Motnje hranjenja in požiranja pri nedonošenčkih

magistrsko delo

Nuša Slana (Avtor), Irena Hočevar-Boltežar (Mentor)

Povzetek

Nedonošeni otroci v Sloveniji predstavljajo 6–7% vseh rojenih otrok. V primerjavi z donošenimi otroki se nedonošenčki srečujejo s številnimi težavami povezanimi s prezgodnjim porodom. Te so lahko posledica zapletov med nosečnostjo oziroma porodom, nezrelosti mišičnega in živčnega sistema ter neoptimalnega bolnišničnega okolja, ki so mu nedonošenčki izpostavljeni v prvih mesecih svojega življenja. Z opravljeno raziskavo smo zato poskušali določiti pogostost motenj hranjenja in požiranja pri nedonošenčkih, dejavnike, ki pri nedonošenih otrocih napovedujejo motnje hranjenja in požiranja ter posledice, ki jih le-te imajo na otroke in njihove starše. V ta namen je bil na podlagi literature oblikovan vprašalnik za starše nedonošenih otrok s porodno težo do vključno 1500 gramov, ki so bili rojeni v Porodnišnici Ljubljana v letih 2013–2015. Vprašalnik je bil poslan staršem 427-ih otrok, ki so ustrezali našim merilom, od tega je bilo vrnjenih 136 ustrezno izpolnjenih vprašalnikov. Pri analizi odgovorov so bile s pomočjo programov Excel in IBM SPSS uporabljene deskriptivne statistične metode ter opravljene parametrične in neparametrične statistične analize. Motnje hranjenja in požiranja so bile prisotne pri 42,6% vseh vključenih nedonošenčkov. Pojavljale so se predvsem v obliki utrujenosti med sesanjem, težav pri začenjanju sesanja, pomanjkanja moči za sesanje, dolgotrajnega hranjenja in nezadostne količine zaužite hrane. Statistično pomembne razlike glede na porodno težo (do vključno 1000 gramov ali od 1001–1500 gramov) smo ugotovili pri dejavnikih gestacijska starost ob porodu (p=0,000), enoplodna nosečnost (p=0,011), spremljajoče bolezni, težave in sindromi (p=0,019), dojenje (p=0,034), prisotnost znakov motenj hranjenja in požiranja (p=0,006), nezadostna količina zaužite hrane (p=0,009), stres ob hranjenju otrok (p=0,000) in logopedska obravnava kasneje v otroštvu (p=0,018). Kot dejavnike, ki pri nedonošenih otrocih napovedujejo motnje hranjenja in požiranja, smo prepoznali porodno težo do vključno 1000 gramov (p=0,011), nizko gestacijsko starost (p=0,018), majhno porodno dolžino ob porodu (p=0,000), spremljajoče bolezni, težave in sindrome (p=0,002), otroci z motnjami hranjenja in požiranja pa so se ločili od vrstnikov brez teh motenj tudi glede pojavljanja težav z nadzorom sline (p=0,011) in spremenjene občutljivosti ust (p=0,002). Kot posledice prisotnih motenj hranjenja in požiranja pa prepoznavamo redkejše dojenje (p=0,001), doživljanje stresa med hranjenjem otroka (p=0,000) in govorno-jezikovne težave kasneje v otroštvu (p=0,022). Po vključitvi signifikantnih spremenljivk v multivariatni model logistične regresije, sta statistično pomemben napovednik motenj hranjenja in požiranja ostala porodna dolžina (p=0,042) ter spremljajoče bolezni, težave in sindromi (p=0,034). Kot pogost in nadvse pomemben dejavnik smo prepoznali tudi doživljanje stresa s strani staršev, saj jih je med hranjenjem otroka kar 38% kdaj občutilo stres. Celostna in pravočasna obravnava motenj hranjenja in požiranja pri nedonošenčkih zahteva interdisciplinaren tim različnih strokovnjakov, v katerem pa ima logoped še vedno premajhno vlogo. Ugotovili smo, da je logopeda obiskovalo 35% nedonošenih otrok in da imajo otroci z resnejšimi motnjami hranjenja in požiranja pogosteje govorno-jezikovne težave, zato menimo, da je vključitev logopeda smiselna in nujna že od rojstva dalje, tako v vlogi strokovnjaka pri obravnavi motenj hranjenja in požiranja kot tudi strokovnjaka za motnje govornega in jezikovnega razvoja.

