TESTE DO PEZINHO: CONHECIMENTO DE PUÉRPERAS / GUTHRIE TEST: KNOWLEDGE OF PUERPERAS

Takemoto AY, Lima LM, Michalczyszyn KC,

Vieira BAJ, Ichisato SMT.

30

GUTHRIE TEST: KNOWLEDGE OF PUERPERAS

TESTE DO PEZINHO: CONHECIMENTO DE PUÉRPERAS PRUEBA DEL TALÓN: CONOCIMIENTO DE PUÉRPERAS

Angélica Yukari Takemoto1_{; Letícia Medeiros de Lima}2_{; Kelly Cristina Michalczyszyn}3_; Bruna Alves de Jesus Vieira4_{; Sueli Mutsumi Tsukuda Ichisato}5

ABSTRACT

Objective: to identify the knowledge of puerperas about the performance of Guthrie test. Method: descriptive study,

of qualitative nature, carried out in the maternity sector of a philanthropic hospital, located in the city of Guarapuava, southern Brazil. Data were collected in July 2015, through recorded interviews, which were submitted to Minayo’s thematic analysis. Results: fifteen puerperas were interviewed. From the analysis of the statements, two categories were constituted: 1) Mothers’ knowledge regarding Guthrie Test and 2) Nursing care before Guthrie Test: reality versus ideology. Final Thoughts: it was possible to identify the superficial level of the puerperas’ knowledge about Guthrie test. These findings evidence the need for guiding the puerperas on the subject. The nurse is responsible for being committed to the care provided, providing the necessary knowledge and clarifying the pertinent doubts about Guthrie test.

Descriptors: Neonatal Screening; Infant, Newborn; Child Health; Health Education; Nursing Care. RESUMO

Objetivo: identificar o conhecimento de puérperas sobre a realização do teste do pezinho. Método: estudo descritivo,

de natureza qualitativa, realizada no setor da maternidade de um hospital filantrópico, localizado no município de Guarapuava, sul do Brasil. Os dados foram coletados no mês de julho de 2015, por meio de entrevistas gravadas, as quais foram submetidos à análise temática de Minayo. Resultados: foram entrevistadas quinze puérperas. A partir da análise das falas, foram constituídas duas categorias: 1) O conhecimento das mães referente ao Teste do Pezinho e 2) Assistência de enfermagem frente o Teste do Pezinho: realidade versus ideário. Considerações Finais: foi possível identificar o nível superficial do conhecimento das puérperas sobre o teste do pezinho. Esses achados tornam evidente a necessidade da orientação sobre o assunto entre as puérperas. Cabe ao enfermeiro, se comprometer com a assistência prestada, provendo o conhecimento necessário e esclarecendo as dúvidas pertinentes sobre o teste do pezinho.

Descritores: Triagem Neonatal; Recém-Nascido; Saúde da Criança; Educação em Saúde; Cuidados de Enfermagem.

RESUMEN

Objetivo: identificar el conocimiento de las puérperas sobre la realización de la prueba del talón. Método: estudio

descriptivo, cualitativo, realizado en el sector de maternidad de un hospital filantrópico, ubicado en el municipio de Guarapuava, sur de Brasil. Los datos fueron recogidos en julio de 2015, a través de entrevistas grabadas, las cuales fueron sometidas al análisis temático de Minayo. Resultados: se entrevistaron quince puérperas. A partir del análisis de los enunciados, se constituyeron dos categorías: 1) Conocimiento de las madres sobre la prueba del talón y 2) Asistencia de enfermería ante la prueba del talón: realidad versus ideal. Consideraciones finales: fue posible identificar el nivel superficial de conocimiento de las puérperas sobre la prueba de punción del talón. Estos hallazgos evidencian la necesidad de una orientación sobre el tema entre las puérperas. Corresponde a la enfermera comprometerse con la asistencia ofertada, aportando los conocimientos necesarios y aclarando las dudas pertinentes sobre la prueba del talón.

