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1.
Rev Assoc Med Bras (1992) ; 69(4): e20221215, 2023.
Article in English | MEDLINE | ID: mdl-37075365

ABSTRACT

OBJECTIVE: The objective of this study was to evaluate the right ventricular myocardial performance index) based on echocardiography in very low birth weight premature neonates, close to hospital discharge. METHODS: This was a prospective cross-sectional study that included premature neonates with birth weight <1,500 g and gestational age <37 weeks at the Intermediate Neonatal Unit of Bonsucesso Federal Hospital from July 2005 to July 2006. The infants underwent two-dimensional color Doppler echocardiography, being the right ventricular myocardial performance index evaluated close to hospital discharge. We compared the neonatal and echocardiographic variables in neonates with and without bronchopulmonary dysplasia. RESULTS: A total of 81 exams were analyzed. The mean birth (standard deviation) weight and gestational age were 1,140 (235) g and 30 (2.2) weeks, respectively. The incidence of bronchopulmonary dysplasia was 32%. The mean right ventricle myocardial performance index (standard deviation) of the sample was 0.13 (0.06). We found a significant difference in aortic diameter [non-bronchopulmonary dysplasia 0.79 (0.07) vs. bronchopulmonary dysplasia 0.87 (0.11) cm, p=0.003], left ventricle in diastole [non-bronchopulmonary dysplasia 1.4 (0.19) vs. bronchopulmonary dysplasia 1.59 (0.21) cm, p=0.0006], ventricular septal thickness [non-bronchopulmonary dysplasia 0.23 (0.03) vs. bronchopulmonary dysplasia 0.26 (0.05) cm, p=0.032], and "a" measurement [(= sum of the isovolumetric contraction time, ejection time, and isovolumetric relaxation time) when calculating the myocardial performance index (p=0.01)]. CONCLUSION: Higher "a" interval in neonates with bronchopulmonary dysplasia suggests right ventricle diastolic dysfunction. We conclude that the right ventricle myocardial performance index is an important indicator both of ventricular function and for serial follow-up testing of very low birth weight premature neonates, especially those with bronchopulmonary dysplasia.


Subject(s)
Bronchopulmonary Dysplasia , Heart Ventricles , Infant, Newborn , Infant , Humans , Heart Ventricles/diagnostic imaging , Prospective Studies , Cross-Sectional Studies , Infant, Premature , Echocardiography, Doppler/methods , Bronchopulmonary Dysplasia/diagnostic imaging , Infant, Very Low Birth Weight
2.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 69(4): e20221215, 2023. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1431231

ABSTRACT

SUMMARY OBJECTIVE: The objective of this study was to evaluate the right ventricular myocardial performance index) based on echocardiography in very low birth weight premature neonates, close to hospital discharge. METHODS: This was a prospective cross-sectional study that included premature neonates with birth weight <1,500 g and gestational age <37 weeks at the Intermediate Neonatal Unit of Bonsucesso Federal Hospital from July 2005 to July 2006. The infants underwent two-dimensional color Doppler echocardiography, being the right ventricular myocardial performance index evaluated close to hospital discharge. We compared the neonatal and echocardiographic variables in neonates with and without bronchopulmonary dysplasia. RESULTS: A total of 81 exams were analyzed. The mean birth (standard deviation) weight and gestational age were 1,140 (235) g and 30 (2.2) weeks, respectively. The incidence of bronchopulmonary dysplasia was 32%. The mean right ventricle myocardial performance index (standard deviation) of the sample was 0.13 (0.06). We found a significant difference in aortic diameter [non-bronchopulmonary dysplasia 0.79 (0.07) vs. bronchopulmonary dysplasia 0.87 (0.11) cm, p=0.003], left ventricle in diastole [non-bronchopulmonary dysplasia 1.4 (0.19) vs. bronchopulmonary dysplasia 1.59 (0.21) cm, p=0.0006], ventricular septal thickness [non-bronchopulmonary dysplasia 0.23 (0.03) vs. bronchopulmonary dysplasia 0.26 (0.05) cm, p=0.032], and "a" measurement [(= sum of the isovolumetric contraction time, ejection time, and isovolumetric relaxation time) when calculating the myocardial performance index (p=0.01)]. CONCLUSION: Higher "a" interval in neonates with bronchopulmonary dysplasia suggests right ventricle diastolic dysfunction. We conclude that the right ventricle myocardial performance index is an important indicator both of ventricular function and for serial follow-up testing of very low birth weight premature neonates, especially those with bronchopulmonary dysplasia.

3.
Sao Paulo Med J ; 133(5): 401-7, 2015.
Article in English | MEDLINE | ID: mdl-26648428

ABSTRACT

CONTEXT AND OBJECTIVE: Prematurity has been correlated with altered lung mechanics. Some infants develop lung injury as a consequence of lung immaturity, invasive mechanical ventilation and exposure to oxygen, thus resulting in bronchopulmonary dysplasia. The aim here was to compare the lung mechanics of preterm infants with and without bronchopulmonary dysplasia during the first year of life. DESIGN AND SETTING: Prospective cohort study in a tertiary-level hospital. METHODS: This study included premature infants at a public hospital who underwent two pulmonary function tests: one at discharge and the other at the corrected age of 4 to 8 months. Tidal volume, lung compliance and lung resistance were measured. Statistical tests were used for comparisons between infants with and without bronchopulmonary dysplasia. RESULTS: 102 children with mean gestational age of 29 ± 2.0 weeks were studied; 17 with bronchopulmonary dysplasia. Lung compliance (0.84 ± 0.29 versus 1.28 ± 0.46; P < 0.001) and tidal volume (6.1 ± 0.94 versus 7.2 ± 1.43; P < 0.01) at discharge were significant lower in children with bronchopulmonary dysplasia than in those without the disease, but no differences were observed at the second test (compliance: 1.53 ± 0.77 versus 1.94 ± 1.01; P = 0.12; and tidal volume: 6.9 ± 1.4 versus 7.3 ± 1.6; P = 0.42). CONCLUSION: Differences in lung mechanics were observed between infants with and without bronchopulmonary dysplasia at hospital discharge but these differences were no longer detected at the final follow-up. The lung mechanics of all the infants improved over this period of time.


