TRANSICIÓN ALIMENTARIA EN BEBÉS PREMATUROS: VALIDEZ DE UN BUNDLE BASADO EN LA TEORÍA DE LA LACTANCIA MATERNA INTERACTIVA

Tavares, Ana Raquel Bezerra Saraiva; Silva, Vanusa Maria Gomes Napoleão; Domingos, João Emanuel Pereira; Saraiva, Emanuela Machado Silva; Primo, Cândida Caniçali; Carvalho, Rhanna Emanuela Fontenele Lima de; Lúcio, Ingrid Martins Leite; Chaves, Edna Maria Camelo

doi:10.1590/1980-265X-TCE-2023-0274en

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Original Article • Texto contexto - enferm. 33 • 2024 • https://doi.org/10.1590/1980-265X-TCE-2023-0274en linkcopiar

TRANSICIÓN ALIMENTARIA EN BEBÉS PREMATUROS: VALIDEZ DE UN BUNDLE BASADO EN LA TEORÍA DE LA LACTANCIA MATERNA INTERACTIVA

Autoría SCIMAGO INSTITUTIONS RANKINGS

Objetivo: construir y validar el contenido de un bundle de transición dietética para bebés prematuros admitidos en la Unidad de Cuidados Intermedios Canguro basado en la Teoría de la Lactancia Materna Interactiva.

Métodos: se trata de una investigación de métodos múltiples realizada en cinco steps: revisión sistemática; diagnóstico situacional; entrevista con enfermeras de la Unidad Canguro; etapa metodológica - (construcción de bundle con aplicación de la Teoría de Lactancia Interactiva, pretest); y validez de contenido con jueces expertos y enfermeras clínicas. La etapa metodológica se realizó de enero a julio de 2022 con enfermeras de la Unidad Canguro de una maternidad pública de Fortaleza-CE. Se invitó a los expertos por correo electrónico utilizando el método de bola de nieve. La validación se produjo mediante el índice de validez de contenido >0,80.

Resultados: el bundle se construyó utilizando 13 ítems, distribuidos y organizados en grupos de edad corregidos: edad corregida de ≤32 weeks; entre 32 a 34 semanas y ≥ 34 semanas. En la etapa de validez, los jueces, tres expertos y siete enfermeras clínicas, juzgaron adecuado el bundle, presentando un Índice de Validez de Contenido de 1,0.

Conclusión: dada la falta de estandarización para la transición alimentaria en la práctica clínica, existe dificultad en reconocer el momento ideal para la transición de la alimentación por sonda orogástrica al pecho materno. El bundle de transición alimentaria, anclado en la Teoría Interactiva de la Lactancia Materna, permite a las enfermeras evaluar el binomio madre-hijo, sus particularidades, el tiempo de ambos, el rol materno, involucrando los sistemas organizacionales de protección, promoción y apoyo a la lactancia materna. Registro Brasileño de Ensayos Clínicos (REBEC) con el número UTN: U1111-1285-3181.

DESCRIPTORES:
Recién Nacido Prematuro; Método Madre-Canguro; Neonatología; Teoría de la Enfermería; Amamantamiento

