O contato pele a pele e a interação mãe e filho pré-termo

Abstract

The increase in the prematurity rates is a public health problem and the survival and proper development of these children are promoted by adapting to the development environment, although, oftentimes, this condition can result in long-term damage, such as the interaction between mother and child. The skin to skin contact, or kangaroo mother care position, appears as a technical facilitator of this approach, even in adverse conditions such as prematurity and the environment of a neonatal intensive care unit. However, this practice is still controversial when evaluated in preterm low birth weight in the first days of life, once the literature shows the need for minimal handling of the newborn. The aim of this study were to evaluate the effect of skin to skin contact in the early interaction between mother and child with preterm infant low weight at 2 and 4 months of corrected gestational age, and to investigate, from the standpoint of mother, the aspects that facilitate and hinder the initial skin to skin contact with the child, mothers perception and feelings during this practice care. For this, we conducted two investigations in the intensive care unit of the Sofia Feldman Hospital. The first one, using qualitative approach with content thematic analysis of semi-structured interviews. The second one, a quantitative approach, comprised arandomized clinical trial, comparing the experimental group, exposed to the technique of skin to skin contact early (between 24 and 72 hours of life), to the control group, which held skin-to-skin late (after 72h) . The participant population underwent randomization, consisted of mothers and their premature babies with a birth weight between 1,000 to 1,800g, respiratory and thermodynamically stable, in use or not, of oxygen supplement. In the qualitative approach, the first 13 participants interviewed were sufficient to reach the saturation criterion. Three central categories were identified: 1. The significance of premature birth 2.The desire to feel the child and the need for authorization of health professionals; 3. The first skin to skin contact: strengthening the bond of motherhood. In the quantitative approach, 39 children and their mothers were evaluated using the still face task held at 2 and 4 months of corrected gestational age. The exposed group were responding early, at 2 months of corrected gestational age, with increased vocalization negative in phase 3 (p = 0.015). Furthermore, at 4 months of corrected gestational age, babies showed increased vocalization positive (p = 0.048), suggesting an attempt to actively trigger social responses of mothers to their requests. Whereas other variables could be associated with the significant results of the still face task, other analyzes were performed. Association was observed only with breastfeeding at fourth month of corrected gestational age (p = 0.032), showing up as an important indicator in the development of mother-child interaction. Our study confirms that the child's birth prematurely causes fear and insecurity in mothers, as well as a break in continuity in the process of formation of the mother-child bond. The early skin to skin contact was noted by the mothers as an action needed to be stimulated, to strengthen them and restore the mother-child interactions. It is possible thattheseresults may encouragechanges in practiceofneonatal intensive careand thushave the potentialto preventfutureemotional disorders. New studies, longitudinal and comparative with greater power are needed to assess the contribution of early skin to skin contact in socio-emotional development of children born prematurely.