Subject(s)
Bronchopulmonary Dysplasia/physiopathology , Infant, Premature/physiology , Infant, Very Low Birth Weight/physiology , Lung/physiopathology , Respiratory Mechanics/physiology , Female , Gestational Age , Humans , Infant , Infant, Newborn , Male , Prospective Studies , Reference Values , Respiratory Function Tests , Statistics, Nonparametric , Time Factors
4.
São Paulo med. j ; 133(5): 401-407, Sept.-Oct. 2015. tab, graf
Article in English | LILACS | ID: lil-767135

ABSTRACT

ABSTRACT CONTEXT AND OBJECTIVE: Prematurity has been correlated with altered lung mechanics. Some infants develop lung injury as a consequence of lung immaturity, invasive mechanical ventilation and exposure to oxygen, thus resulting in bronchopulmonary dysplasia. The aim here was to compare the lung mechanics of preterm infants with and without bronchopulmonary dysplasia during the first year of life. DESIGN AND SETTING: Prospective cohort study in a tertiary-level hospital. METHODS: This study included premature infants at a public hospital who underwent two pulmonary function tests: one at discharge and the other at the corrected age of 4 to 8 months. Tidal volume, lung compliance and lung resistance were measured. Statistical tests were used for comparisons between infants with and without bronchopulmonary dysplasia. RESULTS: 102 children with mean gestational age of 29 ± 2.0 weeks were studied; 17 with bronchopulmonary dysplasia. Lung compliance (0.84 ± 0.29 versus 1.28 ± 0.46; P < 0.001) and tidal volume (6.1 ± 0.94 versus 7.2 ± 1.43; P < 0.01) at discharge were significant lower in children with bronchopulmonary dysplasia than in those without the disease, but no differences were observed at the second test (compliance: 1.53 ± 0.77 versus 1.94 ± 1.01; P = 0.12; and tidal volume: 6.9 ± 1.4 versus 7.3 ± 1.6; P = 0.42). CONCLUSION: Differences in lung mechanics were observed between infants with and without bronchopulmonary dysplasia at hospital discharge but these differences were no longer detected at the final follow-up. The lung mechanics of all the infants improved over this period of time.


RESUMO CONTEXTO E OBJETIVO: Prematuridade tem sido associada com mecânica pulmonar alterada. Algumas crianças desenvolvem lesão pulmonar como consequência de imaturidade pulmonar, ventilação mecânica invasiva e exposição a oxigênio, resultando em displasia broncopulmonar. O objetivo foi comparar a mecânica pulmonar de prematuros com e sem displasia broncopulmonar durante o primeiro ano de vida. DESENHO DO ESTUDO E LOCAL: Estudo de coorte prospectivo em um hospital terciário. MÉTODOS: O estudo incluiu prematuros, de hospital público, que realizaram duas provas de função pulmonar, uma na alta e outra entre quatro e oito meses de idade corrigida. Foram mensurados o volume corrente, a complacência e a resistência pulmonares. Testes estatísticos foram usados para comparações entre crianças com e sem displasia broncopulmonar. RESULTADOS: Foram estudadas 102 crianças com idade gestacional média de 29 ± 2 semanas; 17 com displasia broncopulmonar. A complacência pulmonar (0,84 ± 0,29versus 1,28 ± 0,46; P < 0.001) e o volume corrente (6,1 ± 0,94 versus 7,2 ± 1,43; P < 0.01) na alta foram significativamente inferiores nas crianças com displasia broncopulmonar comparadas às crianças sem a doença, mas não foram observadas diferenças significativas no segundo teste (complacência: 1.53 ± 0.77versus 1.94 ± 1.01; P = 0.12; e volume corrente: 6.9 ± 1.4 versus 7.3 ± 1.6; P = 0.42). CONCLUSÃO: Diferenças na mecânica pulmonar foram observadas entre crianças com e sem displasia broncopulmonar na alta hospitalar, mas essas diferenças não foram detectadas no seguimento final. A mecânica pulmonar de todas as crianças melhorou no decorrer desse período de tempo.


Subject(s)
Female , Humans , Infant , Infant, Newborn , Male , Bronchopulmonary Dysplasia/physiopathology , Infant, Premature/physiology , Infant, Very Low Birth Weight/physiology , Lung/physiopathology , Respiratory Mechanics/physiology , Gestational Age , Prospective Studies , Reference Values , Respiratory Function Tests , Statistics, Nonparametric , Time Factors
5.
Rev. bras. saúde matern. infant ; 15(1): 47-55, Jan-Mar/2015. tab
Article in English | LILACS, BVSAM | ID: lil-746161

ABSTRACT

To assess cognitive, motor, and language development in preterm infants, and perinatal, neonatal and socioeconomic factors associated with abnormal development. Methods: a cross-sectional study was carried out with 104 preterm infants (gestational ages < 33 weeks) (17 - 30 months corrected ages) using the Bayley III Scale. Logistic regression analysis was performed and prevalence ratios calculated. Results: the average language score (81.9) was low, while cognitive (93.7) and motor (91.1) scores were within normal values. There were deficiencies in receptive but not in expressive language. Male sex (OR 2.55 CI 1.01-6.44) and neonatal pneumonia (OR 33.85 CI 3.3-337.8) were associated with abnormal language scores. No factor was associated with abnormal cognitive scores; male gender indicated an increased risk of abnormal motor scores. The lack of a father was a risk factor for impaired motor development (PR: 2.96, CI: 5.6 - 1.55). There was no statistically significant difference in the development of small and appropriate for gestational age children. Conclusions: the Bayley III Scale was useful for assessing language and cognition separately, discriminating between receptive and expressive language. There was a high frequency of language deficiencies, especially in receptive language. Although motor and cognitive average scores were within the normal range, there was a high frequency of children with delayed development in these areas, especially motor development...


