Protocolo para a primeira hora de vida do recém-nascido prematuro

Abstract

Introduction: Premature birth has a significant relationship with infant morbidity and Introduction: Preterm infants are extremely vulnerable and, therefore, during the first hour of life, known as the golden hour, good practices must be performed to reduce neonatal morbidity and mortality. This project aims to meet an institutional demand for improvements in the care of premature infants, is aligned with the research line organization and evaluation of health care systems and was developed in partnership with the institution's staff. General Objective: To implement good practices in the golden hour of premature new-borns. Specific objectives: To design, implement and evaluate the implementation process of the multiprofessional care protocol for the first hour of life of the premature infant under 34 weeks of gestation. Methodology: Implementation research conducted in a Neonatal Unit of a university hospital in the state of Espírito Santo, Brazil. Participants were the multiprofessional team composed of physicians, nurses, nursing technicians and physiotherapists. The research was carried out in 6 stages and used the PDCA cycle. In the first stage, a situational diagnosis was made about care during the first hour of life of preterm infants under 34 weeks of age. In the 2nd stage a work group was formed with 12 professionals from the multidisciplinary team, for the planning and elaboration of the Protocol. In the 3rd stage, online training was carried out, followed by on-site orientation in small groups or individually. In the 4th stage, the Protocol was implemented over 4 months. In the 5th step, a survey of the barriers and facilitators of the implementation process was carried out, using a questionnaire based on the domains of the Consolidated Framework for Implementation Research. In the 6th step the protocol was monitored and reviewed. Bardin's content analysis was used to analyse the qualitative data, and descriptive analysis was used for the quantitative data. Results: Through a collective construction, the institution's first protocol for the care of PIs under 34 weeks of age during their first hour of life was finalized. The material was organized under four main pillars: cardiorespiratory stabilization, hypothermia prevention, hypoglycaemia prevention and infection prevention. After training and implementation, the protocol was evaluated by the professionals as a quality, low cost, and not very complex intervention necessary for the service. Training was considered the main facilitator for team adherence, especially from other sectors, and lack of knowledge was cited among the main barriers. Educational actions ranked first among suggestions for improvement. Products: Protocol, Flowchart, Bundle and educational boards for the first hour of life of premature new-borns under 34 weeks. Conclusion: The protocol and products are already implemented and generating positive impacts in the institution. This research has the potential to be applied regionally and nationally, as it systematically describes an innovative method with the necessary steps and resources to implement good practices. The research influenced changes in practice, but the maintenance of evidence-based care and recommended in the protocol, demands a permanent education of the neonatal team and other sectors involved, to assist adherence and better results.