The aim of the present study was to examine the efficacy and potential side effects of repeated doses of oral sucrose for pain relief during procedures in NICU. Thirty-three preterm neonates were randomly allocated in blind fashion into two groups, the sucrose group (SG=17) and the control group (CG=16). The responses of neonates to pain and distress were assessed during blood collection on four consecutive assessment (ass.) days. For the first assessment, the neonates did not receive any solution before the blood collection procedure. During the next three days, the SG received oral sucrose (25%; 0.5 ml/kg) and the CG received sterile water, 2 min before each minor acute painful procedure. The neonates were evaluated during blood collection each morning. The assessment was divided into five phases: Baseline (BL), Antisepsis (A), Puncture (P), Dressing (D), and Recovery (R). The neonates' facial activity (NFCS), behavioral state, and heart rate were evaluated. The data analysis used cut-off scores for painful and distressful responses. No side effects of using sucrose were detected. There were significantly fewer SG neonates with facial actions signaling pain than CG neonates in P (ass.2) and in A (ass.3). We found significantly fewer SG neonates in the awake state than CG neonates in P (ass.2 and ass.4). There were significantly fewer SG neonates crying during A (ass.2), P (ass.2 and ass.4), and D (ass.3). There was no statistical difference between-groups for physiological response. The efficacy of sucrose was maintained for pain relief in preterm neonates with no side effects.

RESUMO:O objetivo do presente estudo consistiu em avaliar o impacto do nascimento de bebês extremamente prematuros (<1500g). Foram estudadas duas amostras de sujeitos: uma constituída por mães de recém-nascidos pré-termo e com muito baixo peso, hospitalizados em UTI-Neonatal e outra com 34 crianças de oito a dez anos nascidas pré-termo e com peso <1500g e 20 crianças nascidas a termo e com peso > 2500g. Os efeitos precoces da prematuridade foram identificados na análise de conteúdo das verbalizações maternas em 20 sessões de grupo de apoio durante a internação do bebê na UTIN. As crianças da fase escolar foram avaliadas pelos testes de Raven, Desenho da Figura Humana, Escala Comportamental Infantil A2 de Rutter e um questionário (mães). Os resultados mostraram as mães preocupadas com a sobrevivência e evolução dos bebês, com a separação devido à internação na UTIN e sentimento de incompetência em desempenhar seu papel. 49% das crianças da fase escolar evidenciaram inteligência média ou acima e 42% limítrofes; 18% apresentou deficiência auditiva; 82% estavam em escola regular. Problemas comportamentais verificados: agitação, impaciência, inquietude e agarramento à mãe Palavras chave: Pré-termo; Baixo peso; Risco ao desenvolvimento. PRETERM AND LOW BIRTHWEIGHT AS A RISK FOR THE DEVELOPMENT OF CHILDREN ABSTRACT:The aim of the present study consisted of assessing the impact of extremely pre-term low birth weight (<1500g). It were studied two samples of subjects: one of pre-term newborn mothers (with very low weight committed on ICU-Neonatal of HCFMRP-USP) and other made up of 34 children from eight to ten years old that were born pre-term and with <1500g of weight and 20 children born full term and with >2500g. Early effects of prematurity were identified through analysis of mothers verbalizations' content in 20 group support sessions during the babies' commitment on ICU. The assessment phase of school children included Raven's and Human Figure Draw Tests, Child Behavioral Scale A2 of Rutter and a questionnaire to the mothers. It was verified a high mother's preoccupation with babies' survival, evolution, mother's separation, and incompetence sense to perform their role. 49% of school age children showed average intelligence and 42% were borderline; 18% presented aural deficiency; 82% were attending regular school. There appeared behavioral problems as agitation, impatience, and attachment to the mother.

Resumo O presente estudo objetivou avaliar indicadores do desenvolvimento psicológico na fase escolar de crianças nascidas pré-termo com muito baixo peso e compará-los aos de crianças nascidas a termo, quanto às áreas intelectual, emocional e comportamental. A amostra foi composta por 40 crianças de 8 a 10 anos, subdivididas em 2 grupos: Pré-termo (PT), 20 crianças nascidas <37 semanas de idade gestacional e peso <1.500 g e A Termo (AT), 20 crianças nascidas a termo com peso >2.500g. Foram utilizados o Raven, o Desenho da Figura Humana e a Escala Comportamental Infantil. As crianças PT apresentaram mais freqüentemente nível intelectual inferior à média e problemas comportamentais em comparação às AT. Não houve diferença entre os grupos quanto aos aspectos emocionais. Os problemas de enurese, medo, tiques, impaciência e dificuldade de permanência nas atividades foram significativamente mais freqüentes no PT do que no AT. Verificou-se que, no grupo PT, quanto menor o nível intelectual das crianças, mais problemas de comportamento elas apresentavam. Palavras-chave: Pré-termo; muito baixo peso de nascimento; desenvolvimento; inteligência; comportamento.

The purpose of this study was to assess the behavioral and physiological reactivity of preterm neonates during different phases of a blood collection procedure involving arterial puncture. The sample consisted of 43 preterm and very low birth weight neonates with a postnatal age of 1 to 21 days who were hospitalized in the Neonatal Intensive Care Unit. The neonates were evaluated during the whole blood collection procedure. The assessment was divided into five consecutive phases: Baseline (BL); Antisepsis (A), covering the period of handling of the neonate for antisepsis prior to puncture; Puncture (P); Recovery-Dressing (RD), covering the period of handling of the neonate for dressing until positioning for rest in the isolette; and Recovery-Resting (RR). Facial activity was videotaped and analyzed using the Neonatal Facial Coding System (NFCS). The sleep-wake state and heart rate were registered at the bedside. There was a significant increase in NFCS score and heart rate, and more active behavior during phases A, P, and RD relative to BL. Regarding the tactile stimulation of the infant in pre-puncture (A) and post-puncture (RD), it was observed increased NFCS score, heart rate, and active behavior in comparison to the BL and RR phases. There was evidence of distress responses immediately before and after a painful event, quite apart from the pain reaction to the puncture procedure.

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