Descriptores: Tamizaje Neonatal; Recién Nacido; Salud del Niño; Educación en Salud; Atención de Enfermería.

____________________

1 _{Nurse. Doctoral Student in Nursing from the State University of Maringá. Coordinator at the Nursing Course of the Guairacá}

College. E-mail: angelica.takemoto@hotmail.com

2 _{Nurse at the Assisted Reproduction Center of Guarapuava. E-mail: leticia-lima1993@hotmail.com} 3 _{Nursing Graduate Student from the Guairacá College. E-mail: kellymichalcris@gmail.com}

4 _{Nurse. Doctoral Student in Nursing from the State University of Maringá (UEM). E-mail:}

brunaalves.enfermagem@gmail.com

5 _{Nurse. PhD in Nursing. Professor at the Nursing Department and Nursing Postgraduate Programa of the UEM. E-mail:}

sichisato@hotmail.com

INTRODUCTION

Neonatal screening or Guthrie test (GT) aims to identify metabolic, endocrine, hematological, infectious and genetic diseases in the pre-symptomatic phase in the newborn. The test is performed from blood samples collected using a special filter paper, in which a set of tests is done. The procedure should be performed in the baby between the third and fifth day of life, before blood transfusions, and that have received at least two days of protein diet, as it will allow you to track the genetic disease called phenylketonuria. However, GT can be performed up to 30 days of life(1)_.

It is a mandatory procedure at the national level, incorporated by the Unified Health System (SUS) since 1992, used for the triage of congenital hypothyroidism and phenylketonuria. Through Ordinance GM/MS n. 822 of June 6, 2001, the National Neonatal Screening Program (PNTN) was established to expand the tests, including screening for hemoglobinopathies – sickle cell anemia (SCA) and biotinity deficiency, cystic fibrosis(2) _and

recently congenital toxoplasmosis(3)_{. In Paraná,}

early diagnosis of congenital adrenal hyperplasia is included(4)_.

Thus, the PNTN promotes the detection of congenital diseases through laboratory tests, actively search for suspected cases, performs diagnostic confirmation, treatment and specialized follow-up allowing early treatment, reducing the risk of generating severe and irreversible sequelae in the child’s growth and development(5)_.

Unawareness can negatively influence the performance of the test, compromising early diagnosis, initiation of treatment and its continuity(6)_{. Some studies have shown a}

superficial knowledge about the test by both mothers(7,8)_{, and health professionals}(9)_.

Therefore, improving mothers’ knowledge about GT, as well as disseminating information that can clarify health professionals and the general population about the subject, are important strategies to increase test adherence and reduce possible complications generated from the occurrence of identifiable diseases. The sensitization of mothers is part of the responsibility of nursing, since the nurse is responsible for providing information to patients, describing the procedure, its characteristics and the pathologies screened(10)_.

Nurses act as educators and should guide mothers, in both the prenatal and postpartum periods, about the importance of GT in the first days of the child’s life. In addition, they should clarify doubts and affirm that the test is important for the baby’s health, considering

that it detects diseases that lead even to mental deficiency(11)_.

Thus, considering that mothers are the figures commonly designated for the care of their children, especially newborns, and the low number of current scientific evidence on GT and its relationship with nursing care practice, this study seeks to answer the following question: what is the knowledge of the puerperas about GT? It is assumed that acquiring correct and timely information about the procedure will make mothers aware of its importance, avoiding possible sequelae. In addition, the results may support the elaboration of proposals to encourage the mothers’ support through excellence in the care provided by the nursing team in promoting the health and well-being of the newborn.

Therefore, this study aimed to identify the knowledge of puerperal women about the performance of GT.

METHODS

This is a descriptive study of qualitative nature, carried out in the maternity sector of a philanthropic hospital, located in the city of Guarapuava, southern Brazil. The maternity hospital has 20 beds, distributed in four private beds, four for health insurances and twelve belonging to the UHS.Furthermore, this sector is a reference for the care of usual, intermediate and high-risk pregnancies, with an average annual delivery of approximately 1,600 patients.The presence of the companion is allowed throughout the parturition process, however, the hospital is not accredited in the Child-Friendly Hospital Initiative.

