慢性肺疾病(Chronic Lung Disease, CLD)早產兒因疾病及成熟度因素，在餵食過程中容易產生吸吮、吞嚥及呼吸之協調問題，故可能因奶嘴孔洞誘發之流速及吸吮壓力不同，影響餵食成效及生理適應，故本研究目的為比較使用小、中型圓孔及十字孔奶嘴餵食之CLD的早產兒，在口腔餵食過渡期之餵食成效、口腔動作協調性及心跳、呼吸、血氧飽和濃度的差異。
本研究於南部某醫學中心之新生兒加護病房中進行，研究對象為20位CLD早產兒，矯正年齡達32-34週，經臨床醫師確認可以開始嘗試口腔餵食者。採自我交叉研究設計，研究對象在一天內選擇連續三餐隨機分派使用小圓孔、中圓孔、十字孔三種不同奶嘴孔洞餵食，在餵食前10分鐘、中、後30分鐘持續監測心跳(HR)、呼吸(RR)、血氧飽和濃度(SpO2)，並於餵食中測量早產兒的餵食成效及口腔動作協調性。
結果顯示CLD早產兒在口腔餵食過渡初期使用不同奶嘴孔洞於(1) 餵食成效除了總吸吮量百分比外，口腔餵食時間及每分鐘平均吸吮量，以十字孔的餵食時間最久，吸吮量最少 ( p < .001 )；(2) 口腔動作協調性的吸吮次數、每次口腔吸吮動作開始至結束期間（Burst）的次數、單次吸吮的時間、吸吮壓力，十字孔均大於小圓孔及中圓孔( p < .001 )；(3)生理指標除了HR外，十字孔的RR ( p < .020 )及SpO2 ( p < .044 )均大於小圓孔及中圓孔。(4) 餵食中的HR會升高，在管灌餵食後回復至基準值；RR及SpO2會下降，小圓、中圓孔、十字孔的RR分別在餵食後5分鐘、25分鐘、管灌餵食後的平均值會回復至基準值；小圓、中圓孔及十字孔的SpO2在餵食後約5分鐘均會回復至餵食前基準值。
本研究結果提供CLD早產兒在口腔餵食過渡初期，不同奶嘴孔洞對其餵食成效、口腔動作協調性、心肺功能調節生理變化之實証依據，可做為臨床護理人員餵食CLD早產兒選擇適當餵食工具之參考，使護理人員能依早產兒之個別生理狀態提供適當的餵食工具，在口腔餵食中維持CLD早產兒的生理穩定。

Preterm infants with chronic lung disease (CLD) have more difficulties in suck- swallow- breathe coordination during the transitional period of oral feeding. The different types of nipple units may alter milk flows and sucking pressures and then affect feeding performance and physiological stability of preterm infants with CLD. The purpose of this study is to compare the effects of small, middle single hole and cross-cut nipple units on feeding performance, oral-motor coordination, heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2) in preterm infants with CLD.
This study was conducted in an neonatal intensive care unit of an medical center of southern Taiwan. Twenty preterm infants with CLD and postmenstrual age of 32-34 week participated in this study. They were diagnosed for allowing oral feeding. This study used a cross-over design. Infants were randomly assigned to the small, middle single hole, and cross-cut nipple units for oral feeding in a consecutive three meals. Preterm infants HR, RR, SpO2 were measured 10minutes before, during, and 30 minutes after feeding. Sucking frequency, sucking pressure, and feeding performance were measured during feeding.
The essential results were summarized as follows: (a) Time of feeding and mean of sucking amount were statistic significant among differences type of nipple. However, percentage of sucking amount was no statistic significance. (b) The cross-cut group has significant results ( p＜.001 ) in number of sucking, number of burst, and time and pressure of each sucking when it compared to the other two groups. (c) Except HR, the cross-cut group has higher RR( p < .020 ) and SpO2( p < .044 ) than the other two groups. (d) HR increased during the feeding and returned to normal(baseline) after N-G feeding. However, RR and SpO2 increased. The mean of RR in small-single-hole group returned to baseline on the fifth minute, and the mean of RR in middle-single-hole group returned to baseline on the twenty-fifth minute. Each group spent 5 minutes to normalize their SpO2.
This study established in the early period of oral feed preterm infants with CLD, and milk flow of differences type nipple units on feeding performance, oral-motor coordination, and physiological parametersin expect outcom for nursing evidance to feed preterm infants with CLD. These finding provide of clinical caretakers’choice of bottle nipple and selection of an optimal bottle nipple, and on during oral feeding physiological parameters stable in preterm infants with CLD.

財團法人中華民國早產兒基金會（1997）‧他很小，他是我寶貝‧台北：早產兒基金會。
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