Ključne besede

motnje hranjenja in požiranja;porodna teža;vprašalniki;govorno-jezikovne motnje;rast in razvoj otrok;nedonošenost;hranjenje in požiranje;

Podatki

Jezik:	Slovenski jezik
Leto izida:	2019
Tipologija:	2.09 - Magistrsko delo
Organizacija:	UL PEF - Pedagoška fakulteta
Založnik:	[N. Slana]
UDK:	613.24/.25-053.32(043.2)
COBISS:	12562761
Št. ogledov:	458
Št. prenosov:	67
Ocena:	0 (0 glasov)
Metapodatki:

Ostali podatki

Sekundarni jezik:	Angleški jezik
Sekundarni naslov:	Feeding and swallowing disorders in preterm infants
Sekundarni povzetek:	Preterm children represent 6–7% of all children born in Slovenia. Because of their premature birth preterm children have numerous problems. These health problems can be caused by complications during pregnancy or birth, immaturity of the muscular and nervous system or by suboptimal hospital environment in the first months of their life. Because premature birth abruptly interrupts the child’s development in the uterus, many preterm children have feeding and swallowing disorders. The aim of our research was to identify the prevalence of feeding and swallowing disorders in preterm infants, factors which predict swallowing and feeding disorders and the consequences these disorders have on the preterm infants and their parents. For the purpose of research, a questionnaire based on literature was composed for parents of preterm children born in the maternity hospital in Ljubljana between 2013 and 2015 with birth weight less or equal to 1500 grams. The questionnaire was sent to parents of 427 children that met our criteria. We received 136 correctly answered questionnaires. For the analysis descriptive statistical methods, parametric and non-parametric statistical tests were performed using Excel and IBM SPSS program. Feeding and swallowing disorders were present in 42,6% of all preterm infants included. They appeared mainly as fatigue during sucking, difficulty when starting to suck, prolonged feeding and insufficient amount of food intake. Statistically important differences relating to birth weight (up to and including 1000 grams or from 1001 to 1500 grams) were gestational age at birth (p=0,000), singleton pregnancy (p=0,011), accompanying diseases, problems and syndromes (p=0,019), breastfeeding (p=0,034), signs of feeding and swallowing disorders (p=0,006), insufficient amount of food intake (p=0,009), stress when feeding the infant (p=0,000) and speech and language therapy later in childhood (p=0,018). Low birth weight of less or equal to 1000 grams (p=0,011), low gestational age (p=0,018), baby's length at birth (p=0,000), accompanying diseases, problems and syndromes (p=0,002) were identified as factors that predict the appearance of feeding and swallowing disorders. Problems with saliva control (p=0,011) and abnormal oral sensitivity (p=0,002) were also characteristic for children with swallowing and feeding problems. As consequences of feeding and swallowing disorders not being able to be breastfed (p=0,001), stress when feeding the infant (p=0,000) and speech and language problems later in childhood (p=0,022) were recognized. The statistically significant parameters were included in a logistic regression model but only baby's length at birth (p=0.042) and accompanying diseases, problems and syndromes (p=0.034) remained as a statistically significant predictor of feeding and swallowing disorders. As a frequent and very important factor the experience of stress by parents was recognized, as 38% of them ever experienced stress during child feeding. An integrated and on-time treatment of feeding and swallowing disorders in preterm infants demands an interdisciplinary team of various professionals in which a speech and language therapist is still not included enough. It was discovered that 35% of preterm children visited a speech and language therapist and that speech and language problems are more common in preterm children with serious feeding and swallowing disorders. Therefore, we believe the inclusion of a speech and language therapist in the treatment team from birth onwards is reasonable and essential not only as an expert for feeding and swallowing disorders but also for speech and language disorders.
Sekundarne ključne besede:	speech therapy;premature baby;logopedija;nedonošenček;
Vrsta datoteke:	application/pdf
Vrsta dela (COBISS):	Magistrsko delo/naloga
Komentar na gradivo:	Univ. v Ljubljani, Pedagoška fak., Logopedija in surdopedagogika
Strani:	VII, 115 str.
ID:	11206313