Translating Neonatal Resuscitation Guidelines Into Practice in Brazil

Area of Science:

• Neonatology
• Pediatric Resuscitation
• Clinical Practice Guidelines

Background:

• The Brazilian Neonatal Resuscitation Program adapts international guidelines for local practice.
• Analysis of guideline adherence for preterm newborns in a middle-income country is crucial.

Purpose of the Study:

• To evaluate the implementation of Brazilian guidelines for preterm infant resuscitation.
• To assess practice changes in 20 research centers from 2014 to 2020.

Main Methods:

• Prospective data from 8514 infants (23-31 weeks' gestation) were analyzed.
• Frequencies of thermal care, positive pressure ventilation (PPV) methods, oxygen use, intubation, chest compressions, and medications were assessed.
• Logistic regression analyzed the probability of receiving guideline-consistent care.

Main Results:

• Care consistent with guidelines increased for thermal care and T-piece PPV in both preterm groups (23-27 and 28-31 weeks' gestation).
• The probability of using fraction of inspired oxygen (Fio2) 1.00 during PPV decreased significantly in both gestational age groups.
• Odds ratios demonstrated significant improvements in adherence to recommended practices.

Conclusions:

• Brazilian clinical practice for preterm infant resuscitation improved between 2014 and 2020.
• Adoption of thermal care, T-piece PPV, and reduced Fio2 1.00 reflects successful guideline implementation.
• These findings highlight the translation of evidence-based recommendations into neonatal care settings.