The participants were puerperal women, randomly selected, intentionally, regardless of their postpartum period and who met the following inclusion criteria: aged 18 years or older, healthy (with good health) and residents in the city of Guarapuava. Puerperal women who were clinically unstable were excluded from the study. The number of participants was defined based on the discourses and data saturation(12)_{, therefore, 15 women}

participated in the study.

Data were collected in July 2015. The approach for data collection was performed at the most appropriate moment indicated by the puerperal women, avoiding moments when they were busy caring for their children or during the visits received in the hospital. The study was initiated by clarifying the research, followed by the signing of the Informed Consent Form, in the maternity itself, in a room reserved for the interview and without the presence of the companion.

Takemoto AY, Lima LM, Michalczyszyn KC,

Vieira BAJ, Ichisato SMT.

32

interviews audio-recorded, guided by an instrument with semi-structured questions. This instrument consisted of two parts: the first with objective data on the characterization of the participants and the second by a guiding question, such as: What is your knowledge about Guthrie Test? The average time of each

interview was 30 minutes. Then, the statements were heard and fully transcribed.

Subsequently, the transcriptions were submitted to Minayo’s thematic analysis for the identification and organization of the categories. The analysis was carried out, seeking to extract the most significant data for the research. Data analysis followed the following steps: organization of information for analysis; reading of all statements; detailed analysis with coding process; presentation of the themes found in the qualitative narrative; identification of meanings; and the elaboration of thematic categories(13)_.

The study was developed following the ethical precepts established by Resolution 466/2012 of the National Health Council, and its project was approved by the Research Ethics Committee at the Midwestern State University, with opinion n. 1.111.956 (CAEE: 45821115.9.0000.0106). The anonymity and confidentiality of the identity of each participant were preserved by replacing their names with the letter P (puerpera), plus the number according to the sequence of interviews (e.g.: P1).

RESULTS

Participants’ characterization

Among the fifteen puerperas who were part of this study, the age ranged from 18 to 40 years. Most were married (n=9), with complete high school (n=4) and housewives (n=8). As for parity, most were multiparous (n=9).

After analyzing the statements, two categories were constituted: “Mothers’ knowledge regarding Guthrie Test” and “Nursing care before Guthrie Test: reality versus ideology”, which will be presented and described below.

Mothers’ knowledge regarding Guthrie Test

Some mothers, despite recognizing the GT an important procedure, have a superficial knowledge about the subject, as can be seen in the following statements:

It is a test that sees many diseases, isn’t it? And I think they collect blood from the baby’s heel for analysis (P5).

The heel prick I think is to detect if the baby has some disease, so I think it is important, it will find out something (P6).

The heel prick serves to diagnose diseases that may appear (P12).

However, from the speech of some participants, it was possible to identify the unawareness of the appropriate time to perform the GT and its purpose.

I do not know, I have never heard of it. What is this test? Does the hospital offer this test? (P3). For me, I think it is a test to identify some degenerative disease in the baby, but I am not sure (P13).

Maybe it checks on the baby’s diseases, but I do not know what test this is. I have never heard and no one spoke of this test (P14).

When asked about the description of the technique for the GT, few interviewees were able to describe the procedure and when they tried to explain it, they demonstrated incipient knowledge about the subject. This situation can be observed in the following statements:

It must be on the foot, poking through the heel? I think that is it (P4).

I think it is a ‘needle’ in the baby’s heel, I think there is something on the paper strip, something like that, I cannot say it right (P5).

I think it must be a ‘little hole’ in the baby’s foot, but I cannot tell if it is right (P9).

I think it is a small sting on the child’s heel, but I do not know if there is anything else or what they do with that (P12).

On the other hand, it was notorious the unawareness of the collection technique by some interviewees, even in the cases of women who have had other children, including with diagnosis of genetic alteration, discovered from the GT.

My other girl’s, we found out the mutation she had by this test, only I do not know how it is done (P2).

