Asistencia a la lactancia materna para recién nacidos prematuros y de bajo peso al nacer: proyecto de implementación de mejores prácticas

Cunha, Camila Medeiros Cruvinel; Lima, Eliane de Fátima Almeida; Galvão, Dulce Maria Pereira Garcia; Brito, Ana Paula Almeida; Fonseca, Luciana Mara Monti; Primo, Cândida Caniçali

doi:10.1590/1980-220X-reeusp-2023-0380en

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EVIDENCE IMPLEMENTATION REPORT • Rev. esc. enferm. USP 58 • 2024 • https://doi.org/10.1590/1980-220X-reeusp-2023-0380en linkcopiar

Asistencia a la lactancia materna para recién nacidos prematuros y de bajo peso al nacer: proyecto de implementación de mejores prácticas

Autoría SCIMAGO INSTITUTIONS RANKINGS

Objetivo: Describir el proceso de implantación de las mejores prácticas para la asistencia a la lactancia materna en recién nacidos prematuros y de bajo peso al nacer.

Método: Investigación participativa que utilizó la metodología de implementación de evidencia del JBI, realizado en un hospital universitario del sudeste de Brasil, con la participación de un equipo multidisciplinario y gestores.

Etapas: Diagnóstico situacional, auditoría de base y retroalimentación, desarrollo de protocolo, capacitación, implementación y seguimiento.

Resultados: Se definieron siete criterios de auditoría. En la auditoría de base se cumplieron tres criterios y se enumeraron once barreras por resolver. Las estrategias implementadas fueron el desarrollo de protocolo y la capacitación multidisciplinaria e intersectorial. Luego de la capacitación se logró el cumplimiento de los siete criterios auditados en la primera auditoría de seguimiento y de cinco en la segunda, destacando el incremento en el cumplimiento luego de implementar las estrategias trazadas.

Conclusión: El proyecto logró el objetivo de mejorar la práctica basada en evidencia y permitió la implementación del primer protocolo de lactancia materna de la institución, pero destaca la necesidad de mantener la capacitación para la adherencia y la inculturación de nuevas prácticas.

DESCRIPTORES
Lactancia Materna; Recien Nacido Prematuro; Recién Nacido de Bajo Peso; Enfermería Neonatal; Ciencia de la Implementación.

Audit criteria	Sample	Method used to check compliance with best practices
1. Healthcare professionals are trained in best practices	Professionals 62 employees in the baseline and follow-up audit	Individual questionnaire with open and closed questions applied to employees in the sector Question: Have you taken any course on Breastfeeding or received practical training in breastfeeding since joining the team? ( ) No ( ) Yes Considered compliant if the employee answers “yes”
2. Health professionals advise mothers on breastfeeding	Professionals 62 employees in the baseline and follow-up audit	Individual questionnaire with open and closed questions applied to employees in the sector Question: Do you feel safe to provide guidance related to the practice of breastfeeding for preterm and low birth weight infants? ( ) No ( ) Yes ( ) Partially Considered compliant if the employee answers “yes”
3. PTI are placed on the breast when clinically stable	Professionals 62 employees in the baseline and follow-up audit	Individual questionnaire with open and closed questions applied to employees in the sector Question: Do you assist in the breastfeeding of preterm and low birth weight newborns as soon as they become stable? ( ) No ( ) Yes ( ) Partially Considered compliant if the employee answers “yes”
4. Mothers of PTI who wish to breastfeed are advised to begin lactation and expressing milk as soon as possible after birth, if breastfeeding is not possible.	Mothers 10 mothers in the baseline and follow-up audit	Individual interview with the baby’s mother admitted to the Special Care Unit Question: Did anyone on the team offer to help you initiate and maintain lactation? ( ) No ( ) Yes Considered compliant if the mother answers “yes”
5. Mothers of PTI/LBW infants are advised on the benefits of breastfeeding, the frequency of milk expression and techniques for effective expression of milk	Mothers 10 mothers in the baseline and follow-up audit	Individual interview with the baby’s mother admitted to the Special Care Unit Questions: Did anyone on the team show you how to express breast milk by hand and inform how often this should be done to maintain lactation? ( ) No ( ) Yes Considered compliant if the mother answers “yes” or answers a number equal to or greater than 8x/day
6. Mothers of clinically stable PTI/LBW are encouraged to adopt the kangaroo care	Mothers 10 mothers in the baseline and follow-up audit	Individual interview with the baby’s mother admitted to the Special Care Unit Question: Did you have the opportunity to hold your baby in direct contact? ( ) No ( ) Yes If not, was there any justification? Considered compliant if the mother answers “yes” or explains the “no” answer.
7. Alternative feeding methods with expressed breast milk or supplemental formula, including tube and cup, are used safely	Professionals 62 employees in the baseline and follow-up audit	Individual questionnaire with open and closed questions applied to employees in the sector Question: Check the techniques you think you have the ability to perform: ( ) Breastfeeding assistance ( ) Translactation ( ) Gavage ( ) Cup ( ) Finger feeding Considered compliant if the employee selects one or more options. The result will show compliance if the sum of the techniques performed by the professionals reaches a percentage greater than 80%.

