目的：早產兒早期壓力經驗、腦血氧波動皆與未來神經發展障礙有關。屬複合性壓
力處置的晨間護理是新生兒加護病房常規，對脆弱的出生週數 30 週以下早產兒腦血
氧之影響卻仍未知。本研究旨在探討晨間護理對出生週數 30 週以下早產兒腦血氧之
影響及其相關因素，提供未來修正照護流程之參考。
方法：於南部某醫學中心新生兒加護病房採方便取樣法，納入姙娠週數小於 30 週且
出生天數在 14 天內執行晨間護理(含測量體重)者，排除先天性異常者與當天更換保
溫箱的晨間護理；在 14 天內至多收集五次晨間護理數據，且每次測量至少間隔兩
天。採前瞻式觀察法，藉由近紅外線光譜儀(near-infrared spectroscopy, NIRS) 觀察出
生週數 30 週以下早產兒在晨間護理過程前、中、後之腦血氧(rScO2)的連續變化，並
搭配數位影像進行紀錄。收集晨間護理前 10 分鐘之 rScO2、血氧飽和濃度(SpO2)基
準值，以及晨間護理過程與結束後 10 分鐘之數據。研究結果以廣義估計方程式、簡
單線性迴歸分析、史皮爾曼相關係數及 k-means for longitudinal data (kml)進行分析。
結果：自 2021 年 3 月 8 日到 2022 年 4 月 1 日，共納入 11 位早產兒，完成 32 次晨
間護理觀察數據，資料收集時間平均為出生後第 8 天，矯正週數平均為 26 週。結果
顯示晨間護理過程中之 rScO2 顯著低於基準值(p<0.001)，在身體清潔、測量體重、
翻身擺位時也分別顯著低於基準值。男嬰、疾病嚴重度較高、合併腦室內出血第二
級以上者，其整體 rScO2 較低；在基準值時，出生後天數及矯正週數對 rScO2 有不同
影響，但進入晨間護理時出生後天數及矯正週數則不會影響 rScO2 趨勢。SpO2 在晨
間護理過程中顯著低於晨間護理前的基準值(p<0.001)，在身體清潔、測量體重、翻
身擺位時則與基準值沒有差異，整體趨勢變化不會因基本人口學不同而有差異。而
rScO2 與 SpO2 在晨間護理過程呈現中度正相關（R2=0.613, p<0.001），且 Spearman rho 係數為 0.698 (p<0.001)。
結論：複合性壓力處置的晨間護理會影響出生週數 30 週以下早產兒的 rScO2 與
SpO2，晨間護理中的單一護理措施不會影響 SpO2 但會影響 rScO2。

INTRODUCTION
Early-life stress experiences and cerebral oxygenation fluctuation events in very preterm infants are related to neurodevelopment impairment in early childhood. Morning care, considered a complex stressor, impacts cerebral oxygenation(rScO2) in these vulnerable infants. Despite being a nursing routine in the neonatal intensive care unit, the impact of morning care on cerebral oxygenation in very preterm infants has not yet been fully understood. This study aims to investigate the effect of morning care on cerebral oxygenation and other associated factors in preterm infants less than 30 weeks gestational age. The goal is to use the findings to develop guidelines for modifying care practices.

MATERIALS AND METHOD
This is a prospective observational study that aims to examine the change in cerebral oxygenation in very preterm infants using near-infrared spectroscopy (NIRS) before, during, and after morning care over a period of time. The study was conducted in a neonatal intensive care unit in a medical center at southern Taiwan. The enrolled infants were recruited through convenience sampling method by the criteria of less than 30 weeks gestational age and excluded with congenital abnormalities. The researcher observed the morning care process and collected data no more than five times for the same participant within 14 days. Each measurement was separated over two days. The baseline values of cerebral oxygenation and oxygen saturation 10 minutes before and 10 minutes after the morning care were collected. The repeated measure data were analyzed using generalized estimating equations (GEE), simple linear regression, and k-means for longitudinal data (kml) to answer the research questions.

RESULT
The study enrolled 11 premature infants and analyzed 32 observations between 8th March, 2021 to 1st April, 2022. The average data collection days was 8 days after birth, and the average postmenstrual age was 26 weeks. The results found that cerebral oxygenation levels were significantly lower during the morning care process than the baseline values before morning care (p<0.001). Compared to the baseline values, there were significantly lower during body cleaning, measuring weight, and turning position, respectively. The overall rScO2 was lower in male preterm infants, more severe illnesses and at least grade 2 intraventricular hemorrhage. The postnatal days and postmenstrual age affected the rScO2 at the baseline but did not affect the rScO2 trend during morning care. The oxygen saturation (SpO2) during the morning care process was also significantly lower than the baseline value before the morning care (p<0.001). However, there was no difference between the baseline value and the value during the period of body cleaning, weighing, and positioning. The overall trend of the results did not show significant differences based on the basic demographic characteristics of the participants. The study found that the rScO2 and SpO2 during the morning care process were moderately positively correlated (R2 = 0.613, p<0.001) and the Spearman's rho coefficient was 0.698 (p<0.001).

CONCLUSION
The study findings suggest that morning care, as a complex stress intervention, has an impact on the cerebral oxygenation (rScO2) and oxygen saturation (SpO2) of preterm infants born before 30 weeks of gestational age. The results indicated that while individual interventions during morning care, such as body cleaning, weighing, and positioning, do not affect the SpO2, but it does affect rScO2.

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