in the cup-feeding group were matched in terms of sex, type of birth, and gestational age. Two methods of descriptive and inferential statistics were used to analyze the data. In the inferential statistics section, the condition of normality of the data was checked first. In cases where the data had a normal distribution, independent T-tests and Anova were used, and in the case of non-normal distribution, Wilcoxon analysis was used, and the significance level was calculated at 0.05. In the two groups, the time required to start feeding with each of the methods without the need for gastric gavage, the number of times of successful gavage and the volume of milk received in the first 10 days, the duration of hospitalization in the NICU and the time required to directly receive breast milk were compared. Resutls: According to the investigated factors in this study, it was found that there is no significant difference in the distribution of sub-groups of parametric and non-parametric variables in the two groups of finger feeding and cup feeding. Also, by examining the five hypotheses of this research, it was found that the duration of hospitalization, the number of gavages, the volume of milk received and the time to directly receive breast milk in the two groups based on the results of Wilcoxon analysis and Anova analysis to compare the variables based on gestational age does not exist any significant difference between the two groups. Without the need for gastric gavage, in each of these two methods, it was determined that there is a significant difference between the two groups according to the P value obtained in the Wilcoxon analysis of 0.008 in both finger feeding and cup feeding groups. In this way, in the cup-feeding group, they were fed earlier than the finger-feeding group alone and without the need to use a gastric tube (as PG). Also, based on the gestational age, this was confirmed that in the two groups of less than or equal to 30 weeks and 30 to 34 weeks, but in the group of 34 to 36 weeks and 6 days, no significant difference between the two groups was proven. In the present study, the loss of milk by the preterm infants was not measured, and the number of times of gavage and the volume of milk received by the preterm infants in the two research groups were compared. Coclusion: The findings of the Moreira et al. research have similar results to this research, which means that they also concluded that there is no difference in the time to reach direct breast milk in the two groups of finger feeding and cup feeding. Of course, in the aforementioned study, it is mentioned that the amount of milk loss in finger feeding method is less than cup feeding and the time required to feed a preterm infants with finger feeding method is longer than cup feeding. In the Flint study and another study by Araujo, both conducted in 2016, the finger feeding technique introduced a better method in the amount of milk received by the infant, which was not found in the current study. In a study conducted by Neide et al., the cup feeding method was more preferable than the bottle feeding method in terms of receiving milk from the mother's breast. According to the results of this study, it was determined the frequency of gavage during the first 10 days (P=0.297), the volume of milk received in the first 10 days (P=0.224), the duration of hospitalization in the NICU (P=0.787). And the time required to directly receive breast milk (P=0.515), there is no significant difference in the two studied groups. However, in terms of the time to start feeding in such a way that there is no need to feed through the gastric tube (PG) and the baby can be fed by the Cup or Finger method without the need for a gastric tube, there was a difference in the Cup feeding group compared to the Finger feeding group (P=0.008), which means that this time was shorter in the cup feeding group. In general, it can be said that according to surveys and researches taken in Iran and the world, there are three main viewpoints regarding feeding premature babies with breast milk. In one of the popular views that is cited in some articles and researches, it is thought that the finger feeding method has more advantage for infants. The second group of views, which happens to be close to the World Health Organization (WHO), refers to the fact that cup feeding is the preferred and standard way of feeding premature infants. The third point of view indicates that there is no difference between feeding in the two groups. According to the purpose of the present study based on investigate the existence or non-existence of differences between the two methods of feeding in premature infants in fact, this hypothesis is proved that there is no significant difference between feeding with these two methods - apart from the little differences between these two methods when not using The gastric tube is determined, which indicates that feeding with a cup is shorter than feeding with a finger- therefore the result of this study confirm the third point of view. According to the results obtained in this research, in order to complete investigations, it is suggested to conduct more studies with a higher sample size and to consider comparable comparisons in two groups, including the amount of milk consumed in each of the groups, the time required to feed the baby with each from these methods and comparing the amount of weight in two groups.   نوزادان نارس, تغذیه با انگشت, تغذیه با فنجان, دریافت مستقیم شیر مادر Preterm Neonates, Finger feeding, Cup feeding, Exclusive Breast Feeding 1 11 http://rjms.iums.ac.ir/browse.php?a_code=A-10-6702-1&slc_lang=fa&sid=1 Maryam Saboute مریم سابوته saboutem@yahoo.com 3900319475328460091237 3900319475328460091237 Yes Associate Professor, Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran دانشیار، دانشگاه علوم پزشکی ایران، دانشکده پزشکی، گروه کودکان ، تهران، ایران Arash Bordbar آرش بردبار 3900319475328460091238 3900319475328460091238 No Associate Professor, Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran دانشیار، دانشگاه علوم پزشکی ایران، دانشکده پزشکی، گروه کودکان، تهران، ایران Arezoo Zarei آرزو زارعی 3900319475328460091239 3900319475328460091239 No Pediatric Resident, Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran دانشجوی دکتری تخصصی پزشکی کودکان، دانشگاه علوم پزشکی ایران، دانشکده پزشکی، گروه کودکان، تهران، ایران