I cannot talk about how it is done. I do not know if it is a blood test, if blood is collected from the heel, that is why it is called heel prick, I cannot explain it (P7).

As for the ideal moment for the examination, most participants were unable to mention the exact moment for the performance of the GT. These statements are

evident in the following reports:

The test is done after the birth, three days after, right? (P3).

[...] soon after the birth, so much blood test, I think this heel prick is done together (P7). [...] at the right time, I think that after leaving the hospital, I think they guide us to go and make this exam (P8).

[...] with the baby’s first 24 hours of life, so this test is done in the hospital (P11).

Only two participants correctly reported the ideal time to perform the GT. Nevertheless, they were unable to explain the reason for performing the procedure within this period.

[...] it is after the 48 hours. But why? I cannot say the reason (P1).

[...] it is at discharge, usually with two days, but I cannot explain why (P6).

Concerning the pathologies and complications detected in the GT, no interviewee was able to comment specifically on the issue, which could be verified in the following statements:

I cannot name which diseases it detects. The baby undergoes the test, but I do not know what diseases the test investigates (P5).

I do not know which diseases it identifies. I think it detects every type of disease (P7).

Of the diseases, I do not know which ones this heel prick detects (P9).

They never spoke of the diseases in the heel prick. But it must be severe disease (P15).

In short, in this category, it was possible to identify a large deficit in the knowledge of mothers about GT in all its aspects: concept, importance, procedure, pathologies and injuries. However, the results showed that, despite not knowing the test, the interviewees recognize its importance for the newborn’s full growth and development.

Nursing care before Guthrie Test: reality versus ideology

Regarding the nursing care provided, in relation to the practice of guidance on GT, only one of interviewee mentioned having received some kind of information about the procedure still during pregnancy, revealed by the following statement:

I received during prenatal care a little bit, but the

nurse at the health center passed it. Here at the hospital I still have not received any information, only commented the existence of a test do on the baby’s heel, something like that (P9).

The other participants mentioned that they did not receive any information on the subject, in both prenatal care and the hospital. The participants’ statements unveil that health professionals only mention the need for executing the test, without providing the proper guidance, about the reasons, technique, identifiable diseases, among other aspects.

Here at the hospital they said that the heel prick will be done tomorrow, that I will be discharged, but I have not received any other information yet (P1).

In prenatal [...] they only talked about the mother’s test. They have not said anything here at the hospital either. The woman only said that she will pick him up tomorrow for the heel prick (P2).

Here at the hospital they only said that they have to do it and that it is an important test (P4). We know that it has to be done, that it is necessary, but they did not tell me any of this (P12).

When asked about the importance of receiving information on the subject from information booklets, for example, or for discussion, all interviewees considered such strategies relevant, considering that the lack of information is evident.

[...] because it shows us everything, whether it is important or not, we will know (P7).

[...] because it is interesting, then we know everything, why doing this test, when it is done, these things (P8).

[...] it is good to know these things, because then we understand why the baby needs to undergo this test (P15).

For some participants, the best time to receive information related to GT is still during prenatal care, as shown in the following discourses:

I think these things, we need to know during prenatal care, so we can be more informed and know everything (P3).

In prenatal care would be the best, because you already enter the hospital knowing the test, that it is important for the baby (P9).

The right thing would be for us to know in prenatal care, to know and I get to the hospital more

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prepared (P13).

Other interviewees considered their stay in the hospital environment, in the postpartum period, the best time to have these orientations.

I think here at the hospital, to know what it is like, what it is, what it is for. Since this is where you do it, I think it is best to know in the hospital (P4). I think now in the hospital, because we end up forgetting many prenatal stuff. Ideally before, during and after, but if I had to choose, I think on the days in the hospital, already knowing what they are doing (P5).

Given the above, the results point to the deficiency in the orientations given to pregnant and/or puerperal women by the health team, both in prenatal care and in the hospital environment. It was possible to notice that there was no complete transmission of information about neonatal screening, its purpose, its objective, the technique performed to collect the examination, verifying that such information was replaced by the simple phrase that the GT will be performed, without further information.

