Care transition of preterm infants: from maternity to home

Carvalho, Nalma Alexandra Rocha de; Santos, José Diego Marques; Sales, Isabela Maria Magalhães; Araújo, Agostinho Antônio Cruz; Sousa, Anderson da Silva; Morais, Fernanda Ferreira; Rocha, Silvana Santiago da

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Review Article • Acta Paul Enferm. 34 • 2021 • https://doi.org/10.37689/acta-ape/2021AR02503 copy

Care transition of preterm infants: from maternity to home

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To synthesize evidence about maternal care for preterm infants at home and develop a framework that guides the transition of care of preterm infants from maternity to home.

Methods:

This is an integrative literature review that followed methodological recommendations to answer the question: “What is the scientific evidence about maternal care for preterm infants at home?”. To select the articles, LILACS and BDENF were used via the VHL Portal, PubMed/MEDLINE, Scopus, CINAHL and Web of Science via the CAPES Journal Portal.

Results:

A visual synthesis of results was obtained through a framework. This synthesis facilitates knowledge translation and the applicability of nursing interventions during care transition from maternity to home, based on evidence. Analysis of these studies revealed three categories: Feelings of mothers during the care of preterm infants at home ; Caring for preterm infants at home ; Support network for caring for preterm infants at home .

Conclusion:

During the transition from maternity to home, families face a whirlwind of feelings that can be paradoxical. The joy due to hospital discharge can also emerge with anxiety and insecurity about the family’s’ new role. The framework on care transition of preterm infants from maternity to home presented in this study is relevant for facilitating the understanding of the health interventions’ finding and its applicability to promote a safe transition for preterm infants.

Keywords
Infant, premature; Patient discharge; Family; Professional-family relations

Acronym/ Definition	Study’s proposal	Keywords	NCD	Type
P Population/ Problem	Maternal care	“ Comportamento Materno ”	“ Comportamento Materno ”, “ Cuidado Materno ”, “ Cuidado da mãe ”	DeCS
P Population/ Problem	Maternal care	“Maternal Behavior”	“Maternal Behavior”, “Behavior, Maternal”, “Maternal Care Patterns”, “Care Pattern, Maternal”, “Maternal Care Pattern”, “Pattern, Maternal Care”	MeSH/ Títulos CINAHL
I Interest	Preterm infant	“ Recém-Nascido Prematuro ”	“ Recém-Nascido Prematuro ”, “ Bebê Prematuro ”, “ Neonato Prematuro ”, “ Neonato Pré-Termo ”, “ Prematuridade ”, “ Prematuro ”, “ Pré-Termo ”, “ Prematuros ”, “ Recém-Nascido Pré-Termo ”	DeCS
I Interest	Preterm infant	“Infant, Preterm”	“Infant, Preterm”, “Infants, Preterm”, “Preterm Infant”, “Preterm Infants”, “Infant, Preterm”, “Infants, Preterm”, “Preterm Infant”, “Neonatal Prematurity”	MeSH
Co Context	Home	“ Habitação ”	“ Habitação ”, “ Domicílio ”	DeCS
Co Context	Home	“Home nursing”	“Home nursing”	MeSH

