Capacity building of nurses providing neonatal care in Rio de Janeiro, Brazil: methods for the POINTS of care project to enhance nursing education and reduce adverse neonatal outcomes

Six neonatal units, caring for 40% of preterm infants in Rio de Janeiro were invited to participate. In Phase 1 of the study multidisciplinary workshops were held in each neonatal unit to identify the neonatal morbidities of interest and to plan for data collection. In Phase 2 the teaching package was developed and tested. Phase 3 consisted of 12 months data collection utilizing a simple tick-sheet for recording. In Phase 4 (the Intervention) all nurses were asked to complete all six modules of the POINTS of care package, which was supplemented by practical demonstrations. Phase 5 consisted of a further 12 months data collection. In Phase 1 it was agreed to include inborn infants with birthweight ≤ 1500 g or gestational age of ≤ 34 weeks. The primary outcome was death before discharge and secondary outcomes included retinopathy of prematurity and bronchopulmonary dysplasia. Assuming 400-450 infants in both pre- and post-intervention periods the study had 80% power at p = < 0.05 to detect an increase in survival from 68% to 80%; a reduction in need for supplementary oxygen at 36 weeks post menstrual age from 11% to 5.5% and a reduction in retinopathy of prematurity requiring treatment from 7% to 2.5%.The results of the POINTS of Care intervention will be presented in a separate publication.Current Controlled Trials: ISRCTN83110114As neonatal care develops in countries with emerging economies it has been common to observe increasing survival but also increased morbidity among survivors. Retinopathy of prematurity (ROP), one of the major morbidities following preterm birth, has become a significant cause of blindness in children in middle income countries in Latin America, Asia and Eastern Europe. Gilbert and colleagues have called this the "third epidemic" of blindness due to ROP [1,2] being a mixture of first epidemic risk factors (uncontrolled use of 100% oxygen) and second epidemic risk factors (increased survival of extremely low birth weight babies). In these cou