Programa de Pós-graduação em Enfermagem e Saúde
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Item Efeito do knowledge translation para melhoria do manejo da dor em recém-nascidos em uma unidade neonatal(Universidade Federal de Goiás, 2017-07-03) Carvalho, Julyana Calatayud; Castral, Thaíla Corrêa; http://lattes.cnpq.br/8910125241591217; Castral, Thaíla Corrêa; Mendonça, Ana Karina Marques Salge; Ribeiro, Laiane Medeiros; Cavalcante, Marcela Maria Faria Peres; Pereira, Lílian VarandaThere are strategies and interventions with proven effectiveness for the adequate management of neonatal pain. However, the simple dissemination of knowledge at the end of a research and/or training do not guarantee the use of knowledge by health professionals in clinical practice, resulting in a gap between knowing and doing. Given the frequent and repeated exposure of newborns to painful procedures in the neonatal unit and the deleterious consequences of untreated pain, it is urgent to implement innovative actions that promote changes in clinical practice to transform the available evidence into action. Thus, the objective of this study was to evaluate the effect of a multifaceted Knowledge Translation (KT) intervention to improve the management of neonatal pain. It is a quasi-experimental study, with no control group, of pre- and posttest type, performed at the neonatal unit of a public maternity hospital in Goiás, Brazil, from February 2015 to March 2016. The intervention used was Evidence-Based Practice for Improving Quality (EPIQ), which was divided into two phases: preparation and implementation, and change. A Research and Practice Council consisting of health professionals of the neonatal unit led and facilitated the proposed changes. Implementation was carried out in three rapid cycles, with one target for each cycle being established. Several KT strategies were used in combination, according to what the goal and barriers indicated, such as: reminders, bedside training, videos, educational leaflets, auditing and feedback, clinical protocols and didactic presentation. In Cycle 1, all professionals were sensitized to the adequate management of neonatal pain, and 89.4% of the professionals considered it possible to use the presented strategies. In cycle 2, the PIPP-R and EDIN scales were used to assess pain. At the first audit of cycle 2, of the total of 64 painful procedures (aspiration, blood collection and catheter insertion), the PIPP-R scale was applied in 30.8% of these procedures and EDIN in 26.2%. In the second audit of cycle 2, from 38 painful procedures, the PIPP-R scale was registered in 23.7% and EDIN, 23.8%. In cycle 3, the goals of cycle 2 were maintained and 20% oral glucose administration was included for relief of acute pain during peripheral catheter insertion and blood collection. In the audit of cycle 3, glucose was administered in 29.6% from the total of 54 painful procedures. After the completion of the implementation process, a final audit was carried out for 25 days. From the total of 444 painful procedures, the PIPP-R scale was applied in 26.6% and the EDIN scale was applied 50.7%; and glucose was 17 administered in 25.1% of these procedures. We conclude that, while faced with a challenging context and with the multifaceted KT intervention used in this study (EPIQ), it was possible to observe a significant increase, by health professionals, in the use of scales to assess pain and oral glucose administration to relieve neonatal pain. However, strategies to improve and sustain these outcomes are needed to ensure that every newborn has their pain evaluated and treated.Item A amamentação e o leite materno para o alívio da dor de procedimentos em recém-nascidos pré-termo: revisão sistemática(Universidade Federal de Goiás, 2019-07-29) Freitas, Raquel Rodrigues de; Castral, Thaíla Corrêa; http://lattes.cnpq.br/8910125241591217; Castral, Thaíla Corrêa; Bueno, Mariana; Cavalcante, Marcela Maria Faria PeresIntroduction: Preterm newborns in the Intensive Care Unit are exposed to different painful procedures. It is recommended that units providing care to the newborn should establish a pain management program, which includes non-pharmacological analgesic interventions. Breastfeeding in full-term newborns is effective in reducing pain responses, but the evidence for preterms is still inconclusive. Objective: To evaluate and synthesize the literature on the evidences of the effectiveness of breastfeeding or breast milk as non-pharmacological interventions for the management of acute procedural pain in preterm newborns. Methods: Systematic review of randomized clinical trials published between 2011 and 2018 in English, Spanish and Portuguese. Search performed according to the acronym PICO, with the research question: Are breastfeeding and breast milk effective in the management of acute pain of procedures in preterm newborns compared to other non-pharmacological methods. Pain was assessed as the predicted value, considering at least one of the following results: scoring of pain assessment scales and evaluation of physiological, behavioral pain indicators or other indicators. The search performed in the electronic databases of MEDLINE, CENTRAL and LILACS, using controlled terms for preterm newborn, pain, breastfeeding, breast milk and randomized clinical trial. Study methodological quality was assessed using the Cochrane Collaboration tool for bias risk assessment from randomized clinical trials. Results: Fifteen studies were included, and two evaluated the use of breastfeeding (128 preterms) and thirteen (1026 preterms) the use of breast milk as an analgesic intervention. The endpoint evaluated in most of the studies (n= 12, 80%) was the PIPP score. The painful procedures examined were heel puncture, ophthalmologic examination for retinopathy of prematurity, aspiration of the airways, removal of adhesive tape from dressing and venipuncture. Conclusion: Breastfeeding has an analgesic effect on heel puncture for late preterm newborns that demonstrate ability to breastfeed. It did not present significant differences in relation to then onnutritive suction and sucrose 24%. Breast milk has a superior effect in relation to water and no treatment, and it shows better results when combined with nonnutritive suction, kangaroo position and enrollement, and is recommended for pain reduction during heel puncture. Studies should be done to investigate other