DISCUSSION

Health education activities can be performed in any environment that the health professional, especially the nurse, deems convenient.

The results of this study showed that the puerperal women had little knowledge about the need for performance, collection technique and diseases screened by GT. A study conducted in a city in southeastern Brazil with 160 pregnant women identified that 75.0% of them did not know what were the pathologies screened by GT, and 16.3% cited that the diseases possibly detected have genetic etiology and 82.0% felt the need for more information about the test(8)_{. This situation is}

not limited only to the Brazilian context. A study conducted in Southern Ireland obtained a similar result, in which the parents’ unawareness of GT was evident, which was associated with lack of information(14)_{. These}

findings highlight the need for guidance from health professionals on the screening test in this population.

Other factors may contribute negatively to the occurrence of a low knowledge about the subject. Among them, the following stand out: low schooling, socio-economic differences, lack of bond between health professionals/clientele and the lack of preparation of the health team at the time of health education(7,9)_{. It is}

important to emphasize that the main purpose

of the examination is to identify congenital diseases to start treatment, early reducing the damage and health problems of children(15)_.

The findings of the present study highlight that GT, although indispensable for the promotion of the health of the newborn, seems to receive little importance on the part of health professionals in the scope of Primary Health Care, during prenatal care, and those inserted in the hospital environment of postpartum follow-up. Investigations suggest that, during the performance of health education groups for pregnant women, the most worked themes involve the newborn’s care, breastfeeding and personal hygiene of women during the gestational period(16,17)_.

Analyzing the participants’ statements about GT, in some cases, health professionals even comment on the need to perform the test, but without providing the appropriate guidance or clarification regarding women’s doubts and questions. In a study conducted in Canada, it was possible to verify that the parents wanted to receive more information about the GT and even be consulted regarding consent in relation to the test. This showed that, although the procedure was mandatory, the parents wanted to have the right to answer in favor of the test(18)_.

In some studies, there is consensus that prenatal care is the best time to perform educational actions with mothers. Studies show that guidance on GT should still be performed during prenatal care, even if mothers forget some details, because this is the moment that favors learning, since there is a longer time for doubts to be clarified(14,19)_{. In}

addition, in the postpartum period, puerperas experience new emotions and other feelings in the presence of the newborn and may end up not being attentive enough to the information provided(8)_.

Therefore, nurses have an important role in the effectiveness and execution of GT.These professionals are closest to the target clientele since prenatal care, in the Basic Health Unit. Thus, their activities in view of this theme include: informing, clarifying and guiding pregnant women about the test, method and collection period, its importance, purpose and screened pathologies(8)_{, in a structured and}

systematized way(14)_.

It is important to highlight that nurses have guaranteed their space in the midst of the actions inherent to Primary Health Care. They focus on improving the quality of life of the population, based on the organization of the work process and towards the problem-solving capacity of the population’s health problems(10,20)_{. In this case, each health}

professional, especially the nurse, needs to be sensitized about the importance of GT and voluntarily be a multiplier agent in the

dissemination of information about the procedure to mothers and the community in general(4)_.

One of the opportunities that should be used by nurses is during the practice of health education in the formation of groups, as a driving strategy, of reflection, of change of behaviors and attitudes, combined with actions that seek to insert the participants in their own realities. It is one of the forms of light technology for nurses to perform humanized care, favor their role as educators and improve the quality of nursing care provided to this clientele(21)_.

Another opportunity is during the nursing consultation, an independent activity, individualized and performed privately by the nurse. Its principle is to provide conditions for health promotion, prevention of diseases and the maintenance of the quality of life of pregnant women, through a contextualized and participatory approach. During the consultation, in addition to technical competence, nurses should show interest in the pregnant woman and her way of life(22)_.

The individual approach is important for women to expose their concerns, doubts and anxieties in a more comfortable way. This is because nurses’ care should be based on the assumptions of humanized care, recognizing the individuality of the subjects under care and establishing with each pregnant woman a bond, in order to perceive their real health needs(23)_.

