Predictive factors for neuromotor abnormalities at the corrected age of 12 months in very low birth weight premature infants

Abstract

-Background: The increase in survival of premature newborns has sparked growing interest in the prediction of their long-term neurodevelopment. Objective: To estimate the incidence of neuromotor abnormalities at the corrected age of 12 months and to identify the predictive factors associated with altered neuromotor development in very low birth weight premature infants. Method: Cohort study. The sample included 100 premature infants. The outcome was neuromotor development at 12 months classified by Bayley Scale (PDI) and neurological assessment (tonus, reflexes, posture). A multivariate logistic regression model was constructed. Neonatal variables and neuromotor abnormalities up to 6 months of corrected age were selected by bivariate analysis. Results: Mean birth weight was 1126g (SD: 240). Abnormal neuromotor development was presented in 60 children at 12 months corrected age. Conclusion: According to the model, patients with a diagnosis including bronchopulmonary dysplasia, hypertonia of lower extremities, truncal hypotonia showed a 94.0% probability of neuromotor involvement at 12 months.KEY WORDS: infant, premature, child development, psychomotor performance, risk factors.Fatores preditivos para anormalidades neuromotoras aos 12 meses de idade corrigida em prematuros de muito baixo peso resumo -Introdução: O aumento na sobrevida de recém-nascidos prematuros tem suscitado interesse crescente na predição do seu neurodesenvolvimento a longo prazo. Objetivo: Estimar a incidência de anormalidades neuromotoras aos 12 meses de idade corrigida e identificar os fatores associados ao desenvolvimento neuromotor alterado em prematuros de muito baixo peso. Método: Estudo de coorte. A amostra incluiu 100 crianças prematuras.O desfecho foi o desenvolvimento neuromotor aos 12 meses. Modelo de regressão logística multivariado foi construído. Variáveis neonatais e anormalidades neuromotoras até os 6 meses de idade corrigida foram selecionadas por análise bivariada. Resultados: O peso de nascimento médio foi 1126g (DP:240). Aos 12 meses 60% das crianças apresentaram desenvolvimento neuromotor alterado. Conclusão: De acordo com o modelo, pacientes com diagnóstico incluindo displasia broncopulmonar, hipertonia de membros inferiores e hipotonia de tronco tinham 94% de probabilidade de comprometimento neuromotor aos 12 meses. PAlAVRAS-ChAVE: desenvolvimento infantil, desempenho psicomotor, criança, prematuro, fatores de risco.

Efeitos da prematuridade na aquisição da linguagem e na maturação auditiva: revisão sistemática

“…The fulfillment of the mother role is impaired, since in order to perform this task satisfactorily she must be emotionally stable, as the main caregiver. Psychological risk affects mother, child, and bond, which is key for development (3,4) , particularly the development of language (11) . Considering hearing conditions, it is known that auditory monitoring of premature children is also extremely important, not only to avoid or remedy hearing problems, but also to minimize their effects on language acquisition.…”

“…This increase in survival rates of ever smaller and premature infants compels questioning as to the quality of their future life as well as a growing interest in predicting their long-term global development (4,5) . It is worth noting that in order to carry out these analyses in premature infants it is recommended that, for the first two years of life, the corrected age -also known as adjusted age -be considered as well (6) .…”

“…Corrected age translates the adjustment of chronological age according to the degree of prematurity, and is assessed by means of the Capurro or New Ballard method (7) . Due to this interest, several authors have identified abnormal neurological signs during these infants' first year of age, although the studies encounter difficulties in predicting if these signs are definitive or temporary (4)(5)(6)(7)(8) . It is observed that premature infants are at greater risk of development deficits than full-term infants, as the chances of premature infants presenting disabilities in cognitive and attention development and self-regulation are higher.…”

“…It is observed that premature infants are at greater risk of development deficits than full-term infants, as the chances of premature infants presenting disabilities in cognitive and attention development and self-regulation are higher. These issues tend to continue throughout childhood, having been associated with learning and attention disabilities and behavioral problems (3)(4)(5)(6)(7)(8) . Thus, we highlight the importance of studying the development of preterm infants within a context guided by association with different risk factors, which involve variables such as the birth and the outcomes of the infant's clinical conditions during hospitalization (1) .…”

Fatores de risco psíquico ao desenvolvimento infantil: implicações para a fonoaudiologia

“…Entretanto, sabe-se que estes bebês estão sob maior risco para déficits no desenvolvimento em relação aos bebês a termo porque podem ser identificados sinais de vulnerabilidade na criança prematura 21 . O aumento da sobrevida dos recém-nascidos prematuros nas últimas décadas provocou um interesse crescente na predição do desenvolvimento global de longo prazo dessas crianças 22 . A partir desse interesse, vários autores têm detectado sinais neurológicos anormais durante o primeiro ano de vida desses recém-nascidos, embora tenha sido difícil prever se estes sinais serão transitórios ou definitivos 22 .…”