Avaliar o desenvolvimento motor, linguagem e cognitivo em prematuros e fatores perinatais, neonatais e socioeconômicos associados ao desenvolvimento anormal. Métodos: estudo transversal: 104 recém-nascidos pré-termos (idade gestacional <33 semanas) foram avaliados (17 - 30 meses idade corrigida), utilizando a Escala Bayley III. Realizada análise de regressão logística e calculadas razões de prevalência. Resultados: a média do escore de linguagem (81,9) foi baixa, enquanto as dos escores cognitivo (93,7) e motor (91,1) estavam normais. Foram encontrados déficits na linguagem receptiva, não na expressiva. Sexo masculino (OR 2,55 IC 1,01-6,44) e pneumonia neonatal (OR 33,85 IC 3,3-337,8) foram associados com escores anormais de linguagem. Nenhum fator foi associado a pontuações cognitivas anormais; sexo masculino indicou risco aumentado de escores motores anormais. Ausência do pai foi risco para desenvolvimento motor (RP: 2,96 IC 5,6-1,55). Não houve diferença estatística entre o desenvolvimento de crianças pequenas e adequadas para idade gestacional. Conclusões: a escala Bayley III foi vantajosa para avaliar linguagem e cognição separadamente, discriminando linguagem receptiva e expressiva. Houve uma elevada frequência de déficit de linguagem, especialmente receptiva. Embora os escores motor e cognitivo médios estivessem na faixa normal, houve uma alta frequência de atraso nestas áreas, principalmente a motora...


Subject(s)
Humans , Infant, Newborn , Infant , Child Development , Language Development , Intelligence Tests , Cognition Disorders , Infant, Premature
6.
Rev. bras. epidemiol ; 16(2): 525-534, jun. 2013. tab
Article in Portuguese | LILACS | ID: lil-687409

ABSTRACT

Objetivo: Investigar como o passo 4 da Iniciativa Hospital Amigo da Criança foi aplicado, avaliar a prevalência da amamentação na primeira hora após o nascimento e analisar os fatores associados à não amamentação neste período de vida. Métodos: Estudo transversal conduzido em alojamento conjunto de maternidade de alto risco na cidade do Rio de Janeiro, com entrevista com amostra de 403 puérperas. A Razão de Prevalência, com seu respectivo intervalo de confiança de 95%, foi estimada a partir de modelo com função de ligação complementar log log, através do programa SPSS15® . Resultados: A prevalência de amamentação na primeira hora após o nascimento foi de 43,9%. A análise multivariada evidenciou que foram protegidas contra a não amamentação na primeira hora de vida as mulheres de cor não preta (RP = 0,62; IC 95%: 0,42-0,90), multíparas (RP = 0,66; IC 95%: 0,47-0,93), que fizeram pré-natal (RP = 0,23; IC 95%: 0,08-0,67), com parto normal (RP = 0,41; IC 95%: 0,28-0,60), cujos bebês tiveram peso ao nascer igual ou superior a 2.500g (RP = 0,31; IC 95%: 0,11-0,86) e que receberam ajuda da equipe de saúde para amamentar na sala de parto (RP = 0,51; IC 95%: 0,36-0,72). Conclusão: A ajuda prestada pela equipe de saúde à amamentação ao nascimento, que se constitui no “Passo 4 da Iniciativa Hospital Amigo da Criança”, bem como a cor materna não preta, a multiparidade, a realização de pré-natal, o parto normal e o peso adequado ao nascer contribuíram para o inicio do aleitamento materno na primeira hora de vida. .


Objective: To investigate how the 4thStep of the Baby-Friendly Hospital Initiative was applied, assess the prevalence of breastfeeding (BF) within the first hour after birth and analyze factors associated with non-BF in this period of life. Methods: Cross-sectional study conducted in a high-risk maternity-hospital in Rio de Janeiro City, Brazil, with interview to a sample of 403 rooming-in mothers. The prevalence ratio with its respective 95% confidence interval was estimated by the use of SPSS 15® from a model with complementary log log link function. Results: The prevalence of BF in the first hour of life was 43.9%. Multivariate analysis showed that were protected against non-BF in the first hour after birth non-black women (PR = 0.62, 95% CI: 0.42-0.90), multiparous women (PR = 0.66, 95% CI: 0.47-0.93), prenatal care (PR = 0.23, 95% CI: 0.08-0.67), vaginal delivery (PR =0 .41, 95% CI: 0.28-0.60), newborn with birthweight ≥ 2,500g (PR = 0.31, 95% CI: 0.11-0.86) and women who received help from the health team to BF in the delivery room (PR = 0.51, 95% CI: 0.36-0.72). Conclusion: Help provided by the health team to breastfeeding at birth, Step 4 of the Baby-Friendly Hospital Initiative, as well as non black women, multiparous women, receiving pre-natal care, vaginal delivery and appropriate birthweight contributed to breastfeeding in the first hour of life. .


