Neurodesenvolvimento de lactentes nascidos a termo pequenos para a idade gestacional no segundo mês de vida

Abstract

RESUMO -O objetivo deste estudo foi avaliar e comparar o neurodesenvolvimento de lactentes nascidos a termo, com peso adequado (AIG) ou pequeno para a idade gestacional (PIG), no 2º mês de vida. Av a l i a r a mse 67 lactentes: 43 AIG e 24 PIG, utilizando as Bayley Scales of Infant Development. O Index Score (IS) nas Escalas Mental e Motora foi significativamente menor no grupo PIG. Considerando a proporcionalidade corporal (Grupos Controle, Assimétrico e PIG-Simétrico), houve diferença significativa na Escala Motora (p=0,003), com menores pontuações no grupo PIG-Simétrico. Comparados aos percentis de IS do grupo Controle, na Escala Mental, houve diferença entre os grupos Assimétrico X PIG-Simétrico; na Escala Motora, houve diferença entre os grupos Assimétrico X Controle (p=0,039) e PIG-Simétrico X Controle (p=0,0007); não houve diferença entre os grupos Assimétrico e PIG-Simétrico, ambos apresentando menores pontuações que o grupo Controle.PA L AV R A S -C H AVE: pequeno para a idade gestacional, desenvolvimento infantil, desnutrição intra-uterina.Neurodevelopment of full-term small-for-gestacional age infants in the second month of life ABSTRACT -The objective of the present study was to assess and to compare the neurodevelopment of full-term adequate (AGA) or small-for-gestational age (SGA) infants in the second month of life. Sixty-seven infants were evaluated: 43 AGA and 24 SGA, making use of the Bayley Scales of Infant Development. The SGA group Index Score (IS) was significantly lower in Mental and Motor Scales. Considering the body proportionality (Asymmetric, Symmetric-SGA and Control group) there was difference in Motor Scale (p=0.003) with lower scores in the Symmetric-SGA group. Comparing to the Control group IS percentiles, in Mental Scale there was difference between Asymmetric X Symmetric-SGA; in Motor Scale, there was difference between the Asymmetric X Control (p=0.039) and Symmetric-SGA X Control (p=0.007) groups; there was no difference between Asymmetric and Symmetric-SGA although both exhibited lower scores than the Control group.KEY WORDS: small-for-gestational age, infant development, intrauterine malnutrition.O termo restrição do crescimento intra-uterino (RCIU) é freqüentemente mal interpretado em obstetrícia. O recém-nascido (RN) com RCIU é definido como aquele que não atingiu seu crescimento potencial genético intra-uterino, sugerindo um processo patológico durante a vida fetal 1 . Estudos mais recentes mostram a tendência à utilização do termo pequeno para a idade gestacional (PIG) para os fetos ou RN que falharam em atingir o padrão de peso ou antropométrico arbitrário para determinada idade gestacional 1 . Não obstante, os termos RCIU e PIG são, com freqüência, utilizados como sinônimos e os mesmos limites estatísticos são utilizados para sua identificação. No entanto, cabe destacar a possibilidade de alguns neonatos PIG serem apenas constitucionalmente pequenos, quando analisados segundo seu potencial genético de crescimento, representando a porção final da curva de distribuição n...

Validade concorrente e confiabilidade da Alberta Infant Motor Scale em lactentes nascidos prematuros

“…21 The BSID-II has not gone through transcultural adaptation for Brazil, but the scale is nevertheless widely used in follow-up clinics and in child healthcare research. [22][23][24][25] The AIMS and the BSID-II motor scale take different approaches to evaluating development, but are designed to assess the same construct, which is motor development based on progressive evolution of motor abilities. Furthermore, both scales provide a global score which increases as child development progresses, which facilitates comparison of results.…”

A influência da proporcionalidade corporal em crianças nascidas pequenas para a idade gestacional: estudo da maturação da via auditiva

“…It therefore seems logical to think that term and symmetrical SGA NBs could manifest greater losses compared to asymmetrical SGA NBs because they suffered the injury early in the gestation, just as preterm SGA manifest different characteristics because they were exposed to the injury over a shorter period of time (4,5) . Considering that maturation of the brain stem is due to myelination and synaptic plasticity as a function of auditory experience, intrauterine restriction would imperatively lead to neurodevelopmental damage, and injury to the auditory pathways in this region could be responsible for speech difficulties (4,5,22) .…”

“…Injury in this circumstance is likely to have occurred in late pregnancy due to placental insufficiency. In contrast, symmetrical or proportional SGA infants are those whose weight, head circumference and height are all reduced, indicating injury at the beginning of pregnancy and extending throughout the prenatal period, which may lead to greater harm to the fetus (3,4) . The classification of body proportionality of SGA NBs can be obtained using Rohrer's ponderal index (PI), the parameters of which are determined by the weight (in grams) divided by the cubic height (cm 3 ), multiplied by 100.…”

“…There is consensus in the literature that increased risk of neurological morbidity may be associated with inadequate birth weight in relation to gestational age, resulting in a range of effects, from subtle forms of developmental delay to permanent brain damage. In this context, newborns with low birth weight and/or SGA are considered at risk for global or specific changes in language, hearing and learning (4,6,7) , as they represent an example of malnutrition at an early age and are possibly subjected to sequelae later in life caused by their in utero experience (4,8) . Auditory monitoring, therefore, becomes critical because the first two years and, in particular the first six months of life, are critical for the development of oral language (9) .…”

Avaliação do repertório comportamental de bebês nos quatro primeiros meses de vida: uma proposta de análise

“…Um estudo realizado por Goto e cols. 19 procurou avaliar e comparar o neurodesenvolvimento de bebês nascidos a termo, com peso adequado (AIG) ou pequeno para a idade gestacional (PIG), no 2º mês de vida. Avaliaram-se 67 lactentes: 43 AIG e 24 PIG, utilizando as Bayley Scales of Infant Development.…”