CONCURRENT VALIDITY OF THE BRUNET-LÉZINE SCALE WITH THE BAYLEY SCALE FOR ASSESSMENT OF THE DEVELOPMENT OF PRETERM INFANTS UP TO TWO YEARS. / VALIDADE CONCORRENTE DA ESCALA BRUNET-LÉZINE COM A ESCALA BAYLEY PARA AVALIAÇÃO DO DESENVOLVIMENTO DE BEBÊS PRÉ-TERMO ATÉ DOIS ANOS.

OBJECTIVE: To verify the correlation between the areas evaluated by the Brunet-Lézine and the Bayley III scales of preterm infants up to two years. METHODS: The study included 88 children who were divided into 3 groups: Group 1 (1 month to 5 months and 29 days of corrected chronological ages - CCA) with 32 children; Group 2 (6 months to 11 months and 29 days of CCA) with 36 participants; and Group 3 (18 -23 months and 23 days of CCA) with 20 children. The concurrent validity of the Brunet-Lézine scale and the Bayley III scale was calculated using the Pearson correlation or its non-parametric version, the Spearman correlation. RESULTS: Group 1 showed moderate correlation between the developmental quotient for hand-eye and fine motor coordination (DQE), and fine motor score (ρ=0.448; p=0.01). Group 2 had moderate correlation between the developmental quotient for posture and gross motor function (DQP), and the gross motor score (ρ=0.484; p=0.003, between the DQE and fine motor score (r=0.489; p=0.002), and between the developmental quotient for social reactions (DQS) and the socio emotional score (r=0.435; p=0.008). Group 3 showed moderate correlation between the DQP and the gross motor score (ρ=0.468; p=0.037) and strong correlation between developmental quotient for language (DQL) and the score of language (r=0.890; p<0.001). CONCLUSIONS: The Brunet-Lézine scale showed strong correlation with the Bayley III scale regarding the language domain in Group 3, suggesting its validity to assess the language of children aged between 18 and 24 months.

OBJETIVO: Verificar a correlação entre as áreas avaliadas pela Escala Brunet-Lézine e pela Escala Bayley III no desenvolvimento de bebês pré-termo de risco até dois anos de idade. MÉTODOS: Foram incluídas no estudo 88 crianças, divididas em 3 grupos: Grupo 1 (1 mês a 5 meses e 29 dias de idade cronológica corrigida - ICC), com 32 crianças; Grupo 2 (6 meses a 11 meses e 29 dias de ICC), com 36 participantes; e Grupo 3 (18 meses a 23 meses e 23 dias de ICC), com 20 crianças. A validade concorrente entre a Escala Brunet-Lézine e a Escala Bayley III foi calculada por meio da correlação de Pearson ou de sua versão não paramétrica, a correlação de Spearman. RESULTADOS: No Grupo 1 houve correlação moderada entre o quociente de desenvolvimento da coordenação óculo-motriz (QDC) e o escore motor fino (ρ=0,448; p=0,01). No Grupo 2 foi encontrada correlação moderada entre o quociente de desenvolvimento da postura (QDP) e o escore motor grosseiro (ρ=0,484; p=0,003), entre o QDC e o escore motor fino (r=0,489; p=0,002) e entre o quociente de desenvolvimento de sociabilidade (QDS) e o escore socioemocional (r=0,435; p=0,008). No Grupo 3 foi observada correlação moderada entre o QDP e o escore motor grosseiro (ρ=0,468; p=0,037), e correlação forte entre o quociente de desenvolvimento da linguagem (QDL) e o escore da linguagem (r=0,890; p<0,001). CONCLUSÕES: A Escala Brunet-Lézine apresentou forte correlação com a Escala Bayley III quanto à linguagem no Grupo 3, o que sugere a sua validade para avaliar crianças entre 18 e 24 meses de idade nesse quesito.

Validade concorrente da escala brunet-lézine com a escala bayley para avaliação do desenvolvimento de bebês pré-termo até dois anos / Concurrent validity of the brunet-lézine scale with the bayley scale for assessment of the development of preterm infants up to two years

