Protocolo para prevenção da hipotermia em recém-nascido no período perioperatório

Abstract

Maintaining newborns’ (NB) thermal stability is a challenge for health professionals and requires accurate practice, as the performance of invasive and surgical procedures predisposes these patients to hypothermia. It is the most reported adverse event in neonatal units. The general objective was to build and validate a protocol for the prevention of hypothermia in NBs in the perioperative period; the specific objectives were: to identify the strategies that have been used to prevent hypothermia in NBs in the perioperative period; identify the factors that predispose to hypothermia in NBs in the perioperative period, from the perspective of health professionals who are part of the care team; describe care strategies for the prevention of hypothermia in NBs in the perioperative period; and perform content and structure validation of a protocol for the prevention of hypothermia in NBs in the perioperative period. The literature review addressed interventions to control hypothermia in NBs. The theoretical framework cuts across: thermoregulation of surgical NBs; patient safety when approaching surgical NBs; and environmental theory anchoring neutral thermal care to NBs. As a methodological framework, Convergent Care Research (PCA) was chosen, with the setting of a private maternity hospital in the capital of Bahia, developed in two phases: in the first, construction of the protocol with the triangulation of data from the theoretical framework, literature review, observation, interviews and a convergence group, with 21 health professionals as participants; in the second phase, content validation was carried out, guided by the Delphi method, comprising 12 judges. The interpretation of qualitative data was guided by the analysis model proposed by PCA, and in the analysis of quantitative data, the individual and general content validation index was used. The results show that, among the strategies identified in the scientific literature for the prevention of hypothermia, the following stand out: room temperature control; humidification establishment and cleaning quality of the air conditioning; use of an incubator or heated crib; use of thermal mattress; use of caps and blankets; heated fluids; temperature monitoring; coverage of abdominal organs. Factors that predispose to hypothermia are: immaturity of the thermoregulatory system; temperature of the surgical environment; intra-hospital transport; cold liquids; inadequacy in the use of technological resources; non-recognition of hypothermia as a health problem; and failure in continuing education. With data triangulation, a protocol was built and divided into three operative periods, pre, intra and post; each period consisted of five domains, 48 objectives with justification, and 85 care strategies. In validation, a general Content Validation Index of 0.94 was obtained. It can be concluded that the protocol proved to be a novel, judicious, valid and reliable instrument for use in the prevention of hypothermia in NBs in the perioperative period. It is believed that this technology makes it possible to reduce risks, injuries and damage to health, as well as to qualify assistance, based on patient safety policy and environmentalist strategies implemented by Nightingale. In this way, it will make it possible to improve the care provided to NBs’ health, as it can redirect assistance actions and contribute to the reduction of neonatal morbidity and mortality.