A complexidade do cuidado para o controle térmico do recém-nascido prematuro

Aimone Carneiro de Oliveira; Climene Laura de Camargo; Maria Carolina Ortiz Whitaker; Lucas Amaral Martins; Laiane Farias Santos; Emanuela de Almeida Oliveira; Larissa de Carvalho Silveira

doi:10.15253/2175-6783.20232485215

Authors

Aimone Carneiro de Oliveira Universidade Federal da Bahia https://orcid.org/0000-0002-8926-0778
Climene Laura de Camargo Universidade Federal da Bahia https://orcid.org/0000-0002-4880-3916
Maria Carolina Ortiz Whitaker Universidade Federal da Bahia https://orcid.org/0000-0003-0253-3831
Lucas Amaral Martins Universidade Federal do Recôncavo da Bahia https://orcid.org/0000-0003-1497-6576
Laiane Farias Santos Universidade Federal da Bahia https://orcid.org/0000-0002-0689-766X
Emanuela de Almeida Oliveira Universidade Federal da Bahia https://orcid.org/0000-0001-5921-3826
Larissa de Carvalho Silveira Universidade Federal da Bahia https://orcid.org/0000-0002-7082-7279

DOI:

https://doi.org/10.15253/2175-6783.20232485215

Keywords:

Infant, Premature; Body Temperature Regulation; Neonatal Nursing; Neonatology; Nonlinear Dynamics.

Abstract

Objective: to understand the perception of nurses about the complexity of care for thermal control of the premature infant. Methods: qualitative study conducted with 13 nurses from a public maternity hospital, through virtual interviews, with semi-structured script, submitted to Content Analysis and interpreted by the theoretical support of the complex adaptive care system model. Results: the factors present in nurses' care in thermal control of premature infants are related to the complexity permeated by environmental factors such as the temperature of the unit and distribution of air conditioning currents; institutional factors such as the availability and correct use of technologies, and those related to the professional, such as performance, training, and qualification. Conclusion: adjusting the temperature of the unit; better distribution of the air conditioning currents;availability of technologies; a policy of continued education in the service; training in handling the equipment; supervision and requirement for preventive and corrective maintenance of the devices can influence the reduction of thermal instability events in premature infants. Contributions to practice: stimulating professional qualification, planning of intersectoral actions for technological structuring and preventive maintenance of the units, systematization of assistance to premature infants in thermal control minimizing risk of neonatal morbimortality due to thermal instability.

References

Soares T, Pedroza GA, Breigeiron MK, Cunha MLC. Prevalence of hypothermia in the first hour of life of premature infants weighing ≤1500g. Rev Gaúcha Enferm. 2020;41(spe):e20190094. doi: https://doi.org/10.1590/1983-1447.2020.20190094

Trevisanuto D, Testoni D, Almeida MFB. Maintaining normothermia: why and how? Semin Fetal Neonatal Med. 2018;23(5):333-9. doi: https://doi.org/10.1016/j.siny.2018.03.009

Martins LA, Silveira SPX, Avila IMFT, Moraes JAS, Santos DSS, Whitaker MCO, et al. Thermoregulation protocol implementation for newborns in surgical procedures: relato de experiência. Rev Gaúcha Enferm. 2019;40(spe):e20180218. doi: https://doi.org/10.1590/1983-1447.2019.20180218

Ng’eny JC, Velaphi S. Hypothermia among neonates admitted to the neonatal unit at a tertiary hospital in South Africa. J Perinatol. 2020;40(3):433-8. doi: https://doi.org/10.1038/s41372-019-0539-y

Wang L, Liu ZJ, Liu FM, Yu YH, Bi SY, Li B, et al. Implementation of a temperature bundle improves admission hypothermia in very-low-birth-weight infants in China: a multicentre study. BMJ Open Qual. 2022;11(2):e001407. doi: http://dx.doi.org/10.1136/bmjoq-2021-001407

Tay VY, Bolisetty S, Bajuk B, Lui K, Smyth J. The new south wales and the Australian capital territory neonatal intensive care units’ data collection. Admission temperature and hospital outcomes in extremely preterm infants. J Paediatr Child Health. 2019;55(2):216-23. doi: https://doi.org/10.1111/jpc.14187

Kato S, Iwata O, Iwata S, Yamada T, Tsuda K, Tanaka T, et al. Admission temperature of very low birth weight infants and outcomes at three years old. Sci Rep. 2022;12(1):11912. doi: https://doi.org/10.1038/s41598-022-15979-w

Caldas JPS, Ferri WAG, Marba STM, Aragon DC, Guinsburg R, Almeida MFB, et al. Admission hypothermia neonatal morbidity and mortality: evaluation of a multicenter cohort of very low birth weight preterm infants according to relative performance of the center. Eur J Pediatr. 2019; 178(7):1023-32. doi: https://doi.org/10.1007/s00431-019-03386-9

Suchy C, Morton C, Ramos RR, Ehrgott A, Quental MM, Burridge A, et al. Does changing newborn bath procedure alter new born temperature sand exclusive breastfeeding? Neonatal Netw. 2018;37(1)4-10. doi: https://dx.doi.org/10.1891/0730-0832.37.1.4

McCall EM, Alderdice F, Halliday HL, Vohra S, Johnston L. Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants. Cochrane Database Sys Rev. 2018;2:eCD004210. doi:http://doi.org/10.1002/14651858.CD004210.pub5