Subject(s)
Adolescent , Adult , Humans , Infant, Newborn , Middle Aged , Young Adult , Breast Feeding/statistics & numerical data , Cross-Sectional Studies , Time Factors
7.
Arq Neuropsiquiatr ; 70(8): 583-9, 2012 Aug.
Article in English | MEDLINE | ID: mdl-22899028

ABSTRACT

The purpose was to analyze factors associated with cognitive impairment in very low birth weight (VLBW) children born preterm. A prospective cohort of 65 VLBW children was assessed at the age of eight years using the Wechsler Intelligence Scale for Children. A model for the relationship of variables with the cognitive impairment outcome attributed hierarchical levels: distal (socioeconomic variables), intermediate I and II (perinatal and neonatal variables, post-neonatal variables) and proximal (child health and psychosocial stimulation). A multivariate logistic regression was performed. In the multivariate hierarchical logistic regression, the maternal education (OR=0.77, 95%CI 0.63-0.94) and number of prenatal visits (OR=0.73, 95%CI 0.54-0.99) showed a protective association, but the male (OR=7.3, 95%CI 1.54-35.3) was associated with worse results. The VLBW children cognitive performance in the age of eight years benefits from more educated mothers, better prenatal care, and the baby gender as female.


Subject(s)
Child Development/physiology , Cognition Disorders/psychology , Cognition/physiology , Infant, Premature/growth & development , Infant, Very Low Birth Weight/growth & development , Intelligence/physiology , Child , Female , Humans , Infant, Newborn , Logistic Models , Male , Multivariate Analysis , Prospective Studies , Risk Factors , Socioeconomic Factors , Wechsler Scales
8.
Arq. neuropsiquiatr ; 70(8): 583-589, Aug. 2012. tab
Article in English | LILACS | ID: lil-645368

ABSTRACT

The purpose was to analyze factors associated with cognitive impairment in very low birth weight (VLBW) children born preterm. A prospective cohort of 65 VLBW children was assessed at the age of eight years using the Wechsler Intelligence Scale for Children. A model for the relationship of variables with the cognitive impairment outcome attributed hierarchical levels: distal (socioeconomic variables), intermediate I and II (perinatal and neonatal variables, post-neonatal variables) and proximal (child health and psychosocial stimulation). A multivariate logistic regression was performed. In the multivariate hierarchical logistic regression, the maternal education (OR=0.77, 95%CI 0.63-0.94) and number of prenatal visits (OR=0.73, 95%CI 0.54-0.99) showed a protective association, but the male (OR=7.3, 95%CI 1.54-35.3) was associated with worse results. The VLBW children cognitive performance in the age of eight years benefits from more educated mothers, better prenatal care, and the baby gender as female.


O objetivo foi analisar fatores associados à alteração cognitiva na idade escolar de crianças nascidas prematuras de muito baixo peso (PMBP). Uma coorte prospectiva de 65 crianças PMBP foi avaliada aos oito anos através da Escala de Inteligência Wechsler para Crianças. Um modelo para relação das variáveis com o desfecho alteração cognitiva reconheceu níveis hierárquicos: distal (variáveis socioeconômicas), intermediário I e II (variáveis perinatais e neonatais; variáveis pós-neonatais) e proximal (saúde da criança e estímulo psicossocial). Foi realizada análise de regressão logística multivariada. Na regressão logística hierarquizada multivariada, a escolaridade materna (OR=0,77; IC95% 0,63-0,94) e o número de consultas no pré-natal (OR=0,73; IC95% 0,54-0,99) mostraram uma associação protetora; porém o sexo masculino (OR=7,3; IC95% 1,54-35,3) foi associado a piores resultados. O desempenho cognitivo dos PMBP na idade de oito anos é beneficiado pela maior escolaridade das mães, melhor assistência pré-natal e pelo bebê ser do sexo feminino.


Subject(s)
Child , Female , Humans , Infant, Newborn , Male , Child Development/physiology , Cognition Disorders/psychology , Cognition/physiology , Infant, Premature/growth & development , Infant, Very Low Birth Weight/growth & development , Intelligence/physiology , Logistic Models , Multivariate Analysis , Prospective Studies , Risk Factors , Socioeconomic Factors , Wechsler Scales
9.
Rev. bras. epidemiol ; 15(1): 13-24, mar. 2012. tab
Article in Portuguese | LILACS | ID: lil-618262

ABSTRACT

O objetivo do estudo foi investigar a estabilidade do desempenho mental de bebês prematuros de muito baixo peso ao nascer ao longo dos dois primeiros anos de vida e identificar os fatores associados ao seu desempenho mental. Estudo de coorte com 109 crianças. A Escala Mental da Bayley Scales of Infant Development - Second Edition foi aplicada aos 6, aos 12 e entre 18-24 meses de idade corrigida. A estabilidade dos escores entre as avaliações foi investigada através de análise de variância para medidas repetidas. A associação entre as características neonatais e sociais no desenvolvimento mental foi verificada por análise multivariada através de regressão linear, considerando como desfechos os Índices de Desenvolvimento Mental aos 6 meses, 12 meses e entre 18-24 meses de idade corrigida. A média do Índice de Desenvolvimento Mental aos 6 meses foi 83,4 (DP: 12,4), aos 12 meses foi 86,4 (DP: 13,9) e aos 18-24 meses foi 73,4 (DP: 14,5). Observou-se uma diminuição significativa de 13 pontos no escore aos 18-24 meses de idade corrigida. O Índice de Desenvolvimento Mental não apresentou estabilidade ao longo dos dois primeiros anos de vida nesta população de prematuros, exceto para as crianças que tiveram pneumonia neonatal, cujo desempenho foi insatisfatório em todas as avaliações. Dos fatores de risco investigados, apenas o sexo masculino e a pneumonia neonatal estiveram associados aos desfechos.