Corrected age at admission/Interactive Theory of Breastfeeding application	Using OGT	Observe	Unit’s routine conducts
≤ 32 weeks Women’s and children’s biological conditions; Women’s and children’s perception of breastfeeding; Time for breastfeeding; Mothers’ role; Organizational systems to protect, promote and support breastfeeding; Women’s decision-making.	1. Observe premature newborns’ behavior¹¹; 2. Use LATCH Scale before, during and after feeding¹⁴^-¹⁵; 3. Use the smell of breast milk soaked in gauze during gavage¹⁶; 4. Stimulate non-nutritive sucking¹²^-¹³; 5. Use a combination of the two (non-nutritive suction and gavage)¹²^-¹³;	Premature newborns’ behavior towards standardized feeding¹¹; 1. Crying 2. Silent alert 3. Hand-to-mouth activity 4. Suck fingers, fist or finger probe 5. Rooting reflex (chest reaching) (28 to 30 weeks) 6. Inability to settle after changing position, changing diaper, or pacifier Signs of satiety 1. Turns head away 2. Hold hands still 3. Falls asleep 4. Has no interest in restarting feeding after burping/interruption in sucking Adverse events 1. Apnea 2. Bradycardia 3. Oxygen desaturation 4. Combination of these events Observe the wakefulness of newborns and their behavioral state at the time of feeding¹²; Observe episodes of vomiting, refusal to eat, abdominal distension and changes in stool¹⁸. *Observe food intolerance¹¹^,¹⁹.	1. Guide the extraction of breast milk (manual or electric pump) according to routine¹⁸^-¹⁹ and routine conservation/storage; 2. Check premature newborns’ weight according to the Unit’s routine.
32 to 34 weeks Women’s and children’s biological conditions; Women’s and children’s perception of breastfeeding; Time for breastfeeding; Mothers’ role; Organizational systems to protect, promote and support breastfeeding; Women’s decision-making.	1. Use the smell of breast milk soaked in gauze during gavage¹⁶; 2. Stimulate non-nutritive sucking¹²^-¹³; 3. Oral stimulation (OS) (stroking the cheeks, lips, gums and tongue for 10 minutes once a day)³^,¹²^-¹³; 4. Use a combination of the two (non-nutritive suction and oral stimulation)¹²^-¹³.	Premature newborns’ behavior towards standardized feeding¹¹; 1. Crying 2. Silent alert 3. Hand-to-mouth activity 4. Suck fingers, fist or finger probe 5. Rooting reflex (chest reaching) (28 to 30 weeks) 6. Inability to settle after changing position, changing diaper, or pacifier Signs of saciety 1. Turns head away 2. Hold hands still 3. Falls asleep 4. Has no interest in restarting feeding after burping/interruption in sucking Adverse events 1. Apnea 2. Bradycardia 3. Oxygen desaturation 4. Combination of these events Observe the wakefulness of newborns and their behavioral state at the time of feeding¹²; Observe episodes of vomiting, refusal to eat, abdominal distension and changes in stool¹⁸. *Observe food intolerance¹²^-²⁰.	1. Observe premature newborns’ behavior¹¹; 2. Use LATCH Scale before, during and after feeding¹⁴^-¹⁵; 3. Guide the extraction of breast milk (manual or electric pump) according to routine¹⁸^-¹⁹ and routine conservation/storage; 4. Check premature newborns’ weight according to the Unit’s routine.
≥34 weeks Women’s and children’s biological conditions; Women’s and children’s perception of breastfeeding; Time for breastfeeding; Mothers’ role; Organizational systems to protect, promote and support breastfeeding; Women’s decision-making.	1. Use the smell of breast milk soaked in gauze during gavage¹⁶; 2. Oral stimulation (OS) (stroking the cheeks, lips, gums and tongue for 10 minutes once a day)³^,¹²^-¹³; 3. Use a combination of the two (non-nutritive suction and oral stimuation)¹²^-¹³; 4. Use cup¹⁷^-¹⁹, spoon²⁰ or finger probe⁴^,²¹; 5. Start translactation³^,²²^-²⁴.	Premature newborns’ behavior towards standardized feeding¹¹; 1. Crying 2. Silent alert 3. Hand-to-mouth activity 4. Suck fingers, fist or finger probe 5. Rooting reflex (chest reaching) (28 to 30 weeks) 6. Inability to settle after changing position, changing diaper, or pacifier Signs of saciety 1. Turns head away 2. Hold hands still 3. Falls asleep 4. Has no interest in restarting feeding after burping/interruption in sucking Adverse events 1. Apnea 2. Bradycardia 3. Oxygen desaturation 4. Combination of these events Observe the wakefulness of newborns and their behavioral state at the time of feeding¹²; Observe episodes of vomiting, refusal to eat, abdominal distension and changes in stool¹⁸. *Observe food intolerance¹²^,²⁰.	1. Observe premature newborns’ behavior¹⁰; 2. Use LATCH Scale before, during and after feeding¹⁴^-¹⁵; 3. Guide the extraction of breast milk (manual or electric pump) according to routine¹⁸^-¹⁹ and routine conservation/storage; 4. Check premature newborns’ weight according to the Unit’s routine.

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Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[TFN1] *LATCH scale: assesses nursing mothers’ and their newborns’ performance during breastfeeding, such as latching on to the breast, audible swallowing, type of nipple, comfort and absence of pain and whether the mother needs help to maintain the position¹⁴^-¹⁵; ^†Oral stimulation (OS).