Barriers found	Strategies	Resources	Results
1. Lack of breastfeeding protocol for PTI/LBW infants; reduced number of documents on the topic in the institution	Preparation of protocol, SOPs, flowcharts, and process mappings	Multidisciplinary working group; Breastfeeding Commission	Working group established; Protocol and documents prepared and approved
2. Low supply of breastfeeding training in the hospital	Training of health professionals who serve the binomial	Auditorium; Multimedia; Didactic resources	Trained team
3. Maternal absence and lack of routine for PTI/LBW mothers within the institution	Preparation of process mapping; Holding of support groups with mothers	Auditorium; Multimedia; Serial album; Informative folders; Multidisciplinary and intersectoral working group	Creation and compliance with the role of employees in the routine of the mother of PTI/LBW; Preparation of invitations for employees interested in participating in permanent support groups
4. Professionals feel insecure or partially safe when providing guidance for establishing and maintaining breastfeeding	Training of professionals who serve the binomial; Develop and implement flowcharts related to breastfeeding	Classroom; Multimedia; Didactic resources; Serial album	Mothers guided daily by professionals; Implementation of the Flowchart for Referring Mothers to the HMB
5. Divergence in professional conduct and guidance	Preparation of the protocol; Training of professionals	Multidisciplinary working group; Classroom; Multimedia; Didactic resources	Protocol drawn up and approved; Trained team and uniformly oriented mothers
6. Discontinuity in the work carried out between the sectors in which PTI/LBW breastfeeding occurs	Training of professionals; Development of an instrument for dialogue between sectors that serve the binomial	Binomial characterization instrument	Team in the training process; Intersectoral communication instrument in the validation phase in the hospital
7. Mothers have difficulty performing stimulation, milk expression, and resistance to placing PTNB/LBW infants in kangaroo position	Conversation circles and individual guidance	Ward/Unit/Auditorium; Serial album; Information folder; Cartoon; Didactic resources	All mothers perform lactation maintenance and kangaroo position (when the newborn is stable)
8. Difficulty establishing when to begin the tube-to-oral transition	Seminar: Breastfeeding preterm and low birth weight infants: transition from tube to oral diet	Classroom; Multimedia; Didactic resources	Greater dialogue between professionals, systematic and individualized reassessments, team training in best evidence-based practices
9. Lack of knowledge of the Ten Steps to Successful Breastfeeding as guidelines for breastfeeding in the institution	BFHI Trainings	Auditorium; Multimedia; Dynamics	Knowledge and reproduction of the Ten Steps to Successful Breastfeeding in the work routine
10. Lack of collection site at the institution	Conversations with the institution’s management board	Location and own team	Ensure a place that operates 24 hours a day to extract milk and maintain mothers’ milk production
11. Offering supplements, bottles and pacifiers for various reasons without documents supporting their use	Preparation of documents	Multidisciplinary working group; Breastfeeding Commission	Regulate the use of the complement and devices only in special situations; Documents in the preparation phase

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[TFN1] Note: PTI – Preterm infant; LBW – Low birth weight.