Efeitos da estimulação da sucção não nutritiva com dedo enluvado na transição alimentar em recém-nascido prematuro de muito baixo peso

Abstract

Objetivos analisar os efeitos da estimulação da sucção não nutritiva com a técnica do dedo enluvado, sobre o início e a transição alimentar da via gástrica para a via oral em prematuros de muito baixo peso. Métodos estudo aleatório, prospectivo, longitudinal, experimental e controlado, que incluiu 40 prematuros internados na UTI Neonatal do Hospital de Clínicas, com idade gestacional £ 32 semanas e peso de nascimento £ 1500g, clinicamente estáveis. Os prematuros foram distribuídos aleatoriamente, por meio de sorteio, em 2 grupos: grupo controle, sem SNN e grupo experimental, com SNN com dedo enluvado, 3 vezes ao dia, 3 dias na semana. Foram avaliados critérios quanto ao escore da avaliação da prontidão para início da alimentação oral, intercorrências durante a sucção nutritiva (SN) e o tempo de transição alimentar. Resultados quando comparado o grupo experimental em relação ao grupo controle observou-se um escore significantemente maior na avaliação da prontidão para início da alimentação via oral, uma menor frequência de sinais de estresse durante a sucção nutritiva e um menor tempo de transição alimentar da via gástrica para via oral. Conclusão a estimulação da sucção não nutritiva com a técnica do dedo enluvado melhorou a prontidão do prematuro para início da alimentação via oral, diminuiu a frequência dos sinais de estresse durante a alimentação via oral e reduziu o tempo de transição alimentar no grupo experimental quando comparado ao grupo controle.

Desempenho da alimentação oral em recém-nascidos prematuros estimulados pela técnica treino de deglutição

“…Indicating that patients who were stimulated with a lower CGA, had a marked improvement in the readiness score. Previous studies have shown an increase in the readiness score in the SG, regardless of the progression of CGA, with an increase in this score, even in early CGAs (16) . In another study, subjects who received early OF were able to reach oral feeding milestones significantly earlier than their control group peers (34.5±1.6 vs. 36.0±1.5 weeks, respectively) (25) .…”

“…Analyzing the pre-stimulation and post-stimulation data, post-stimulation improvement was observed, with increase in the total score and overall improvement observed in the sample, which was 11.3 points. In a previous study, the pre-term readiness score was lower in the control group (CG), when compared to the stimulation group (SG) (NNS) at the beginning of the OF (22) . Another study verified a statistically significant difference between the scores of the first and second evaluation of PTNBs (23) .…”

“…A study, for example, randomized PTNBs for SG and CG, verifying that the transitional time from tube to OF was 26.8 (±12.3) days for SG and 38.4 (±14.0) days for the CG (25) . Another study observed that the OF readiness score was lower in the CG when compared to the SG (NNS), and the transition time from the gastric tube to OF was lower in the SG (three days) when compared to the CG (five days) (22) . In a previous study, the SG (NNS) presented a mean of readiness for OF of 32.8 (±1.0) and median time of transition from the gastric to OF of three (2-5) days (16) .…”

“…After the protocol was applied, the direct score calculation was done. The protocol establishes that a score ≥28 indicates PTNB eligibility for the initiation of OF (15,16) . The feeding skills assessment was performed at the time of the first feeding, using the "finger-feeding" technique.…”

“…A short gastric tube attached to the examiner's gloved fifth digit was attached to a 20 ml disposable syringe with a plunger. The tube was placed in the newborns oral cavity, who sucked the examiner's finger, extracting the milk (16,17,18) . Feeding performance was assessed by overall transfer (OT,% ml taken during a prescribed feeding / ml), proficiency (PRO,% ml taken during the first 5 min/ml prescribed) and milk transfer rate (TR, ml/min) (10) , verified at the time of the first oral feeding, with premature infants being monitored for SpO2, HR and RF, all remaining stable.…”