The systematic approach corroborated the results obtained by published studies: schoolchildren born with very low birth weights exhibited increased risk of learning difficulties when compared with those born at full term. There was a predominance of children with multiple academic subjects compromised and mathematics was the most affected. Risk was observed to follow an ascending gradient as birth weight reduced. There was an association between very low birth weight and cognitive compromise.

Help provided by the health team to breastfeeding at birth, Step 4 of the Baby-Friendly Hospital Initiative, as well as non black women, multiparous women, receiving pre-natal care, vaginal delivery and appropriate birthweight contributed to breastfeeding in the first hour of life.

neonatal sepsis was an independent risk factor for neuromotor development impairment at 12 months of corrected age, but not for mental development impairment.

Resultados: No estudo de validade concorrente, a correlação encontrada entre as duas escalas foi alta (r = 0,95) e estatisticamente significativa (p < 0,01) na população total de lactentes, alcançando valores mais altos aos 12 meses (r = 0,89) do que aos 6 meses (r = 0,74). A confiabilidade interobservador apresentou valores satisfatórios de ICC em todas as idades avaliadas, variando de 0,76 a 0,99. Conclusão:A AIMS é uma escala válida e confiável para ser utilizada na avaliação do desenvolvimento motor de lactentes de risco na população da rede pública de saúde brasileira.J Pediatr (Rio J). 2008;84(5):442-448: Prematuro, desenvolvimento infantil, avaliação, Alberta Infant Motor Scale, reprodutibilidade dos testes. AbstractObjective: To verify the concurrent validity and interobserver reliability of the Alberta Infant Motor Scale (AIMS) in premature infants followed-up at the outpatient clinic of Instituto Fernandes Figueira, Fundação Oswaldo Cruz (IFF/Fiocruz), in Rio de Janeiro, Brazil.Methods: A total of 88 premature infants were enrolled at the follow-up clinic at IFF/Fiocruz, between February and December of 2006. For the concurrent validity study, 46 infants were assessed at either 6 (n = 26) or 12 (n = 20) months' corrected age using the AIMS and the second edition of the Bayley Scales of Infant Development, by two different observers, and applying Pearson's correlation coefficient to analyze the results. For the reliability study, 42 infants between 0 and 18 months were assessed using the Alberta Infant Motor Scale, by two different observers and the results analyzed using the intraclass correlation coefficient. Results:The concurrent validity study found a high level of correlation between the two scales (r = 0.95) and one that was statistically significant (p < 0.01) for the entire population of infants, with higher values at 12 months (r = 0.89) than at 6 months (r = 0.74). The interobserver reliability study found satisfactory intraclass correlation coefficients at all ages tested, varying from 0.76 to 0.99. Conclusions:The AIMS is a valid and reliable instrument for the evaluation of motor development in high-risk infants within the Brazilian public health system. J Pediatr (Rio J). 2008;84(5):442-448: Prematurity, child development, assessment, Alberta Infant Motor Scale, validity and reliability.

The results show high prevalence of lung functional and tomographic abnormalities in asymptomatic very low birth weight infants at the time of discharge. They also show an association between lung morphological and functional abnormalities.

Objective: The objective of this study was to verify the incidence of respiratory morbidity in the first year of life in very low birth weight preterm infants and also to compare the presence of respiratory morbidity in the first year of life according to neonatal risk factors.Methods: This is a prospective cohort study. We studied preterm newborn infants weighing less than 1,500 g and with gestational age less than 34 weeks who were born between 1998 and 2000. During the first year of life, the infants received monthly medical follow-up and during each visit we evaluated the patients considering the presence of obstructive airway syndrome and/or pneumonia and/or hospital admission due to respiratory conditions. The incidence rate of respiratory morbidity in the first year of life was measured. Chi-squared test was used to compare proportions. Results:The cohort was constituted of 97 preterm infants with mean birthweight of 1,113 g and mean gestational age of 28 weeks. The incidence rates of obstructive airway syndrome, pneumonia and hospital admission were 28, 36 and 26%, respectively. The incidence rate of respiratory morbidity was 53%. There was a significant difference between the incidence rates of respiratory morbidity among infants who had a prolonged use of oxygen (83%) and those who did not (43%). Conclusion:More than 50% of the infants presented respiratory morbidity in the first year of life and there was a high percentage of pneumonia and hospitalization due to respiratory conditions. Infants who had a prolonged use of oxygen presented with higher respiratory morbidity incidence rate than infants who did not use oxygen for a long period.J Pediatr (Rio J). 2004;80(6):503-10: Respiratory morbidity; very low birthweight, preterm infant, follow-up.

