低出生体重児の保育器収容中における器外での抱っこがバイタルサインに及ぼす影響 <報告>
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両親にとって児を抱くということは自然な行動であり,愛着形成や親としての自覚を高めるうえでも有効であるといわれている.当NICUでは体重,受胎後退齢,保育器内温度,摂取カロリー等の基準を定めて器外保育(コットヘ移床)を開始し,その後は両親が自由に抱っこできるようにしている.しかし在胎週数が少なく,出生体重の小さい児では,器外保育開始基準を満たすまでに日数を要する.そこで,保育器外からの面会や手指の接触だけでは得られにくい,肌と肌の触れ合いを提供するために,器外保育開始以前の一時的な抱っこを両親に勧めている.しかし,保育器収容中の抱っこは「低体温をまねく」「人工呼吸器装着中や酸素供給中は,児のバイタルサインが変動する」などの否定的意見もあった.そこで我々は,抱っこ開始の妥当な時期を明確にしたいと考え,バイタルサインへの影響について統計学的評価を行った.その結果週齢27遇以降で,いくつかの条件を設定すれば,保育器収容中に抱っこを行なっても,バイタルサインに影響を及ぼさなかった.It is said that carrying a baby is a natural behavior to parents and is effective for making up attachment and increasing self-knowledge as a parent. A baby in our NICU will be started on cot nursing(transfer to cot from incubator) under some standards for weight, post-conceptional age, incubator temperature and calorie intake etc., and then parents will have a time to carry their baby freely. Generally speaking, a baby born at low gestational age and as low birthweight will take many days to meet a standard for the start of cot nursing. So we encourage parents to carry a baby temporarily before the start of cot nursing to present a chance of skin-to-skin contact, which may be difficult to be obtained only by visiting from out of incubator or touching fingers with each other. But there are some opposite opinions for carrying a baby cared for in an incubator, such as hypothermia or changes of vital signs of a baby in ventilatory care or oxygen supply. We evaluated the influence on vital signs from carrying a baby to clarify an appropriate period of initiating it. As a result, carrying had no influence on vital signs under some standardized conditions, even if a baby was after 27 weeks of post-conceptional age or cared for in an incubator.
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