Chen KY, Wei TY, Huang HY, Hsu YH. Project to decrease the incidence of neonatal hypothermia in the newborn center. Hu Li Za Zhi. 2019;66(4):71-88. doi: https://doi.org/10.6224/JN.201908_66(4).09

Chaffee MW, McNeill MM. A model of nursing as a complex adaptive system. Nurs Outlook. 2007;55(5):232-41.doi:http://doi.org/10.1016/j.outlook.2007.04.003

Cabral MFCT, Viana AL, Gontijo DT. Use of the complexity paradigm in the field of health: scope review Esc Anna Nery. 2020;24:e20190235. doi: http://doi.org/10.1590/2177-9465-EAN-2019-0235

Abiramalatha T, Ramaswamy VV, Bandyopadhyay T, Pullattayil AK, Thanigainathan S, Trevisanuto D, et al. Delivery room interventions for hypothermia in preterm neonates: a systematic review and network meta-analysis. JAMA Pediatr. 2021; 175(9):e21077. doi: https://doi.org/10.1001/jamapediatrics.2021.0775

Younger SJ. Leveraging advanced practice nursing in complex health care systems. Nurs Adm Q. 2020;44(2):127-35. doi: http://doi.org/10.1097/NAQ.0000000000000408

Aquino WKM, Lopes MVO, Silva VM, Fróes NBM, Menezes AP, Almeida AAP, et al. Accuracy of the defining characteristics in nursing diagnoses of Hyperthermia in newborns. Rev Bras Enferm. 2018;71(2):357-62. doi: https://doi.org/10.1590/0034-7167-2017-0037

Moser A, Korstjens I. Series: Practical guidance to qualitative research. Part 3: sampling, data collection and analysis. Eur J Gen Pract. 2018;24(1):9-18. doi: https://doi.org/10.1080/13814788.2017.1375091

Bardin L. Análise de conteúdo. Lisboa: Edições 70; 2016.

Nguyen L, Mitsakakis N, Sucha E, Lemyre B, Lawrence SL. Factors associated with hypothermia within the first 6 hours of life in infants born at ≥34º weeks’ gestation: a multivariable analysis. BMC Pediatr. 2022;22:447. doi: https://doi.org/10.1186/s12887-022-03512-x

Dubos C, Delanaud S, Brenac W, Chahin YF, Carpentier M, Tourneux P. The newborn infant’s thermal environment in the delivery room when skin-to-skin care has to be interrupted. J Matern Fetal Neonatal Med. 2020; 35(19):3707-13. doi: http://doi.org/10.1080/14767058.2020.1838479

Pisoni GB, Gaulis C, Suter S, Rochat MA, Makohliso S, Roth-Kleiner M, et al. Ending neonatal deaths from hypothermia in Sub-Saharan Africa: call for essential technologies tailored to the context. Front Public Health. 2022;7;10:851739. doi: https://doi.org/10.3389/fpubh.2022.851739

Thapa R, Yih A, Chauhan A, Poudel S, Singh S, Shrestha S, et al. Effect of deploying biomedical equipment technician on the functionality of medical equipment in the government hospitals of rural Nepal. Hum Resour Health. 2022;20(1):21. doi: http://doi.org/10.1186/s12960-022-00719-y

Silva IR, Silva TP, Ferreira MJC, José SAP, Leite JL. The work context and the intervenient factors for the consumption of research by clinical nurses. Cogitare Enferm. 2018;23:e53447, doi: http://dx.doi.org/10.5380/ce.v23i2.53447

Jani P, Mishra U, Buchmayer J, Walker K, Gözen D, Maheshwari R, et al. Thermoregulation and golden hour practices in extremely preterm infants: an international survey. Pediatr Res. 2022;93(6):1701-9. doi: https://dx.doi.org/10.1038/s41390-022-02297-0

Lima ACMM, Prada LCM, Marinho AP, Lima KF, Macedo SKO, Uehara CS, et al. Risk factors and morbimortality associated with hypothermia upon admission to the neonatal intensive care unit. Resid Pediatr. 2022;12(3):1-6. doi: https://doi.org/10.25060/residpediatr-2022.v12n3-493

Martins LA, Santos IJ, Moura JS, Santos DV, Morais AC, Camargo CL. Repercussions of hypothermia on the health of surgical newborns: nurses perspective. Rev Min Enferm. 2022;26:e1467. doi: https://doi.org/10.35699/2316-9389.2022.40561

Lima LS, Reis EAF, Silva EM, Moura JPG. Nursing care in the thermo-regulation of preterm newborns: an integrative review. Cogitare Enferm. 2020;25:e70889. doi: https://doi.org/10.5380/ce.v25i0.70889

Pype P, Mertens F, Helewaut F, Krystallidou D. Healthcare teams as complex adaptive systems: understanding team behaviour through team members perception of interpersonal interaction. BMC Health Serv Res. 2018;18(1)570. doi: https://doi.org/10.1186/s12913-018-3392-3

Dantas MA, Moraes RCM. Knowledge and attitudes of the nursing team of a maternity hospital in the promotion of neonatal thermoregulation. Res Soc Dev. 2021;10(10):e593101019110. doi: https://doi.org/10.33448/rsd-v10i10.19110