Monitoramento eletrofisiológico do sistema auditivo central em crianças nascidas pequenas para a idade gestacional

Abstract

RESUMO Objetivo Monitorar o sistema auditivo central de crianças nascidas pequenas para a idade gestacional, por meio da avaliação eletrofisiológica da audição, para verificar a ocorrência de eventuais disfunções neurais nesse sistema. Métodos Estudo longitudinal, cuja casuística foi composta por 23 crianças distribuídas em quatro grupos: 1) grupo de quatro crianças nascidas pequenas para a idade gestacional e a termo; 2) grupo de sete crianças nascidas pequenas para a idade gestacional e pré-termo; 3) grupo de quatro crianças nascidas com peso adequado para a idade gestacional e a termo; 4) grupo de oito crianças nascidas adequadas para a idade gestacional e pré-termo, cuja idade ao final da pesquisa foi de 3 anos (variação entre 34 e 39 meses). O critério de inclusão foi presença bilateral de emissões otoacústicas transientes. Todas as crianças foram submetidas ao potencial evocado auditivo de tronco encefálico ao nascimento, aos 6 meses e aos 3 anos de idade e à pesquisa do potencial evocado auditivo de longa latência aos 3 anos. Resultados crianças nascidas pequenas para a idade gestacional e a termo tiveram maior ocorrência de alterações, em relação aos demais grupos, com aumento da latência das ondas III e V e interpicos I-III e I-V. Todas apresentaram resultados normais no potencial evocado auditivo de longa latência. Conclusão Crianças nascidas pequenas para a idade gestacional e a termo apresentam disfunções na condução neural no tronco encefálico e devem ser consideradas de risco para alterações do desenvolvimento das habilidades auditivas necessárias para garantir qualidade de processamento da informação acústica.

Auditory Pathway Maturation in Full-term Small for Gestational Age Children: A Systematic Review with Meta-analysis

“…So, five studies concluded with their investigations that there are changes in neural development in the SGA population influencing the maturation process of the auditory pathway, resulting in abnormalities in the BAEP test. 10 12 16 26 31 On the other hand, five studies 15 25 27 28 29 did not evidence differences between the SGA and AGA groups. These disparities among the results can be justified by some peculiarities among the studies, such as the population studied, differences of methodologies, the type of study used, and the small number of participants in some of the studies.…”

“…These disparities among the results can be justified by some peculiarities among the studies, such as the population studied, differences of methodologies, the type of study used, and the small number of participants in some of the studies. 16,26 Seeking a better understanding of the influence of body proportionality in the process of auditory maturation in SGA newborns, two study groups were analyzed in the first six months of life, one classified as asymmetric and the other as a symmetric group. In the first days of life, there was an alteration in the BAEP in more than 30% in SGA groups, both symmetric and asymmetric, suggesting transitory retro cochlear alterations.…”

“…The prolongation of wave V latency can have different meanings, such as the maturation process of central auditory pathways or by peripheral conductive alteration, for instance. 30 All studies used in our review only included in their investigations full-term participants with normal hearing, who presented the bilateral presence of otoacoustic emissions and a type A tympanometry curve 10,16,25,27,31 and were free of risk factors, known for affecting hearing function. 15,26,28,29 Therefore, the risk factor studied that could affect hearing function was the SGA factor.…”

“…These disparities among the results can be justified by some peculiarities among the studies, such as the population studied, differences of methodologies, the type of study used, and the small number of participants in some of the studies. 16 26…”

“…14 Later, it was shown that the significant delay of wave I and the reduction of I-V interpeak interval in the SGA population would be related to the immaturity of the basal end of the cochlea. 15 Recently, it was demonstrated that SGA children had an increase in the latency of waves III and V and interpeak I-III and I-V. 16 In line, it has been shown that prenatal factors responsible for intrauterine growth restriction (IUGR) can change the conduction time and development of brainstem or long-term nervous system development, resulting in a suboptimal outcome. 12 Indeed, young adults born as SGA babies have a reduction in auditory processing and in selective attention functions.…”