The aim of this study was to investigate the stability of mental performance of very low birth weight premature infants during the first two years of life, and to identify factors associated with mental performance.The study included 109 children. The Mental Scale of Bayley Scales of Infant Development - Second Edition was administered at 6, 12 and 18-24 months of corrected age. The stability of the scores between assessments was verified by the analysis of variance for repeated measures.The association of the major social and neonatal characteristics with mental development was confirmed using multivariate analysis by linear regression, considering the following outcomes: mental development indices at 6 months, 12 months and between 18-24 months of corrected age. The mean Mental Developmental Index (MDI) was 83.4 (SD: 12.4) at 6 months, 86.4 (SD: 13.9) at 12 months, and 73.4 (SD: 14.5) at 18-24 months. A significant decrease in the mental developmental index (13 points) at 18-24 month corrected age was observed. The Mental development index did not show stability during the first two years of life in this population of preterm infants, except for children with neonatal pneumonia whose performance was unsatisfactory in all assessments. Among the risk factors investigated only male gender and neonatal pneumonia were associated with outcomes.


Subject(s)
Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Child Development , Infant, Premature/growth & development , Infant, Very Low Birth Weight/growth & development , Mental Health , Neuropsychological Tests , Prospective Studies , Psychomotor Performance
10.
Cad Saude Publica ; 27(6): 1154-64, 2011 Jun.
Article in Portuguese | MEDLINE | ID: mdl-21710012

ABSTRACT

Cognitive impairment is a neurodevelopmental sequela that is more prevalent in very low birth weight (VLBW) premature children. There are few Brazilian studies on this group's cognitive development at school age. The current study proposes a theoretical discussion on the determinants of cognitive development at school age in VLBW preterm children, using a hierarchical analytical model. According to this model, biological and environmental factors interrelate on several levels (distal, intermediate, and proximal), resulting in changes in cognitive development. The aim is to investigate the possible mediation of variables and their interrelationships and the resulting events that could lead to cognitive impairment as the outcome. Selection of risk factors was based on a literature review of factors associated with adverse cognitive outcomes. Better understanding of the interrelationships between these factors could lead to more appropriate prevention and intervention in this group, thereby increasing their chances of educational and social inclusion.


Subject(s)
Child Development/physiology , Cognition/physiology , Infant, Low Birth Weight , Infant, Premature , Child , Female , Humans , Infant, Newborn , Male , Risk Factors , Socioeconomic Factors
11.
Cad. saúde pública ; 27(6): 1154-1164, jun. 2011. ilus
Article in Portuguese | LILACS | ID: lil-591269

ABSTRACT

O déficit cognitivo é a sequela do neurodesenvolvimento mais prevalente na população de prematuros de muito baixo peso. Poucos são os trabalhos nacionais sobre o desenvolvimento desta população na idade escolar. Este estudo propõe uma discussão teórica sobre os fatores determinantes do desenvolvimento cognitivo na idade escolar de prematuros de muito baixo peso ao nascer, utilizando o modelo hierarquizado de análise. Neste modelo, fatores biológicos e ambientais se relacionariam em diversos níveis: distal, intermediário e proximal, resultando em alterações no desenvolvimento cognitivo. Pretende-se, desta forma, aprofundar a questão das mediações possíveis das variáveis e suas inter-relações e consequentes eventos que podem levar ao desfecho. Para a seleção dos fatores de risco foi realizada uma revisão da literatura sobre fatores associados a resultados cognitivos desfavoráveis. Pressupõe-se que o melhor conhecimento das inter-relações destes fatores auxiliaria na prevenção e intervenção mais adequada nesta população, aumentando suas chances de inclusão escolar e social.


Cognitive impairment is a neurodevelopmental sequela that is more prevalent in very low birth weight (VLBW) premature children. There are few Brazilian studies on this group's cognitive development at school age. The current study proposes a theoretical discussion on the determinants of cognitive development at school age in VLBW preterm children, using a hierarchical analytical model. According to this model, biological and environmental factors interrelate on several levels (distal, intermediate, and proximal), resulting in changes in cognitive development. The aim is to investigate the possible mediation of variables and their interrelationships and the resulting events that could lead to cognitive impairment as the outcome. Selection of risk factors was based on a literature review of factors associated with adverse cognitive outcomes. Better understanding of the interrelationships between these factors could lead to more appropriate prevention and intervention in this group, thereby increasing their chances of educational and social inclusion.


Subject(s)
Child , Female , Humans , Infant, Newborn , Male , Child Development/physiology , Cognition/physiology , Infant, Low Birth Weight , Infant, Premature , Risk Factors , Socioeconomic Factors
12.
São Paulo med. j ; 128(6): 328-335, Dec. 2010. ilus, graf, tab
Article in English | LILACS | ID: lil-573994

ABSTRACT

CONTEXT AND OBJECTIVE: High-resolution computed tomography (HRCT) is considered to be the best method for detailed pulmonary evaluation. The aim here was to describe a scoring system based on abnormalities identified on HRCT among premature infants, and measure the predictive validity of the score in relation to respiratory morbidity during the first year of life. DESIGN AND SETTING: Prospective cohort study in Instituto Fernandes Figueira, Fundação Oswaldo Cruz. METHODS: Scoring system based on HRCT abnormalities among premature newborns. The affected lung area was quantified according to the number of compromised lobes, in addition to bilateral pulmonary involvement. Two radiologists applied the score to 86 HRCT scans. Intraobserver and interobserver agreement were analyzed. The score properties were calculated in relation to predictions of respiratory morbidity during the first year of life. RESULTS: Most of the patients (85 percent) presented abnormalities on HRCT, and among these, 56.2 percent presented respiratory morbidity during the first year of life. Scores ranged from zero to 12. There was good agreement between observers (intraclass correlation coefficient, ICC = 0.86, confidence interval, CI: 0.64-0.83). The predictive scores were as follows: positive predictive value 81.8 percent, negative predictive value 56.3 percent, sensitivity 39.1 percent, and specificity 90.0 percent. CONCLUSION: The scoring system is reproducible, easy to apply and allows HRCT comparisons among premature infants, by identifying patients with greater likelihood of respiratory morbidity during the first year of life. Its use will enable HRCT comparisons among premature infants with different risk factors for respiratory morbidity.


