Estratégias de manuseio mínimo para melhoria do cuidado intensivo ao recém-nascido prematuro: Uma revisão integrativa

Abstract

Minimal handling is defined as the standardization of procedures performed by the multidisciplinary team of the neonatal intensive care unit, ensuring the reduction of manipulations of premature newborns. The target population of minimal handling are preterm infants with birth weight less than or equal to 1500 grams, that is, those classified according to gestational age less than 37 weeks and very low weight or extremely low weight. This needs specialized care, in a place such as the neonatal intensive care unit, an intensive care environment for newborns who need specific care. The aim of this study is to analyze productions about minimal handling strategies in intensive care for premature newborns. This is an integrative review work, which was built in six stages, using the PICO strategy (P - Population/patient/problem; I - Intervention; C - Comparison; O - Outcome) to formulate the question of research “What are the minimal handling strategies used to improve the quality of intensive care for premature newborns?”, had eleven articles selected during the months of July to October 2022, from a sample of articles from the ScienceDirect, Medical Literature Analysis and Retrieval System Online (Medline) and Web of Science databases, using the descriptors: Infant, Premature and Patient Handling (in Portuguese) and the respective alternative terms, data were categorized using a summary table containing study identification (authors and year of publication), methodology (type of study and indexed database), research (population and main results) and level of evidence, allowing the critical analysis of the included studies, followed by the interpretation of the collected data and ending with the presentation of the review. Most of the articles found were produced in the United States of America, classified at level I of evidence, published in 2022 and mainly described minimal handling strategies for the following objectives: neuroprotection, monitoring and positioning or organization of the premature newborn. The strategies described involved grouping care, interval handling, use of heaters when performing procedures, use of high humidity, prone position, nesting, head in midline, elevation of the head, noise and light reduction. These and the other listed strategies resulted in a reduction in pain, severe intracranial hemorrhages, length of stay, days on invasive mechanical ventilation and better quality of life after discharge. Despite the difficulty encountered due to the lack of specific descriptors and the low number of publications on the subject directly, eleven articles were found and several strategies were evidenced, such as: grouping of care, specific positions, inclusion of parents and changes in ambience, it was also possible observe the simplicity with which most strategies can be implemented and executed, and that they lead to a reduction of days in invasive mechanical ventilation and in intensive care, for the implementation of these strategies we recommend further studies and development of a protocol that includes them.