RESUMO Objetivo: Verificar a correlação entre as áreas avaliadas pela Escala Brunet-Lézine e pela Escala Bayley III no desenvolvimento de bebês pré-termo de risco até dois anos de idade. Métodos: Foram incluídas no estudo 88 crianças, divididas em 3 grupos: Grupo 1 (1 mês a 5 meses e 29 dias de idade cronológica corrigida - ICC), com 32 crianças; Grupo 2 (6 meses a 11 meses e 29 dias de ICC), com 36 participantes; e Grupo 3 (18 meses a 23 meses e 23 dias de ICC), com 20 crianças. A validade concorrente entre a Escala Brunet-Lézine e a Escala Bayley III foi calculada por meio da correlação de Pearson ou de sua versão não paramétrica, a correlação de Spearman. Resultados: No Grupo 1 houve correlação moderada entre o quociente de desenvolvimento da coordenação óculo-motriz (QDC) e o escore motor fino (ρ=0,448; p=0,01). No Grupo 2 foi encontrada correlação moderada entre o quociente de desenvolvimento da postura (QDP) e o escore motor grosseiro (ρ=0,484; p=0,003), entre o QDC e o escore motor fino (r=0,489; p=0,002) e entre o quociente de desenvolvimento de sociabilidade (QDS) e o escore socioemocional (r=0,435; p=0,008). No Grupo 3 foi observada correlação moderada entre o QDP e o escore motor grosseiro (ρ=0,468; p=0,037), e correlação forte entre o quociente de desenvolvimento da linguagem (QDL) e o escore da linguagem (r=0,890; p<0,001). Conclusões: A Escala Brunet-Lézine apresentou forte correlação com a Escala Bayley III quanto à linguagem no Grupo 3, o que sugere a sua validade para avaliar crianças entre 18 e 24 meses de idade nesse quesito.

ABSTRACT Objective: To verify the correlation between the areas evaluated by the Brunet-Lézine and the Bayley III scales of preterm infants up to two years. Methods: The study included 88 children who were divided into 3 groups: Group 1 (1 month to 5 months and 29 days of corrected chronological ages - CCA) with 32 children; Group 2 (6 months to 11 months and 29 days of CCA) with 36 participants; and Group 3 (18 -23 months and 23 days of CCA) with 20 children. The concurrent validity of the Brunet-Lézine scale and the Bayley III scale was calculated using the Pearson correlation or its non-parametric version, the Spearman correlation. Results: Group 1 showed moderate correlation between the developmental quotient for hand-eye and fine motor coordination (DQE), and fine motor score (ρ=0.448; p=0.01). Group 2 had moderate correlation between the developmental quotient for posture and gross motor function (DQP), and the gross motor score (ρ=0.484; p=0.003, between the DQE and fine motor score (r=0.489; p=0.002), and between the developmental quotient for social reactions (DQS) and the socio emotional score (r=0.435; p=0.008). Group 3 showed moderate correlation between the DQP and the gross motor score (ρ=0.468; p=0.037) and strong correlation between developmental quotient for language (DQL) and the score of language (r=0.890; p<0.001). Conclusions: The Brunet-Lézine scale showed strong correlation with the Bayley III scale regarding the language domain in Group 3, suggesting its validity to assess the language of children aged between 18 and 24 months.

Regional pulmonary blood flow: Comparison of dynamic contrast-enhanced MR perfusion and phase-contrast MR.

Regional pulmonary blood flow can be assessed using both dynamic contrast-enhanced (DCE) MR and phase-contrast (PC) MR. These methods provide somewhat complementary information: DCE MR can assess flow over the entire lung while PC MR can detect rapid changes in flow to a targeted region. Although both methods are considered accurate, one may be more feasible than the other depending on pathology, patient condition, and availability of an intravenous route. The objective of this study was to establish a consensus between the two methods by comparing paired DCE MR and PC MR measurements of relative blood flow in Yorkshire piglets (N = 5, age = 7 days, weight = 3.3 +/- 0.6 kg) under various physiological states including regional lung collapse. A strong correlation (R(2) = 0.71, P < 0.01) was observed between the methods. In conclusion, DCE MR and PC MR provide a consistent measure of changes in regional pulmonary blood flow.

Tadalafil improves oxygenation in a model of newborn pulmonary hypertension.

OBJECTIVES: Sildenafil, a phosphodiesterase-5 inhibitor, significantly improves oxygenation when used in animal models and patients with pulmonary hypertension. Tadalafil is a new and clinically available phosphodiesterase-5 inhibitor that, aside from causing pulmonary vasodilation, has been shown to increase cardiac output in pulmonary hypertensive adults. Its hemodynamic effects on the newborn, however, have not been tested. The objective was to evaluate the effect of tadalafil on central hemodynamics and arterial oxygenation in a piglet model of acute pulmonary hypertension. DESIGN: Laboratory experiment. SETTING: University laboratory. SUBJECTS: Seven anesthetized and mechanically ventilated newborn piglets. INTERVENTIONS: Pulmonary hypertension was induced and maintained in seven anesthetized and mechanically ventilated newborn piglets following acute exposure to 11% oxygen. The experimental animals received orla tadalafil (1 mg/kg), whereas the control animals were given an equal volume of normal saline. Systemic and pulmonary hemodynamic variables were measured, and the cardiac output and ejection fraction were obtained from two-dimensional echocardiogram and Doppler measurements in all animals. Serial arterial blood gases were also obtained, and the alveolar-arterial oxygen gradient was calculated. MEASUREMENTS AND MAIN RESULTS: In contrast with the control animals, in which no significant changes were noted, in the experimental animals pulmonary arterial pressure decreased on average by 54% and cardiac output increased by 88% following tadalafil administration (p < .05). Tadalafil increased the PaO2 by 48% +/- 21% (p < .01), likely as a result of a 74% +/- 13% reduction in the alveolar-arterial oxygen gradient (p < .01). CONCLUSIONS: In a newborn animal model of acute pulmonary hypertension, oral tadalafil administration reduces pulmonary vascular resistance and increases arterial oxygenation by increasing cardiac output and reducing the lung shunt fraction. This previously untested compound deserves additional investigation in laboratory models of persistent pulmonary hypertension of the newborn.