CONTEXTO E OBJETIVO: Tomografia computadorizada de alta resolução (TCAR) é considerada o melhor método para avaliação pulmonar detalhada. O objetivo foi descrever um sistema de escore baseado em alterações identificadas nas TCAR de lactentes prematuros e medir a validade preditiva do escore em relação à morbidade respiratória no primeiro ano de vida. TIPO DE ESTUDO E LOCAL: Estudo de coorte prospectiva no Instituto Fernandes Figueira, Fundação Oswaldo Cruz. MÉTODOS: Sistema de escore baseado em alterações nas TCAR de lactentes prematuros. A área pulmonar alterada foi quantificada conforme o número de lobos alterados, acrescido do comprometimento pulmonar bilateral. Dois radiologistas aplicaram o escore em 86 TCAR. Foram analisadas as confiabilidades intraobservador e interobservador e calculadas as propriedades do escore em relação à predição da morbidade respiratória no primeiro ano de vida. RESULTADOS: A maioria (85 por cento) dos pacientes apresentou TCAR anormal, e dentre estes, 56,2 por cento apresentaram morbidade respiratória no primeiro ano de vida. Valores do escore variaram de zero a 12. Houve boa concordância entre os observadores (coeficiente de correlação intraclasse, CCI = 0,86, intervalo de confiança, IC: 0,64-0,83). Os valores preditivos do escore foram: valor preditivo positivo 81,8 por cento, valor preditivo negativo 56,3 por cento, sensibilidade 39,1 por cento e especificidade 90,0 por cento. CONCLUSÃO: O sistema de escore é reprodutível, de fácil aplicação e permite a comparação de TCAR de pacientes prematuros, identificando pacientes com maior probabilidade de morbidade respiratória no primeiro de vida. Seu uso permitirá a comparação de TC de lactentes prematuros com diferentes fatores de risco para morbidade respiratória.


Subject(s)
Humans , Infant , Infant, Newborn , Infant, Premature, Diseases , Lung Diseases , Tomography, X-Ray Computed/methods , Epidemiologic Methods , Infant, Premature , Infant, Premature, Diseases/mortality , Infant, Premature, Diseases/pathology , Lung Diseases/mortality , Lung Diseases/pathology , Tomography, X-Ray Computed/standards
13.
Arq Neuropsiquiatr ; 68(5): 749-54, 2010 Oct.
Article in English | MEDLINE | ID: mdl-21049187

ABSTRACT

OBJECTIVE: The study aimed to assess bronchopulmonary dysplasia (BPD) as a predisposing factor for alteration in the psychomotor development index (PDI) in premature infants and verify the incidence of neuromotor alterations at 6 months corrected age. METHOD: This was a prospective cohort study that followed the neuromotor development of 152 very low birth weight premature infants, with psychomotor development index as the outcome. The study used the Bayley Scale of Infant Development at 6 months corrected age, and neurological examination. RESULTS: Incidence of BPD was 13.2% (n = 20). Logistic regression analysis showed an association between BPD and altered psychomotor development index (OR 3.98; 95%CI: 1.04-15.1) after adjusting for confounding variables. Neurological examination was altered in 67.1% of the 152 infants. CONCLUSION: Bronchopulmonary dysplasia acted as an independent predisposing factor for alteration in the psychomotor development index in premature infants at 6 months corrected age.


Subject(s)
Bronchopulmonary Dysplasia/complications , Child Development , Infant, Premature , Psychomotor Disorders/etiology , Psychomotor Performance , Female , Humans , Incidence , Infant , Infant, Newborn , Male , Psychomotor Disorders/epidemiology , Risk Factors
14.
Sao Paulo Med J ; 128(3): 130-6, 2010 May.
Article in English | MEDLINE | ID: mdl-20963364

ABSTRACT

CONTEXT AND OBJECTIVE: High-resolution computed tomography (HRCT) of the lungs is more sensitive than radiographs for evaluating pulmonary disease, but little has been described about HRCT interpretation during the neonatal period or shortly afterwards. The aim here was to evaluate the reliability of the interpretation of HRCT among very low birth weight premature infants (VLBWPI; < 1500 g). DESIGN AND SETTING: Cross-sectional study on intra and interobserver reliability of HRCT on VLBWPI. METHODS: 86 VLBWPI underwent HRCT. Two pediatric radiologists analyzed the HRCT images. The reliability was measured by the proportion of agreement, kappa coefficient (KC) and positive and negative agreement indices. RESULTS: For radiologist A, the intraobserver reliability KC was 0.79 (confidence interval, CI: 0.54-1.00) for normal/abnormal examinations; for each abnormality on CT, KC ranged from 0.05 to 1.00. For radiologist B, the intraobserver reliability KC was 0.79 (CI: 0.54-1.00) for normal/abnormal examinations; for each abnormality on CT, KC ranged from 0.37 to 0.83. The interobserver agreement was 88% for normal/abnormal examinations and KC was 0.71 (CI: 0.5- 0.93); for most abnormal findings, KC ranged from 0.51-0.67. CONCLUSION: For normal/abnormal examinations, the intra and interobserver agreements were substantial. For most of the imaging findings, the intraobserver agreement ranged from moderate to substantial. Our data demonstrate that in clinical practice, there is no reason for more than one tomographic image evaluator, provided that this person is well trained in VLBWPI HRCT interpretation. Analysis by different observers should be reserved for research and for difficult cases in clinical contexts.