Through a relationship of empathy and trust between nurse and client, the professional transmits safety to mothers by offering information, clarifying doubts and imposing on them the responsibility of ensuring the health of their babies, preventing complications and promoting the improvement of quality of life.

In general, the evidence of the present study reveals the deficiency in the orientations given to pregnant and/or puerperal women on GT by nurses, either in prenatal care or in the maternity. It is noteworthy that nurses work in education and knowledge transmission, being responsible for guiding pregnant women and/or

mothers on the subject, aiming at a better understanding of the procedure and providing a humanized and quality care.

This study presents methodological-logical limitations. One of them is related to the fact that only the mothers’ perspectives were included. Perhaps, the knowledge/perceptions of fathers could be different, expanding the understanding of the phenomenon under investigation. Moreover, the fact that the interviews were conducted during the immediate puerperium, still in hospital, may have influenced the data collected, since women could be more concerned with the newborn’s care, breastfeeding and recovery.Thus, new studies involving the family in this theme should be developed, with interviews conducted during pregnancy or after hospital discharge, in order to validate the findings of this research and expand them.

FINAL THOUGHTS

The present study evidenced that the knowledge of puerperal women about GT remains insufficient. However, the results indicate that many mothers recognize its importance to ensure the newborn’s healthy growth and development, as well as showed great interest in receiving more information about GT, either through meetings, lectures or informative booklets.

Regarding nursing care, it was observed, indirectly, that there might be failures in the care provided by the team, during prenatal care and in the maternity. The importance of nurses in health education and the technical training of professionals about GT stand out to expand knowledge and improve the quality of care to the child population.

Finally, it is believed that the results found contribute significantly to the deepening of the theme, generating an important knowledge about the failures in nursing care regarding the orientation on GT.Such information represents a primordial knowledge to meet the health needs of this population in an integral and humanized way.

Individual author´s contributions: Takemoto AY and Lima LM: Participated in the design and writing of the project; data collection, analysis and interpretation; writing of the article and final approval of the version to be published. Michalczyszyn KC and Vieira BAJ: contributed to the writing of the article and relevant critical analysis of the intellectual content. Ichisato SMT: contributed to the writing of the article; relevant critical analysis of the intellectual content and approval of the final version to be published. All authors declare to be responsible for all aspects of the work, ensuring its accuracy and integrity.

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REFERENCES

1. Oliveira RG. Cuidados básicos com o recém-nascido. In: Oliveira RG. Blackbook pediatria. 5ª ed. Belo Horizonte: Blackbook Editora; 2019. p. 649-655.

2. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Especializada e Temática. Triagem neonatal biológica: manual técnico. Brasília: Ministério da Saúde; 2016.

3. SBP. Sociedade Brasileira de Pediatria. SUS passará a ofertar exame de detecção para a toxoplasmose congênita incorporado ao Teste do Pezinho. Publicado em 31 mar. 2019 [citado 2020 mai 17] Disponível em: https://www.sbp.com.br/imprensa/detalhe/nid/sus-passara-a-

ofertar-exame-de-deteccao-para-a-toxoplasmose-congenita-incorporado-ao-teste-do-pezinho/.

4. Fepe. Fundação Ecumênica de Proteção ao Excepcional. Teste do Pezinho [Internet]. Fepe; 2020 [citado 2020 mai. 15]. Disponível em: https://www.fepe.org.br/teste-do-pezinho-pr/ 5. Wheeler BJ. Promoção de saúde do recém-nascido e da família. In: Hockenberry ML, Wilson D,

Rodgers CC. Wong Fundamentos de enfermagem pediátrica. 10ª ed. Rio de Janeiro: Elsevier; 2018. Cap. 7, p. 190-228.

6. Mendes CA, Guigen AP, Anastácio-Pessan FL, Dutka JCR, Lamônica DAC. Knowledge of parents regarding newborn screening test, after accessing the website “Babies’ Portal” - Heel prick test. Rev CEFAC. 2017; 19(4):475-83.

