Neurodevelopmental assessment of very low birth weight preterm infants at corrected age of 18-24 months by Bayley III scales

Abstract

Objective: To evaluate the prevalence of delay and factors associated with neurodevelopmental scores in premature infants. Methods:Cross-sectional study to assess the development by Bayley Scales III, including very low birth weight preterm infants aged 18 to 24 months who were under follow-up at the outpatient clinic for preterm infants. Congenital malformation, genetic syndrome, symptomatic congenital infection at birth, deafness, and blindness were excluded. Numerical variables were compared by Mann-Whitney or Student t test and categorical variables by chi-square or Fisher's exact test. Factors associated with developmental scores were analyzed by linear regression, and statistical significance level was established at p < 0.05. Results:Out of the 58 children included, four (6.9%) presented cognitive delay, four (6.9%) motor, 17 (29.3%) language, 16 (27.6%) social-emotional and 22 (37.0%) adaptive-behavior delay. By multiple linear regression, the variables: social classes CDE (-13.27; 95%CI: -21.23 to -5.31), oxygen dependency at 36 weeks of corrected age (-8.75; 95%CI: -17.10 to -0.39) decreased the cognitive developmental score. Periventricular leukomalacia decreased the cognitive (-15.21; 95%CI: -27.61 to -2.81), motor to -1.59) and adaptivebehavior scores ). The female sex was associated with higher motor (10.67; 95%CI: 2.77 to 12.97), language (15.74; 95%CI: 7.39 to 24.09) and social-emotional developmental scores (10.27; 95%CI: 1.08 to 19.46). Conclusions:Very low birth weight preterm infants aged from 18 to 24 months of corrected age presented more frequently language, social-emotional and adaptive-behavior delays. The variables: social classes CDE, periventricular leukomalacia, bronchopulmonary dysplasia and male sex reduced the neurodevelopmental scores.J Pediatr (Rio J). 2012;88(6):471-8: Infant premature, very low birth weight infant, child development. ResumoObjetivo: Avaliar a prevalência de atraso e fatores associados aos escores de desenvolvimento em crianças nascidas prematuras.Métodos: Estudo transversal para avaliar o desenvolvimento por escalas Bayley III, incluindo-se prematuros de muito baixo peso de 18 a 24 meses de idade corrigida, acompanhados no Ambulatório de Prematuros da instituição. Excluíram-se: malformação congênita, síndrome genética, infecção congênita sintomática ao nascimento, surdez e cegueira. As variáveis numéricas foram comparadas por teste t de Student ou MannWhitney, e as categóricas, por qui-quadrado ou teste exato de Fisher. Para análise dos fatores associados aos escores de desenvolvimento, utilizou-se a regressão linear, considerando-se significante p < 0,05.Resultados: Das 58 crianças avaliadas, quatro (6,9%) apresentaram alteração cognitiva; quatro (6,9%), motora; 17 (29,3%), de linguagem; 16 (27,6%), socioemocional; e 22 (37,9%), de comportamento adaptativo. À regressão linear múltipla, os fatores classe socioeconômica CDE (-13,27; IC95% -21,23 a -5,31) e dependência de oxigênio com 36 semanas de idade corrigida (-8,75; IC95% -17,10 a -0,39) diminuíra...

Variáveis de risco para o desenvolvimento da linguagem associadas à prematuridade

“…A number of studies in the field of child development have investigated the association between preterm birth and handicap in this development, comprising sensory, growth, language and / or learning gaps (2,3,4,5,6,7,8,9,10,11) . However, such risk is not due to prematurity per se, but can be attributed to the adverse conditions associated with preterm birth, which may evolve to nervous system damage (5,8,19,21,22) . The aim of this study was to assess the adversities to which children born under the complex condition of prematurity are exposed, determining which factors are involved in the language development delay.…”

“…Damage to any of these aspects may specifically affect language skills, which develops in parallel and integrally / intrinsically with cognitive skills (1) . This development may be affected by several complications during gestational, perinatal and / or postnatal periods, among which prematurity is one of the known risk factors for linguistic impairment (1,2,3,4,5,6,7,8,9,10,11) . According to the World Health Organization (12) , newborns are babies with a gestational age of less than 37 completed weeks (borderline preterm infants: 35-36 gestational weeks; moderate preterm infants: 31-34 gestational weeks; extremely preterm infants: <30 gestational weeks) given that, the lower the gestational age, the greater the probability of mortality, abandonment and health problems.…”

“…Regarding the linguistic development of this risk group, there are evidences that preterm infants have changes in several linguistic subdomains (5,6,8) and those changes are variable, i.e., a child may have impairments in phonological development, but not in lexical development (18) . There are reports in the literature involving the population of preterm infants pointing out that impairments in expressive language are more frequent when compared to those of receptive language (10,11) and that, between 2 and 3 years of age, pragmatic disorders, characterized by a difficulty in the heuristic function and in respecting communicative turns, participating and maintaining dialogic activities, are observed (9) .…”

“…At preschool age, phonological disorders and difficulties with narratives prevail (10) . Prematurity is undoubtedly a risk factor for neuropsychomotor and linguistic development, but clinical practice associated with results of a few studies (8,19) has shown that the risk for development does not originate from prematurity per se, but from its relation to several complications resulting from this condition (e.g., weight, gestational age, perinatal events).…”

Batería Luria Inicial y desarrollo de las funciones psicológicas superiores [Initial Battery Luria and development of higher psychological functions]

“…El perfil cognitivo que muestra el niño 1.500-2.500 g es menos discapacitante que las demás poblaciones por debajo a 1.500 g (Bjuland, Løhaugen, Martinussen y Skranes, 2012; Fernandes et al, 2012;Kwinta et al, 2012;Walhovd et al, 2012), quizás por la condición clínica «bajo peso al nacer» y el efecto de la prematuridad.…”