Neurodesenvolvimento em Crianças Nascidas Pré-Termo de Muito Baixo Peso: Fatores de Risco Ambientais e Biológicos

Abstract

Introdução: Pretendeu-se avaliar o neurodesenvolvimento em recém-nascidos pré-termo de muito baixo peso aos 24-30 meses de idade e correlacioná-lo com fatores de risco biológicos e ambientais. Métodos: Estudo observacional, retrospetivo de uma coorte de crianças nascidas entre janeiro de 2005 e dezembro de 2013, com idade gestacional inferior a 32 semanas e/ou peso de nascimento inferior a 1500 g numa maternidade de apoio perinatal diferenciado. Avaliou-se o neurodesenvolvimento aos 24-30 meses através da schedule of growing skills scales II. Considerou--se como existência de sequelas moderadas / graves a presença de paralisia cerebral, quociente de desenvolvimento global inferior a 70, cegueira ou surdez neurossensorial com necessidade de prótese auditiva. Analisaram-se, por regressão logística, os fatores de risco biológicos e ambientais associados significativamente à ocorrência de défice moderado / grave. Resultados: As 551 crianças estudadas apresentavam um peso de nascimento médio de 1222 ± 320 g e idade gestacional média de 29,4 ± 2,3 semanas. Ocorreram 46/551 óbitos (8%). Obteve-se informação do neurodesenvolvimento em 439/505 (87%) crianças. Apresentaram sequelas no neurodesenvolvimento 46/439 (10%): quociente de desenvolvimento global inferior a 70, 29/439 (7%), paralisia cerebral 26/439 (6%), surdez com necessidade de prótese auditiva 8/439 (2%) e um (0,2%) caso de cegueira. No modelo de regressão logística as variáveis que se associaram de modo significativo a sequelas moderadas / graves foram a leucomalácia periventricular quística, baixa escolaridade materna, perímetro craniano inferior ao percentil 3 aos 24-30 meses, malformações congénitas, crianças inseridas em família não convencional e sépsis tardia. Discussão: Fatores biológicos e ambientais são determinantes no neurodesenvolvimento, pelo que devem ser acionadas atempadamente medidas de intervenção nas crianças mais vulneráveis. Palavras-chave:Criança; Distúrbios do Neurodesenvolvimento; Fatores de Risco; Fatores Socioeconómicos; Recém-Nascido de Muito Baixo Peso; Recém-Nascido Prematuro Abstract Introduction: We aimed to assess neurodevelopment outcome in very low birth weight preterm newborns at 24-30 months of age and to correlate it with biological and environmental risk factors. Methods: In an observational case-cohort study of infants born between January 2005 and December 2013, with gestational age less than 32 weeks and/or birth weight less than 1500 g in a maternity hospital with specialised perinatal support, we assessed neurodevelopmental outcome at 24-30 months by means of the Schedule of Growing Skills II. Moderate/severe deficit was considered to be present if the child had cerebral palsy, overall Developmental Quotient less than 70, blindness or profound sensorineural deafness requiring hearing aids. Biological and environmental risk factors independently associated with the presence of moderate/severe deficit were analysed by logistic regression. Results: The 551 children studied had a mean birth weight and gestational age of ...

Evaluation of Survival and Neurodevelopmental Outcomes in Neonates Born Very Preterm

“…As it is described in the literature, lower status is a risk factor for NDI. [3,7,35,43] In our study, the bivariate analysis showed that a higher level of maternal education was a protective factor for NDI, however this was not demonstrated in the multivariate analysis. In a systematic review, unlike factors related to infant characteristics, the in uence of parental education appeared to persist into middle childhood.…”

“…6%). [28,35] In our study, the incidence of CP was lower (4.8% in GA ≤ 27w and 3% at 28-31w) than what is reported in surveillance of cerebral palsy in Europe: 14% at ≤ 27w of GA, 6% at 28-31w and < 1% at 32-36w. [6, 28] Comparison with other studies in relation to the presence of NDI must be made with caution, since the methodology, the scale applied and the population studied differ in the various published studies.…”

“…Advances in medical care have led to improved survival rates among preterm infants globally [1][2][3][4][5], with the greatest increase in survival rates occurring in extreme preterm infants (EPT). [6] It is described that the increased survival of EPT infants is accompanied by a higher incidence of morbidity.…”

“…[6, 28] Comparison with other studies in relation to the presence of NDI must be made with caution, since the methodology, the scale applied and the population studied differ in the various published studies. Picciolini et al reported that 9.2% of VPT had NDI; Vermont Oxford Network reported 34.2% (included only ELBW) and EPICure reported 11.8% (included only < 27w) [27,32,35,. 36] Currently, there are few studies in Portugal evaluating neurodevelopment in VPT.…”