7. Arduini GAO, Balarin MAS, Silva-Grecco RL, Marqui ABT. Knowledge of puerperal mothers about the guthrie test. Rev Paul Pediatr. 2017; 35(2):151-7.

8. Silva MPC, Contim D, Ferreira LA, Marqui ABR. Guthrie test: pregnant women’s perception during prenatal care. Rev Bras Saúde Mater Infant. 2017; 17(2):291-8.

9. Acosta DF, Strefling ISS, Gomes VLO. Triagem neonatal: (re)pensando a prática de enfermagem. Rev Enferm UFPE on line. 2013; 7(2):572-8.

10. Gomes APS, Sousa AR, Passos NCR, Santana TS, Rosário CR. Conhecimento sobre triagem neonatal: discursos de mães e pais de recém-nascidos. REVISA [Internet]. 2019 [citado 2020

mai 15]; 8(3):255-63. Disponível em:

http://revistafacesa.senaaires.com.br/index.php/revisa/article/view/421/309

11. Marqui ABT. The blood drop screening (guthrie) test and the role of nurses: a reflection. Rev Enferm Atenção Saude [Internet]. 2016 [cited 2020 mai 15]; 5(2):92-100. Available from:

http://seer.uftm.edu.br/revistaeletronica/index.php/enfer/article/view/1605/pdf_1

12. Minayo MCS. Amostragem e saturação em pesquisa qualitativa. Revista Pesquisa Qualitativa. 2017; 5(7):1-12.

13. Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. São Paulo: Abrasco; 2013. 14. Fitzgerald C, Heery E, Conneally N, Linnane B, George S, Fitzpatrick P. An evaluation of pregnant women’s knowledge and attitudes about newborn bloodspot screening. Midwifery [Internet]. 2017 [cited 2020 mai 15]; 45:21-7. Available from:

http://dx.doi.org/10.1016/j.midw.2016.11.007

15. Wright SJ, Ulph F, Dharni N, Payne K. Eliciting preferences for information provision in newborn bloodspot screening programs. Value Heal [Internet]. 2017 [cited 2020 mai 15]; 20(4):651-61. Available from: http://dx.doi.org/10.1016/j.jval.2016.11.007

16. Ribeiro S, Lacerda RB, Oliveira BV, Malaquias BSS, Santos AS. “Good gestate”: implementation of a group for pregnant women. REFACS. 2019; 7(2):263-9.

17. Baquião LSM, Ângelo ST, Costa AMB, Dias ALG, Constâncio JVB. Práticas educativas a gestantes em situação de vulnerabilidade social. Braz J of Develop. 2020; 6(4):16903-7.

18. Hayeems RZ, Miller FA, Barg CJ, Bombard Y, Cressman C, Painter-Main M, et al. Using newborn screening bloodspots for research: public preferences for policy options. Pediatrics. 2016; 137(6):e20154143.

19. Botkin JR, Rothwell E, Anderson RA, Rose NC, Dolan SM, Kuppermann M, et al. Prenatal education of parents about newborn screening and residual dried blood spots a randomized clinical trial. JAMA Pediatr. 2016; 170(6):543–9.

20. Finkler AL, Toso BRGO, Viera CS, Obregón PL, Rodrigues RM. The process of work in primary health care to children. Cienc Cuid Saude. 2016; 15(1):171-9.

21. Rolim K, Cavalcante R, Cavalcante J, Pinheiro C, Magalhães F, Abreu F, et al. Educação em saúde às gestantes: estratégia de promoção aos cuidados do recém-nascido. Atas CIAIQ. 2016; 16:1193-201.

22. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Atenção ao pré-natal de baixo risco – manual técnico. Brasília: Ministério da Saúde; 2012. 23. Silva LA, Alves VH, Rodrigues DP, Santos MV, Guerra JVV, Marchiori GRS. Human and materials

resources in prenatal care: useful values for the guarantee of pregnant woman care humanization. Rev Enferm Cent-Oeste Min. 2018; 8:e2831.

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