Detecção de risco para problemas no desenvolvimento de bebês nascidos pré-termo no primeiro ano / Identification of risk factors for developmental problems during the first year of life in preterm infants

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

Several biological and environmental risk factors influence the development of preterm infants. The objective of this study was to assess risk factors for development delay in preterm infants born with low birth weight, focusing on the following domains: neurobehavioral achievements in the neonatal phase, as well as personal-social, language and motor developments in the first 8 months of postnatal age. We also aimed to: identify the better predictive model for development, based on the biological and socioeconomic variables measured in our sample of low birth weight preterm; to longitudinally follow and to describe the development of these infants during the first 8 months of corrected chronological age (CA); to test the psychometric parameters and to estimate the predictive value of the Neurobehavioral Assessment of Preterm Infant (NAPI) and Denver II tests (DDST-II), in assessing the motor development of the infants. Our sample consisted of 190 preterm infants (<37 weeks of gestational age) and with low birth weight (<2,500 grams) seen during their first year of age, born and initially assisted at a neonatal specialty center at the Infant Maternity Hospital of Goiania (GO), Brazil. At the neonatal phase, the infants were assessed using the NAPI test; from 2-4 months of CA, we used the Test of Infant Motor Performance (TIMP); from 4-6 months and 6-8 months of CA, we used, the DDST-II; from 6-8 months of CA, we used the Alberta Infant Motor Scale (AIMS). Initial assessments were performed in the neonatal unit of intermediate risk (while the infants were hospitalized); subsequent assessments were conducted in our outpatient hospital clinic (ambulatory) for high risk infants. Descriptive statistics included mean, range, and standard deviation for continuous variables, and frequency and percentage for categorical variables. The in-between group comparisons were conducted using the Chi-square Test or Student T Test. For predictive assessments, we used logistical regression. The significance level for each test was set at 5%. Over 31% of the infants in our sample showed signs of impaired neurobehavioral development in the neonatal phase. Infants assessed from 2-4 months of CA had 51% of risk for developmental problems according to the DDST-II; 48% obtained abnormal classifications in the TIMP. Similarly, 43 % of the infants were at risk in the DDST-II, and 47% had abnormal motor development according to the AIMS at 4-6 months of CA. At 6-8 months of CA, 33% of the infants were at risk as per the DDST-II, and 36% of the infants had abnormal motor development according to the AIMS. When comparing the development of the infants as per the chronological and corrected age, it became evident the needs for correcting the age in all assessed age-ranges. The main variables imposing risk and influencing the development of our sample were: weight <1.500g; gestational age 32 weeks; high neonatal clinical risk; presence of intracranial hemorrhage; lack of natural breast feeding; low levels of education by the household head; number of individuals living in the household; reduced number of rooms in the household; low socio-economic level. The 80 infants that were longitudinally followed had 24% of delay, as measured by the neurobehavioral assessment conducted in the neonatal phase, and mantained the risk levels for global development, as well as deleyed in motor development between 2 to 8 months of CA. Regarding our concurrent validty study, the DDST-II test showed 64% of agreement with the TIMP test between 2 and 4 months of CA; the agreement with AIMS betwen 4 and 6 months of CA was 89%, and from 6-8 months of CA it was 82%. Regarding the predictive values, the NAPI assessment for motor and global developments agreeed with the DDST-II test in 52%, in the age ranges measured by the AIMS.

ASSUNTO(S)

delay preterm infants risk factors atraso no desenvolvimento detecção de risco bebê pré-termo risk detection desenvolvimento infantil fatores de risco child development

ACESSO AO ARTIGO

Documentos Relacionados