Translating Neonatal Resuscitation Guidelines Into Practice in Brazil.

BACKGROUND AND OBJECTIVES: The Brazilian Neonatal Resuscitation Program releases guidelines based on local interpretation of international consensus on science and treatment recommendations. We aimed to analyze whether guidelines for preterm newborns were applied to practice in the 20 Brazilian Network on Neonatal Research centers of this middle-income country. METHODS: Prospectively collected data from 2014 to 2020 were analyzed for 8514 infants born at 230/7 to 316/7 weeks' gestation. The frequency of procedures was evaluated by gestational age (GA) category, including use of a thermal care bundle, positive pressure ventilation (PPV), PPV with a T-piece resuscitator, maximum fraction of inspired oxygen (Fio2) concentration during PPV, tracheal intubation, chest compressions and medications, and use of continuous positive airway pressure in the delivery room. Logistic regression, adjusted by center and year, was used to estimate the probability of receiving recommended treatment. RESULTS: For 3644 infants 23 to 27 weeks' GA and 4870 infants 28 to 31 weeks' GA, respectively, the probability of receiving care consistent with guidelines per year increased, including thermal care (odds ratio [OR], 1.52 [95% confidence interval (CI) 1.44-1.61] and 1.45 [1.38-1.52]) and PPV with a T-piece (OR, 1.45 [95% CI 1.37-1.55] and 1.41 [1.32-1.51]). The probability of receiving PPV with Fio2 1.00 decreased equally in both GA groups (OR, 0.89; 95% CI, 0.86-0.93). CONCLUSIONS: Between 2014 and 2020, the resuscitation guidelines for newborns <32 weeks' GA on thermal care, PPV with a T-piece resuscitator, and decreased use of Fio2 1.00 were translated into clinical practice.

Brazilian adaptation and validation of the Empowerment of Parents in the Intensive Care-Neonatology (EMPATHIC-N) questionnaire / Adaptação brasileira e validação do questionário Empowerment of Parents in the Intensive Care-Neonatology (EMPATHIC-N)

Abstract Objectives: Considering the lack of questionnaires that propose to evaluate parental satisfaction with the Neonatal Intensive Care Unit (NICU) in Brazil, this study aimed to carry out the translation of the EMPATHIC-N questionnaire into Brazilian Portuguese, the cross-cultural adaptation and validation of its contents. Method: The translation and cultural adaptation of the questionnaire was carried out according to the protocol established by the Translation and Cross-Cultural Adaptation Group of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) in 2005. The validation of the content was carried out by a panel of experts, who evaluated each item from "very irrelevant" to "very relevant". Items with a mean Likert scale value <3.5 were excluded. Cronbach's alpha of the domains was calculated. Results: The questionnaire was submitted to two pilot tests with mothers of newborns admitted to the NICU of the study, after which some terms were modified to achieve global understanding. Cronbach's alpha remained above 0.7 in all items. Conclusion: The tool resulting from the translation, cultural adaptation, and validation of the EMPATHIC-N questionnaire showed to be adequate to assess satisfaction of parents of newborns admitted to the NICU in Brazil.

Resumo Objetivos: Considerando a ausência de questionários que se proponham a avaliar satisfação de pais em Unidade de Cuidados Intensivos Neonatal (UCIN) no Brasil, o presente estudo teve o objetivo de fazer a tradução do questionário Empowerment of Parents in the Intensive Care- Neonatology (Empathic-N) para o português brasileiro, adaptação transcultural e validação de seu conteúdo. Método: Foi feita tradução e adaptação transcultural do questionário, segundo protocolo estabelecido pelo Grupo da Tradução e Adaptação Transcultural da Sociedade Internacional para Pesquisas Farmacoeconômicas (Ispor) em 2005. A validação do conteúdo foi feita por um comitê de especialistas, que avaliaram cada item de “muito irrelevante” a “muito relevante”. Foram excluídos os itens com média da Escala Likert menor do que 3,5. Foi calculado alfa de Cronbach dos domínios. Resultados: Na tradução foi invertida a ordem de algumas frases de acordo com a sintaxe do português brasileiro e alterado o tempo verbal para terceira pessoa do pretérito imperfeito. A maior parte das afirmativas manteve o sentido com a retradução, as diferenças foram atribuídas ao uso de sinônimos pelos dois tradutores. Foi submetido a dois testes-piloto com mães de recém-nascidos internados na UCIN do estudo, modificaram-se alguns termos até se atingir compreensão global. O alfa de Cronbach permaneceu acima de 0,7 em todos os itens. Conclusão: O instrumento resultante da tradução, adaptação transcultural e validação do Empathic-N mostra-se adequado para avaliar satisfação dos pais de recém-nascidos internados em UCIN no Brasil.

Brazilian adaptation and validation of the Empowerment of Parents in the Intensive Care-Neonatology (EMPATHIC-N) questionnaire.

OBJECTIVES: Considering the lack of questionnaires that propose to evaluate parental satisfaction with the Neonatal Intensive Care Unit (NICU) in Brazil, this study aimed to carry out the translation of the EMPATHIC-N questionnaire into Brazilian Portuguese, the cross-cultural adaptation and validation of its contents. METHOD: The translation and cultural adaptation of the questionnaire was carried out according to the protocol established by the Translation and Cross-Cultural Adaptation Group of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) in 2005. The validation of the content was carried out by a panel of experts, who evaluated each item from "very irrelevant" to "very relevant". Items with a mean Likert scale value <3.5 were excluded. Cronbach's alpha of the domains was calculated. RESULTS: The questionnaire was submitted to two pilot tests with mothers of newborns admitted to the NICU of the study, after which some terms were modified to achieve global understanding. Cronbach's alpha remained above 0.7 in all items. CONCLUSION: The tool resulting from the translation, cultural adaptation, and validation of the EMPATHIC-N questionnaire showed to be adequate to assess satisfaction of parents of newborns admitted to the NICU in Brazil.