Subject(s)
Bronchopulmonary Dysplasia/diagnostic imaging , Infant, Premature, Diseases/diagnostic imaging , Infant, Very Low Birth Weight , Lung/diagnostic imaging , Tomography, X-Ray Computed/methods , Humans , Infant, Newborn , Infant, Premature , Observer Variation , Reproducibility of Results , Tomography, X-Ray Computed/statistics & numerical data
15.
Arq. neuropsiquiatr ; 68(5): 749-754, Oct. 2010. tab
Article in English | LILACS | ID: lil-562802

ABSTRACT

OBJECTIVE: The study aimed to assess bronchopulmonary dysplasia (BPD) as a predisposing factor for alteration in the psychomotor development index (PDI) in premature infants and verify the incidence of neuromotor alterations at 6 months corrected age. METHOD: This was a prospective cohort study that followed the neuromotor development of 152 very low birth weight premature infants, with psychomotor development index as the outcome. The study used the Bayley Scale of Infant Development at 6 months corrected age, and neurological examination. RESULTS: Incidence of BPD was 13.2 percent (n=20). Logistic regression analysis showed an association between BPD and altered psychomotor development index (OR 3.98; 95 percentCI: 1.04-15.1) after adjusting for confounding variables. Neurological examination was altered in 67.1 percent of the 152 infants. CONCLUSION: Bronchopulmonary dysplasia acted as an independent predisposing factor for alteration in the psychomotor development index in premature infants at 6 months corrected age.


OBJETIVO: Avaliar a displasia broncopulmonar (DBP) como fator predisponente para alteração no índice de desenvolvimento psicomotor em prematuros e verificar a incidência das alterações neuromotoras aos 6 meses de idade corrigida. MéTODO: Estudo de coorte prospectivo que acompanhou o desenvolvimento neuromotor de 152 prematuros de muito baixo peso, cujo desfecho foi o desenvolvimento psicomotor. Utilizou-se a Bayley Scale of Infant Development aos 6 meses de idade corrigida e exame neurológico. RESULTADOS: A incidência de DBP foi de 13,2 por cento (n=20). A análise de regressão logística mostrou associação entre a DBP e alteração no índice de desenvolvimento psicomotor (RC 3,98 IC 95 por cento:1,04-15,1) após ajuste para as variáveis de confundimento. O exame neurológico apresentou-se alterado em 67,1 por cento das 152 crianças. CONCLUSão: A displasia broncopulmonar atuou como fator predisponente independente para alteração no índice de desenvolvimento psicomotor em prematuros aos 6 meses de idade corrigida.


Subject(s)
Female , Humans , Infant , Infant, Newborn , Male , Bronchopulmonary Dysplasia/complications , Child Development , Infant, Premature , Psychomotor Performance , Psychomotor Disorders/etiology , Incidence , Psychomotor Disorders/epidemiology , Risk Factors
16.
São Paulo med. j ; 128(3): 130-136, May 2010. ilus, tab
Article in English | LILACS | ID: lil-561482

ABSTRACT

CONTEXT AND OBJECTIVE: High-resolution computed tomography (HRCT) of the lungs is more sensitive than radiographs for evaluating pulmonary disease, but little has been described about HRCT interpretation during the neonatal period or shortly afterwards. The aim here was to evaluate the reliability of the interpretation of HRCT among very low birth weight premature infants (VLBWPI; < 1500 g). DESIGN AND SETTING: Cross-sectional study on intra and interobserver reliability of HRCT on VLBWPI. METHODS: 86 VLBWPI underwent HRCT. Two pediatric radiologists analyzed the HRCT images. The reliability was measured by the proportion of agreement, kappa coefficient (KC) and positive and negative agreement indices. RESULTS: For radiologist A, the intraobserver reliability KC was 0.79 (confidence interval, CI: 0.54-1.00) for normal/abnormal examinations; for each abnormality on CT, KC ranged from 0.05 to 1.00. For radiologist B, the intraobserver reliability KC was 0.79 (CI: 0.54-1.00) for normal/abnormal examinations; for each abnormality on CT, KC ranged from 0.37 to 0.83. The interobserver agreement was 88 percent for normal/abnormal examinations and KC was 0.71 (CI: 0.5- 0.93); for most abnormal findings, KC ranged from 0.51-0.67. CONCLUSION: For normal/abnormal examinations, the intra and interobserver agreements were substantial. For most of the imaging findings, the intraobserver agreement ranged from moderate to substantial. Our data demonstrate that in clinical practice, there is no reason for more than one tomographic image evaluator, provided that this person is well trained in VLBWPI HRCT interpretation. Analysis by different observers should be reserved for research and for difficult cases in clinical contexts.


CONTEXTO E OBJETIVO: Tomografia computadorizada de alta resolução dos pulmões (TCAR) é mais sensível que radiografias para avaliar doença pulmonar, entretanto, pouco tem sido descrito sobre a interpretação da TCAR no período neonatal ou imediatamente após. O objetivo foi avaliar a confiabilidade na interpretação da TCAR em lactentes prematuros de muito baixo peso (LPMBP, < 1500 g). TIPO DE ESTUDO E LOCAL: Estudo transversal sobre confiabilidade intra e interobservador da TCAR em LPMBP. MÉTODOS: 86 LPMBP foram submetidos a TCAR. Dois radiologistas pediátricos analisaram as tomografias. A confiabilidade foi medida pela proporção de concordância, coeficiente kappa (KC) e índices de concordância positiva e negativa. RESULTADOS: Para o radiologista A, na confiabilidade intraobservador o KC foi 0,79 (intervalo de confiança, IC: 0,54-1.0) para exames normais/anormais; para cada alteração tomográfica o KC variou de 0,05 a 1. Para o radiologista B, na confiabilidade intraobservador o KC foi 0,79 (IC: 0,54-1.0) para exames normais/anormais e variou de 0,37 a 0,83 para cada alteração tomográfica. Concordância interobservador foi de 88 por cento para exames normais/anormais e o KC foi 0,71 (IC: 0,5-0,93) e variou de 0,51-0,67 em muitos achados anormais. CONCLUSÃO: Para exames normais/anormais, as concordâncias intra e interobservador foram substanciais. Para muitos achados tomográficos, a concordância intraobservador variou de moderada a substancial. Nossos dados demonstram que, na prática clínica, não há razão para mais de um avaliador das imagens tomográficas, desde que este seja bem treinado na interpretação de TCAR de LPMBP. A análise por diferentes observadores estará reservada para pesquisa e casos difíceis no contexto clínico.