factors that interfere with the efficacy of breastfeeding, such as maternal factors and breastfeeding time, and in addition to investigate different dosages of milk that ensure the best dose / effect to promote analgesia.Item Incidência e fatores preditivos da interrupção de aleitamento materno exclusivo em prematuros(Universidade Federal de Goiás, 2016-04-14) Luz, Lucyana Silva; Castral, Thaíla Corrêa; http://lattes.cnpq.br/891012524159121; Castral, Thaíla Corrêa; Scochi, Carmen Gracinda Silvan; Minamisava, Ruth; Vieira, Flaviana; Salge, Ana Karina MarquesPrematurity is one of the main causes of infant mortality and morbidity associated with perinatal conditions, being responsible for the majority of neonatal deaths in Brazil. Exclusive Breastfeeding (EBF) is one of the main interventions for neonatal deaths reduction, being recommended for early start and keeping until six months of age. However, breastfeeding a premature infant (PT) is a challenge given its physiological and biological immaturity, unstable health and hospitalization. EBF level is low among PT and early weaning is frequent. It is important to know the factors that contribute to this circumstance. Thus, this study assessed EBF incidence and associated risk factors for EBF interruption in PT after 15 days of hospital discharge. It is a prospective cohort accomplished in a public maternity of Goiás with 113 PT admitted in the neonatal unit. Data about PT feeding, since birth until 15 days after hospital discharge, were collected from PT’s medical chart and interview with the mother using a semi-structured questionnaire. EBF interruption of PT 15 days after hospital discharge was considered as the outcome variable and several maternal and neonatal exposure variables were tested. Data quantitative analysis of PT’s gestation, birth and health conditions was done through descriptive statistics. Maternal and neonatal exposure effects on the outcome variable were evaluated through COX regression model. Variables that presented statistical significance (p<0.10) in the univariate analysis were included in the backward multivariate regression model. Significant variables in the model (p<0.05) were interpreted by the hazard ratio (Hazard Risk – HR) and the respective 95% confidence interval. EBF incidence was 81.4% in hospital discharge and 66.4% 15 days after hospital discharge. In the univariate analysis, variables: breast problems, double pregnancy, gestational age at birth, birth weight, admittance time, ventilation time and effective breastfeeding in the first week of life were statistically significant. In the multivariate analysis, variables double gestation, ventilation time and birth weight were statistically significant. A 15% decrease in EBF incidence can be verified 15 days after hospital discharge. EBF interruption risk at home is higher when PT is born from double pregnancy and the lower the PT’s birth weight. On the other side, EBF interruption risk at home is lower the lower the mechanic ventilation time. The implementation of actions is necessary by a multi-professional staff that promotes early start and keeping of EBF during hospitalization in the neonatal unit, as well as the articulation of these actions with basic care and public policies to increase EBF levels from birth up to six months of life.Item Uso da bolsa canguru em bebês a termo saudáveis: a relação com a amamentação e a percepção materna(Universidade Federal de Goiás, 2017-04-25) Souza, Romilda Rayane Godoi; Siqueira, Karina Machado; http://lattes.cnpq.br/0644332775668979; Castral, Thaíla Corrêa; http://lattes.cnpq.br/8910125241591217; Castral, Thaíla Corrêa; http://lattes.cnpq.br/8910125241591217; Siqueira, Karina Machado; http://lattes.cnpq.br/0644332775668979; Munari, Denize Bouttelet; Cavalcante, Marcela Maria Faria Peres; Salge, Ana Karina MarquesEarly skin-to-skin contact up to one hour after birth for every unborn child is associated with early initiation of breastfeeding, success at first feeding, cardiorespiratory stability, and blood glucose. However, this contact is usually not maintained in rooming-in care or at home, in term infants. We believe that the proximity between mother and baby through the use of kangaroo bag may also benefit healthy term infants. The objective of this study was to identify the benefits to breastfeeding of prolonged maternal contact in a healthy term baby, through the use of the kangaroo bag in rooming-in care and at home, and the maternal perception of this experience. This study was carried out in two stages. Stage 1, with a quantitative approach, of transversal descriptive type and stage 2 had a qualitative approach, based on the methodological framework of appreciative investigation. The sample initially consisted of 98 mothers who accepted to use the kangaroo bag and answered a phone call between the first and second month of the baby's life (29-81 days) to verify the frequency of use of the kangaroo bag, to apply the Breastfeeding Self-Efficacy Scale/Short Form (BSES-SF) and to obtain breastfeeding data. We performed quantitative analysis by means of absolute frequency, mean and standard deviation; and tests of association between variables. Qualitative data were obtained through a home visit to 23 mothers, with three guiding questions and were analyzed according to content analysis, thematic modality, and anchored in the principles of appreciative investigation. All mothers used the kangaroo bag at rooming-in care, however, at home 39.8% used three or more times per week. The BSES-SF score of all mothers was classified as high. 70.4% of the infants remained in exclusive breastfeeding (EBF). We identified the association between EBF and the use of the kangaroo bag at home, using at least one time after discharge (pvalue = 0.014). The mothers reported that the kangaroo position promoted improvement in mother-infant contact; a greater autonomy and maternal independence; the baby stays calmer and safer; a reduction of colic; improvement of sleep; approximation of the baby to family members; besides the need to disseminate the knowledge and adaptation of the mothers regarding the use of the kangaroo bag. The results suggest benefits of the kangaroo bag for breastfeeding for healthy term infants in the sample studied. Thus, the use of the kangaroo bag is a new form of maternal, contributing to the development of the baby and improving the maternal and family relationship.