Detecção de risco para problemas no desenvolvimento de bebês nascidos pré-termo no primeiro ano

Abstract

Several biological and environmental risk factors influence the development of preterm infants. The objective of this study was to assess risk factors for development delay in preterm infants born with low birth weight, focusing on the following domains: neurobehavioral achievements in the neonatal phase, as well as personal-social, language and motor developments in the first 8 months of postnatal age. We also aimed to: identify the better predictive model for development, based on the biological and socioeconomic variables measured in our sample of low birth weight preterm; to longitudinally follow and to describe the development of these infants during the first 8 months of corrected chronological age (CA); to test the psychometric parameters and to estimate the predictive value of the Neurobehavioral Assessment of Preterm Infant (NAPI) and Denver II tests (DDST-II), in assessing the motor development of the infants. Our sample consisted of 190 preterm infants (< 37 weeks of gestational age) and with low birth weight (<2,500 grams) seen during their first year of age, born and initially assisted at a neonatal specialty center at the Infant Maternity Hospital of Goiania (GO), Brazil. At the neonatal phase, the infants were assessed using the NAPI test; from 2-4 months of CA, we used the Test of Infant Motor Performance (TIMP); from 4-6 months and 6-8 months of CA, we used, the DDST-II; from 6-8 months of CA, we used the Alberta Infant Motor Scale (AIMS). Initial assessments were performed in the neonatal unit of intermediate risk (while the infants were hospitalized); subsequent assessments were conducted in our outpatient hospital clinic (ambulatory) for high risk infants. Descriptive statistics included mean, range, and standard deviation for continuous variables, and frequency and percentage for categorical variables. The in-between group comparisons were conducted using the Chi-square Test or Student T Test. For predictive assessments, we used logistical regression. The significance level for each test was set at 5%. Over 31% of the infants in our sample showed signs of impaired neurobehavioral development in the neonatal phase. Infants assessed from 2-4 months xiv of CA had 51% of risk for developmental problems according to the DDST-II; 48% obtained abnormal classifications in the TIMP. Similarly, 43 % of the infants were at risk in the DDST-II, and 47% had abnormal motor development according to the AIMS at 4-6 months of CA. At 6-8 months of CA, 33% of the infants were at risk as per the DDST-II, and 36% of the infants had abnormal motor development according to the AIMS. When comparing the development of the infants as per the chronological and corrected age, it became evident the needs for correcting the age in all assessed age-ranges. The main variables imposing risk and influencing the development of our sample were: weight <1.500g; gestational age ≤32 weeks; high neonatal clinical risk; presence of intracranial hemorrhage; lack of natural breast feeding; low levels of education by the household head...

Motor development evaluated by Test of Infant Motor Performance: comparison between preterm and full-term infants

“…On the other hand, differing from the present study, several authors have found an association between gestational age 31,32 or birthweight 31,32 or a longer stay in the hospital after birth 31 and risk factors for delayed motor development. This difference, in comparison to our results, could be explained by the use of different criteria to determine associations.…”

Estudio del desarrollo motor de niños prematuros nacidos con menos de 1.500 g según la Alberta Infan Motor Scale (AIMS). Comparaciones clínicas y funcionales

“…El concepto de RN de riesgo neurológico nació en Inglaterra en 1960, siendo definido, como aquel niño que por sus antecedentes pre, peri o postnatales, tiene más probabilidades de presentar, problemas en el desarrollo, ya sean cognitivos, motores, sensoriales o de comportamiento, pudiendo ser transitorios o definitivos [17]. Barbosa et al [118], Oreiro [119] y Formiga et al [120] consideran que mismo teniendo condiciones esenciales para un buen desarrollo, donde se haya minimizado factores causantes de una morbilidad neonatal leve, los RNMBPN y RNEBPN presentan un desarrollo neurosensoriomotor inferior en comparación a los niños nacidos a término.…”

“…Silveira et al [202], verificaron que un 25% de los recién nacidos con [220] defienden que retrasar el momento de la intervención hasta que las anormalidades neuromotoras sean evidentes, hace que el proceso de rehabilitación sea menos efectivo y con mayor coste emocional para la familia En algunos estudios del desarrollo de niños prematuros se ha observado que el desarrollo motor grosero es considerado el más retrasado dentro de otras áreas analizadas [221]. Formiga [120], en su estudio referente a la evaluación motora de niños prematuros, verificó que un 48% de sus niños presentaron retraso motor entre los 2 y 4 meses de edad, un 47% presentaron retraso motor entre los 4 y 6 meses y un 36% de sus niños presentaron retraso motor entre los 6 y 8 meses (siempre considerando ECORR, en casos de evaluaciones realizadas en niños prematuros). En un estudio de Campbell et al [48], que utilizaron la AIMS para determinar retraso motor, encontraron un 28% de la muestra con retraso a los 6 meses de edad.…”

“…Se considera el PN de los niños un factor muy importante para su pronóstico tanto en el momento del nacimiento como un su desarrollo futuro. En general, los niños nacidos con peso inferior a 1.500 g son aquellos considerados de riesgo para el desarrollo porque son más vulnerables para problemas respiratorios, poseen dificultades para mantener la temperatura corporal y organizar sus movimientos, además de sufrir diversos procedimientos durante su periodo ingreso hospitalario [120]. En relación al PN, ya se ha discutido anteriormente, que estos niños presentan retraso motor principalmente porque el criterio de selección de la muestra ha sido prematuros nacidos con peso inferior a 1.500 g y ha quedado claro que ellos presentan en su primer año de vida retrasos motores.…”

“…En un estudio de Formiga [120] la característica PN y TI también fueron consideradas predictivas para problemas en el desarrollo motor de niños prematuros.…”