Sildenafil acutely reverses the hypoxic pulmonary vasoconstriction response of the newborn pig.

Sildenafil is a pulmonary vasodilator shown to be effective in neonates, but conflicting data exist regarding its effect on arterial oxygenation. To address this issue, we tested the sildenafil effect on the piglet's hypoxic pulmonary vasoconstriction (HPV) response. A segmental lung atelectasis was created by obstructing the corresponding bronchus. Total pulmonary and specific flows to the atelectatic and contra-lateral lobes were measured by magnetic resonance (MR) before and 30-min post sildenafil (0.2 and 1 mg/kg i.v.) or saline administration. Flow was reduced (p < 0.01) in the atelectatic and increased in the contra-lateral lobe indicating an effective HPV response. Sildenafil at both doses significantly (p < 0.01) increased flow solely to the atelectatic lobe. At a dose of 1 mg/kg, sildenafil induced a decrease in Pao2 from 285 +/- 37 to 161 +/- 22 mm Hg (p < 0.01). We conclude that the HPV response in the newborn is capable of almost completely reducing blood flow to nonventilated lung units and is reversed following sildenafil i.v. administration in a dose-dependent manner. In the presence of lung parenchymal disease, the use of i.v. sildenafil as a pulmonary vasodilator may worsen arterial oxygenation by reversing the HPV response in nonventilated lung units.

Human meconium has a pulmonary vascular and airway smooth muscle relaxant effect.

Meconium aspiration is believed to cause persistent pulmonary hypertension syndrome of the newborn (PPHN) via vasoconstriction, whereas meconium has a relaxant effect on rat tracheal muscle. We evaluated the meconium effect on lung vascular and airway muscle. Three-days old and adult rat 3rd-4th generation arteries and adjacent bronchi were studied in vitro. Fresh homogenized meconium did not induce arterial or airway muscle contraction. In precontracted arteries, meconium induced muscle relaxation that was greater (p < 0.01) in the newborn (53 +/- 5%), when compared with adult vessels (34 +/- 3%). This relaxant response was partially abrogated (p < 0.01) by L-NAME (28 +/- 4%) and enhanced by a superoxide scavenger (55 +/- 4%). Precontracted bronchial muscle relaxed to meconium in vitro and the magnitude of response was greater in the adult when compared with the newborn (p < 0.01). In vitro incubation with meconium (3 h) reduced agonist-stimulated force and enhanced endothelium-dependent relaxation (p < 0.01). Airway meconium instillation followed by mechanical ventilation enhanced thromboxane-induced newborn rat pulmonary arterial muscle contraction in vitro (p < 0.01). We conclude that meconium is a pulmonary vasodilator in vitro Meconium is first noted to be present at 12 wk gestation in humans. It is the by-product of fetal amniotic fluid, lanugo, skin cells, and vernix caseosa swallowing, as well it contains cells derived from the gastrointestinal tract (). Meconium composition also includes four different biliary acids (cholic, chenodeoxycholic, deoxycholic, and lithocholic) and minerals of which copper, zinc, magnesium, calcium iron, and phosphorus are the most common (). In addition, it contains plasmatic proteins such as alpha1-antitripsin and phospholipase A2 (4,5).

O uso dos inibidores da 5-fosfodiesterase do tratamento da hipertensão pulmonar do recém-nascido / The use of 5-phosphodiesterase inhibitor in the treatment of persistent pulmonary hypertension of the newborn

O objetivo do trabalho foi fazer uma revisão bibliográfica afim de obter informações atualizadas sobre o papel dos inibidores da 5-fosfodiesterase no tratamento da hipertensão pulmonar do recém-nascido, visto que 30% dos pacientes são refratários ao tratamento com óxido nítrico inaltório. Foi realizada revisão bibliográfica através do Public Medline entre os anos de 1980 e 2003. A maioria dos artigos selecionados é original. A partir da leitura é revisada, pode-se observar que existem suficientes evidências para o uso dos inibidores da 5-fosfodieterase no tratamento da hipertensão pulmonar no recem-nascidos uma vez que essas drogas possuem efeito vasodilatador pulmonar comprovado. Concluiu-se que recém-nascidos portadores de hipertensão pulmonar podem se beneficiar com o uso dos inibidores da 5-fosfodiesterase.