CRIAÇÃO DE UM PROTOCOLO DE FISIOTERAPIA AQUÁTICA PARA PREMATUROS INTERNADOS NA UNIDADE DE TERAPIA INTENSIVA NEONATAL

• Autor(a) principal: Rambo, Daniela Cristina
• Data de Publicação: 2019
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional Universidade Franciscana
• Texto Completo: http://www.tede.universidadefranciscana.edu.br:8080/handle/UFN-BDTD/759
• topic: Recém-Nascido Prematuro. Hidroterapia. Unidade de Terapia Intensiva Neonatal. Dor.; Premature Newborn. Hydrotherapy. Neonatal Intensive Care Unit. Pain.; Recién nacido prematuro. Hidroterapia. Unidad de Terapia Intensiva Neonatal. Dolor; Saúde Materno Infantil

Introduction: Prematurity is defined as birth under 37 weeks of gestational age and is responsible for 70% of deaths in the first year of life. Brazil is one of the countries with higher rates of prematurity today. After birth, most premature infants are admitted to the Neonatal Intensive Care Unit, where they undergo several invasive procedures that cause pain. The adoption of measures of pain control is still a challenging task for health professionals. However, pain relief procedures are important as they can improve homeostasis and stability of the premature newborn. Aquatic physiotherapy is a resource for relieving the pain and discomfort of the newborn, as it has physiological, psychological and functional properties that favor the recovery process. Objectives: Create aquatic physical therapy protocol for premature newborns in the Neonatal Intensive Care Unit, from the analysis of scientific works on the application of aquatic therapy in infants and children, and an experimental study on the effects of aquatic physical therapy for premature hospitalized in a Neonatal Intensive Care Unit. Methodology: For the analysis of the scientific productions, an integrative literature review was carried out, through research in the PubMed, Scielo and VHL databases, including publications from 2007 to 2017. The experimental study was performed at a hospital in the Rio Grande do Sul’s Northwest Region, at the Neonatal Intensive Care Unit (NICU), with data collection from March to August 2018. The inclusion criteria were: premature newborns hospitalized in the collection period presenting stable clinical signs in ambient air and/or 0.5l/m nasal cateter; minimum 7 days stay in the NICU; oral and/or orogastric feeding. The newborns were evaluated in two days: on the first day the vital signs verification, pain and sleep evaluation were performed, an then we performed a blood puncture and a reassessment of the variables. On second day, the same variables were evaluated, the blood puncture were performed and then we did aquatic physiotherapy, with reevaluation of the variables at the end of the intervention. Results: 8 articles were selected for review. Four studies aimed to evaluate the effects of intervention on pain, stress and sleep in hospitalized newborns; two addressed the effects of aquatic physical therapy in children with spasticity and congenital malformation; two others assessed the application of aquatic physiotherapy for development. Most articles aim to assess the effects of aquatic physical therapy on pain, stress and sleep in newborns, except for two studies that evaluate the motor performance of the infants. Aquatic therapy has shown decreased heart and respiratory rate, improved sleep and reduced pain, increased oxygen saturation, as well as good results in the motor development of babies, improving muscle tone and quality of life. In experimental study it was observed that the heart rate and sleep showed significant differences between pre- and post-intervention. The variables: peripheral saturation, respiratory rate and pain showed significant differences between pre- and post-procedure of the first day, but not between pre- and post-intervention. However, it was possible to observe a difference between the evaluation after the first day and the second day. Conclusions: It is demonstrated the need to create practices that can minimize pain and its effects in premature infants, as well as foment non-pharmacological analgesia, such as aquatic physiotherapy, in order to provide comfort and favor the development of the newborn, in addition to raising awareness in neonatal and pediatric health professionals. Product and its applicability: The research process resulted in the creation of an aquatic physical therapy protocol for premature newborns in the NICU, and its content developed in four stages. Its applicability is directed to physiotherapists, with emphasis on analgesia conducts in hospitalized preterm infants and the product can be implanted in the routine of all NICUs in Brazil. The final version of the protocol is available in a printed manual.