n°	Authors/Year	Type of study	Country/ Language	Main results
01	2004⁽¹³13. Fonseca LM, Scochi CG, Rocha SM, Leite AM. Cartilha educativa para orientação materna sobre os cuidados com o bebê prematuro. Rev Lat Am Enfermagem. 2004;12(1):65–75.⁾	Participatory methodology	Brazil/ Portuguese	Through an educational booklet, guidance was given to mothers on simplified care for their preterm children.
02	2008⁽¹⁴14. Simioni AS, Geib LT. Percepção materna quanto ao apoio social recebido no cuidado às crianças prematuras no domicílio. Rev Bras Enferm. 2008;61(5):545–51.⁾	Descriptive	Brazil/ Portuguese	The mothers’ perception reveals predominantly intra-family support, mainly by the grandmother, responsible for building and managing the nest and social inclusion.
03	2009⁽¹⁵15. Morais AC, Quirino MD, Almeida MS. O cuidado da criança prematura no domicílio. Acta Paul Enferm. 2009 Feb;22(1):24–30.⁾	Descriptive	Brazil/ Portuguese	Mothers performed care according to their needs in view of their child’s growth and development.
04	2010⁽¹⁶16. Soares DC, Cecagno D, Milbrath VM, Oliveira NA, Cecagno S, Siqueira HC. Faces do cuidado ao prematuro extremo no domicílio. Ciênc Cuid Saúde. 2010;9(2):238-45.⁾	Exploratory-descriptive	Brazil/ Portuguese	Mothers appear as an important figure during their child’s hospitalization period. Family support was a difficulty encountered; however, it was based on past situations with other children.
05	2010⁽¹⁷17. Souza N, Araújo A, Costa I, Medeiros Junior A, Accioly Junior H. Vivência materna com o filho prematuro: refletindo sobre as dificuldades desse cuidado. REME Rev Min Enferm. 2010;14(1):159–5.⁾	Descriptive	Brazil/ Portuguese	Preterm children’s development can be hindered by the lack of family psycho-emotional support.
06	2010⁽¹⁸18. de Souza NL, Pinheiro-Fernandes AC, Clara-Costa IC, Cruz-Enders B, de Carvalho JB, da Silva ML. Domestic maternal experience with preterm newborn children. Rev Salud Publica (Bogota). 2010;12(3):356–67.⁾	Descriptive	Brazil/ Portuguese	Negative feelings interfere with family life, work and social life, as well as the health team’s lack of preparation on the guidelines for care transition from hospital to home.
07	2011⁽¹⁹19. Murdoch MR, Franck LS. Gaining confidence and perspective: a phenomenological study of mothers’ lived experiences caring for infants at home after neonatal unit discharge. J Adv Nurs. 2012;68(9):2008–20.⁾	Phenomenological	USA/ English	Hospital to home transition was marked by fear; however, as her son’s health improved, there was a gain in confidence by mothers.
08	2012⁽²⁰20. Botêlho SM, Boery RN, Vilela AB, Santos WS, Pinto LS, Ribeiro VM, et al. O cuidar materno diante do filho prematuro: um estudo das representações sociais. Rev Esc Enferm USP. 2012;46(4):929–34.⁾	Social Representations Theory	Brazil/ Portuguese	Family dynamics and the environment at home are configured as influencers in the recovery of preterm babies’ health, as well as their development.
09	2012⁽²¹21. Braga P, Almeida C, Leopoldino I. Percepção materna do aleitamento no contexto da prematuridade. Rev Enferm Centro-Oeste Min. 2012;2(2):151–8.⁾	Descriptive	Brazil/ Portuguese	Mothers’ insecurity was observed in caring for their children at home since there is a judgment by caregivers about the need for a health team to assist them.
10	2012⁽²²22. Couto FF, Praça NS. Recém-nascido prematuro: suporte materno domiciliar para o cuidado. Rev Bras Enferm. 2012;65(1):19–26.⁾	Descriptive	Brazil/ Portuguese	The importance of an educational booklet offered by service is highlighted, as well as the relevance of social support, especially family support, for caring for babies at home.
11	2012⁽²³23. Schmidt K, Higarashi I. Experiência materno no cuidado domiciliar ao recém-nascido prematuro. REME Rev Min Enferm. 2012;16(3):391–9.⁾	Descriptive	Brazil/ Portuguese	The need to apply a flowchart to inform the formal support networks that will monitor preterm infants after discharge stood out.
12	2013⁽²⁴24. Frota MA, da Silva PF, de Moraes SR, Martins EM, Chaves EM, da Silva CA. Alta hospitalar e o cuidado do recém-nascido prematuro no domicílio: vivência materna. Esc Anna Nery. 2013;17(2):277–83.⁾	Descriptive	Brazil/ Portuguese	It was observed that some mothers did not receive guidance on home care from the team that provided assistance to their children.
13	2014⁽²⁵25. Nabiwemba EL, Atuyambe L, Criel B, Kolsteren P, Orach CG. Recognition and home care of low birth weight neonates: a qualitative study of knowledge, beliefs and practices of mothers in Iganga-Mayuge Health and Demographic Surveillance Site, Uganda. BMC Public Health. 2014;14(1):546.⁾	Descriptive	Iran/ English	At the time of hospital discharge, parents had doubts about home care to be performed on their children.
14	2014⁽²⁶26. Sassá AH, Gaíva MA, Higarashi IH, Marcon SS. Nursing actions in homecare to extremely low birth weight infant. Acta Paul Enferm. 2014;27(5):492–8.⁾	Convergent-assistance research	Brazil/ Portuguese	Nurses provided guidance aimed at parents’ doubts and insecurities, mostly related to the babies’ weight.
15	2016⁽²⁷27. Boykova M. Life after discharge: what parents of preterm infants say about their transition to home. Newborn Infant Nurs Rev. 2016;16(2):58–65.⁾	Descriptive	USA/ English	Interference was observed in family dynamics, marked by fatigue, social isolation and concern regarding caring for babies.
16	2017⁽²⁸28. Namnabati M, Hemati Z, Taleghani F, Sadeghnia A. Home-based care needs of preterm infants discharged early from the neonatal intensive care unit: A descriptive qualitative study. Iran J Neonatol. 2017;8(4):74–82.⁾	Descriptive	Uganda/ English	Mothers who gave birth at the hospital had a better understanding of appropriate home care practices for low birth weight babies, compared to mothers who had children at home or at a lower level health facility.
17	2017⁽²⁹29. Veronez M, Borghesan NA, Corrêa DA, Higarashi IH. Vivência de mães de bebês prematuros do nascimento a alta: notas de diários de campo. Rev Gaúcha Enferm. 2017;38(2):e60911.⁾	Descriptive	Brazil/ Portuguese	The importance of properly assisting mothers in this initial and critical phase of hospitalized preterm infants is emphasized, emphasizing welcoming and permanent guidance for care as strategies that promote maternal autonomy and home adaptation.
18	2018⁽³⁰30. Petty J, Whiting L, Green J, Fowler C. Parents’ views on preparation to care for extremely premature infants at home. Nurs Child Young People. 201;30(4):22–7.⁾	Narrative investigation	England/ English	The parents’ experience of being discharged at home with a preterm baby can be emotionally challenging and requires a series of support mechanisms to cope with the transition period, such as the participation of health professionals.
19	2018⁽³¹31. Sales IM, Santos JD, da Rocha SS, Gouveia MT, de Carvalho NA. Contributions of the nursing team in the second stage of the Kangaroo-Mother Care Method: implications for hospital discharge of the newborn. Esc Anna Nery. 2018 Dec;22(4).⁾	Convergent-assistance research	Brazil/ Portuguese	A folder was elaborated that contemplated themes related to the Kangaroo Position, skincare and hygiene of infants, and respiratory changes as a warning sign, so that care could continue at home.

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[1] Corresponding author Nalma Alexandra Rocha de Carvalho, E-mail: enf.nalma.carvalho@hotmail.com