CONTEXT AND OBJECTIVE: There have been dramatic increases in very low birth weight infant survival. However, respiratory morbidity remains problematic. The aim here was to verify associations between pulmonary mechanics, pulmonary structural abnormalities and respiratory morbidity during the first year of life. DESIGN AND SETTING: Prospective cohort study at Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro. METHODS: Premature infants with birth weight < 1500 g were studied. Lung function tests and high-resolution chest tomography were performed before discharge. During the first year, infants were assessed for respiratory morbidity (obstructive airways, pneumonia or hospitalization). Neonatal lung tests and chest tomography and covariables potentially associated with respiratory morbidity were independently assessed using relative risk (RR). RR was subsequently adjusted via logistic regression. RESULTS: Ninety-seven newborn infants (mean birth weight: 1113g; mean gestational age: 28 weeks) were assessed. Lung compliance and lung resistance were abnormal in 40% and 59%. Tomography abnormalities were found in 72%; respiratory morbidity in 53%. Bivariate analysis showed respiratory morbidity associated with: mechanical ventilation, prolonged oxygen use (beyond 28 days), oxygen use at 36 weeks, respiratory distress syndrome, neonatal pneumonia and patent ductus arteriosus. Multivariate analysis gave RR 2.7 (confidence interval: 0.7-10.0) for simultaneous lung compliance and chest tomography abnormalities. Adjusted RR for neonatal pneumonia and mechanical ventilation were greater. CONCLUSIONS: Upon discharge, there were high rates of lung mechanism and tomography abnormalities. More than 50% presented respiratory morbidity during the first year. Neonatal pneumonia and mechanical ventilation use were statistically significant risk factors.

OBJETIVO: Verificar os valores de predição de dois exames (neurológico e ultra-sonográfico) realizados no período neonatal, em relação ao desenvolvimento neuromotor e cognitivo de prematuros. MÉTODO: Foram estudados 70 prematuros com peso de nascimento inferior a 1.500g. A média do peso de nascimento e idade gestacional foram, respectivamente, 1.185g (DP:180) e 32,2 semanas (DP:1,4). Foi realizada avaliação neurológica pelo método de Dubowitz e Dubowitz e ultra-sonografia cerebral por volta de 40 semanas de idade corrigida. Após a alta do berçário estas crianças foram acompanhadas no ambulatório de seguimento. RESULTADOS: Com idade média de 21 meses (DP: 4,9) corrigidos para a prematuridade, 25,7% das crianças apresentaram comprometimento neuromotor, e 20,3%, alteração cognitiva. O exame neurológico neonatal foi mais sensível que específico em relação à alteração neuromotora (sensibilidade:77,7%, especificidade:57,6%), e cognitiva (sensibilidade: 78,5%, especificidade: 56,4%), e apresentou baixo valor de predição tanto para alteração neuromotora (38,9%) quanto cognitiva (31,4%). A ultra-sonografia apresentou elevada especificidade tanto para o desenvolvimento neuromotor (92,3%) quanto cognitivo (89,1%). O valor preditivo da ultra-sonografia foi satisfatório para anormalidades neuromotoras (69,2%), porém baixo para as alterações cognitivas (50,0%). CONCLUSÃO: A associação dos dois exames com resultados anormais apresentou valores de predição mais elevados para as anormalidades nas duas áreas do desenvolvimento.