Manuseio mínimo, estratégia de cuidado ao desenvolvimento do prematuro: uma revisão integrativa

Abstract

Introduction: Prematurity is a condition in which birth occurs before 37 weeks, which deprives the baby of essential and organizing experiences that would happen in utero. Advances in perinatal care, which have increased over the years, expose the newborn to health interventions that are fundamental in supporting life, however, associated with undesirable effects and often harmful to the physiological state. Objective: To understand the results of the practice of minimal handling as developmental care for the neonatal public in other studies and clinical experiences, in order to understand its implications, outcomes and contributions to health. Methodology: This is a residency completion work on the presentation of an integrative review with a descriptive approach and qualitative character, obtained from the SciELO and PUBMED databases, composing the final version of 21 articles. Results and Discussion: Excessive handling and interventions lead the NB to stress, neural and behavioral disorganization, causing developmental deficits. Stress has been associated with potentially lasting effects on brain organization, neuroendocrine responses and length of hospital stay, and may predispose premature infants to sleep disturbances due to frequent interruptions or noise, affecting neurosensory processing, learning and neural plasticity. To minimize stressors, categories of interventions in the Neonatal Intensive Care Unit were created, called Developmental Care, through the control of external stimuli (vestibular, auditory, visual, tactile), grouping of activities and positioning or bandaging the premature baby from approximate mode to intrauterine. In addition, it is possible to assess the newborn's responses through the Individualized Developmental Care Program for Newborns (NIDCAP). For nursing, as an actor in care, it lacks handling in three axes: environmental management, relaxation techniques and therapeutic positioning. Strategies for reducing light and noise, decreasing the tone of conversations and device alarms, structured positioning with a preference for containment around the baby compared to standard positioning under a simple crib mattress, accompanied by training and professional evaluation, use of fabric over the incubators, monitoring of sleep by video-electroencephalography, neutral thermal environment, control of the relative humidity of the air in the incubators, creation of protocols, among them, the one of minimum management with “sleeping time” contributes positively to the reduction of manipulation and factors preterm stressors. Massage and strict protocols are practices that contribute little to care and increase the length of stay. Final considerations: Minimal manipulation as part of Developmental Care contributes positively to prematurity, promoting better prognosis for the neonate.