Subject(s)
Humans , Infant, Newborn , Bronchopulmonary Dysplasia , Infant, Premature, Diseases , Infant, Very Low Birth Weight , Lung , Tomography, X-Ray Computed/methods , Infant, Premature , Observer Variation , Reproducibility of Results , Tomography, X-Ray Computed/statistics & numerical data
17.
Sao Paulo Med J ; 128(6): 328-35, 2010 Dec.
Article in English | MEDLINE | ID: mdl-21308155

ABSTRACT

CONTEXT AND OBJECTIVE: High-resolution computed tomography (HRCT) is considered to be the best method for detailed pulmonary evaluation. The aim here was to describe a scoring system based on abnormalities identified on HRCT among premature infants, and measure the predictive validity of the score in relation to respiratory morbidity during the first year of life. DESIGN AND SETTING: Prospective cohort study in Instituto Fernandes Figueira, Fundação Oswaldo Cruz. METHODS: Scoring system based on HRCT abnormalities among premature newborns. The affected lung area was quantified according to the number of compromised lobes, in addition to bilateral pulmonary involvement. Two radiologists applied the score to 86 HRCT scans. Intraobserver and interobserver agreement were analyzed. The score properties were calculated in relation to predictions of respiratory morbidity during the first year of life. RESULTS: Most of the patients (85%) presented abnormalities on HRCT, and among these, 56.2% presented respiratory morbidity during the first year of life. Scores ranged from zero to 12. There was good agreement between observers (intraclass correlation coefficient, ICC = 0.86, confidence interval, CI: 0.64-0.83). The predictive scores were as follows: positive predictive value 81.8%, negative predictive value 56.3%, sensitivity 39.1%, and specificity 90.0%. CONCLUSION: The scoring system is reproducible, easy to apply and allows HRCT comparisons among premature infants, by identifying patients with greater likelihood of respiratory morbidity during the first year of life. Its use will enable HRCT comparisons among premature infants with different risk factors for respiratory morbidity.


Subject(s)
Infant, Premature, Diseases/diagnostic imaging , Lung Diseases/diagnostic imaging , Tomography, X-Ray Computed/methods , Epidemiologic Methods , Humans , Infant , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/mortality , Infant, Premature, Diseases/pathology , Lung Diseases/mortality , Lung Diseases/pathology , Tomography, X-Ray Computed/standards
18.
Cad Saude Publica ; 25(6): 1399-408, 2009 Jun.
Article in Portuguese | MEDLINE | ID: mdl-19503970

ABSTRACT

The aim of this paper was to estimate respiratory morbidity and its determinants for premature infants aged 12 to 36 months. The population comprised 84 infants from a cohort of very low birth weight premature infants. The outcome was the respiratory morbidity incidence rate. The relationship between the independent variables and respiratory morbidity was estimated using a Poisson regression model. From 12 to 24 months of age, 56.3% of children had experienced at least one episode of respiratory disease. >From 24 to 36 months, 38.1% of children were affected. Variables significantly associated with respiratory morbidity were bronchopulmonary dysplasia (RR = 1.9; 95%CI: 1.2-2.9), abnormal lung compliance (RR = 1.6; 95%CI: 1.1-2.3), neonatal pneumonia (RR = 2.8; 95%CI: 1.9-4.0), patent ductus arteriosus (RR = 1.6; 95%CI: 1.1-2.5), and respiratory morbidity in the first year of life (RR = 1.7; 95%CI: 1.2-2.5). The incidence of respiratory morbidity remains high in this group of high-risk infants, which calls for regular follow-up and effective interventions to prevent respiratory disease and to improve the quality of life of these children and their families.


Subject(s)
Infant, Premature, Diseases/epidemiology , Respiratory Tract Diseases/epidemiology , Brazil/epidemiology , Bronchopulmonary Dysplasia/epidemiology , Child, Preschool , Ductus Arteriosus, Patent/epidemiology , Female , Follow-Up Studies , Gestational Age , Humans , Infant , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/prevention & control , Infant, Very Low Birth Weight , Male , Morbidity , Pneumonia/epidemiology , Respiratory Sounds , Respiratory Tract Diseases/prevention & control , Risk Factors , Sex Factors , Socioeconomic Factors
19.
Arq Neuropsiquiatr ; 67(2A): 235-41, 2009 Jun.
Article in English | MEDLINE | ID: mdl-19547815

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.


Subject(s)
Infant, Premature, Diseases/etiology , Infant, Very Low Birth Weight , Psychomotor Disorders/etiology , Age Factors , Brazil/epidemiology , Epidemiologic Methods , Humans , Infant , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/epidemiology , Neurologic Examination , Psychomotor Disorders/epidemiology , Psychomotor Performance
20.
Arq. neuropsiquiatr ; 67(2a): 235-241, June 2009. graf, tab
Article in English | LILACS, BVSAM | ID: lil-517034

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 percent probability of neuromotor involvement at 12 months.


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 por cento 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 por cento de probabilidade de comprometimento neuromotor aos 12 meses.


Subject(s)
Humans , Infant , Infant, Newborn , Infant, Premature, Diseases/etiology , Infant, Very Low Birth Weight , Psychomotor Disorders/etiology , Age Factors , Brazil/epidemiology , Epidemiologic Methods , Infant, Premature , Infant, Premature, Diseases/epidemiology , Neurologic Examination , Psychomotor Disorders/epidemiology , Psychomotor Performance
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