Protocolo multidisciplinar para hipotermia terapêutica em recém-nascidos

Abstract

Therapeutic hypothermia is a treatment technique used to prevent brain injuries in newborns with perinatal asphyxia. In Brazil, approximately 13 to 15 newborns die every day as a result of this damage. The use of this treatment as a technology in the country is still incipient, reflecting in low production on the subject, mainly related to nursing care. Based on this problem, this treatment technique presents itself as a challenging process, making it necessary to develop an instrument to standardize care actions in an effective, precise, assertive and congruent manner. This project aims to meet an institutional demand for improvements in the application of therapeutic hypothermia in premature infants, and is aligned with the line of research, organization and evaluation of health care systems. General objective: To systematize the care of newborns with perinatal asphyxia. Specific objectives: To develop a multidisciplinary protocol of therapeutic hypothermia for newborns with perinatal asphyxia; To train the multidisciplinary team in the care of newborns with therapeutic hypothermia; To assess the team's knowledge; To implement a multidisciplinary therapeutic hypothermia protocol. Methodology: Participatory research that used implementation science as a reference and the domains of the Consolidated Framework for Implementation Research. The study was conducted at a university hospital in southeastern Brazil, with the participation of the multidisciplinary team and managers. The study was organized into four stages, through the continuous improvement cycle (Plan, Do, Check, Act): situational diagnosis; protocol development; training; protocol implementation; identification of barriers and facilitators; protocol review. The first stage consisted of situational diagnosis and assessment of the neonatal team's knowledge about therapeutic hypothermia and hypoxic-ischemic encephalopathy, and the organization of the working group. The second stage consisted of protocol development and training workshops. The third stage assessed the team's knowledge after implementation. In the fourth stage, actions were organized to review the protocol and ensure sustainability of its implementation. Results: Protocols for therapeutic hypothermia for newborns with perinatal asphyxia were developed. Flowcharts, process maps, and infographics were used to guide the work of employees in this process. Multidisciplinary training was also provided. Final considerations: This project achieved the objective of improving evidence-based practice by the multidisciplinary team and enabled the development and implementation of the first multidisciplinary protocol for therapeutic hypothermia for newborns with perinatal asphyxia at the institution. This research has the potential to be applied at regional and national levels, as it systematically describes an innovative method with the steps and resources needed to implement the best scientific evidence. The research influenced changes in practice, but maintaining evidence-based care recommended in the protocol requires ongoing education of the neonatal team and other sectors involved to assist in adherence and better results.