The trajectory of head circumference and neurodevelopment in very preterm newborns during the first two years of life: a cohort study.

OBJECTIVE: To evaluate the growth trajectory of head circumference and neurodevelopment, and to correlate head circumference with cognitive, language, and motor outcomes during the first two years. METHOD: Prospective cohort study in a tertiary hospital including 95 newborns under 32 weeks or 1500 g. Neonates who developed major neonatal morbidities were excluded. The head circumference was measured at birth, at discharge, and at terms, 1, 3, 5, 12, 18, and 24 months of corrected age, and the Bayley Scales (Bayley-III) were applied at 12, 18 and 24 months of corrected age to assess cognitive, language and, motor domains. Scores below 85 were classified as mild/moderate deficits and scores below 70 as severe deficits. The association between head circumference Z score and Bayley scores was assessed using Pearson's correlation. The study considered a significance level of 0.05. RESULTS: There was a decrease of -0.18 in the head circumference Z score between birth and discharge and the catch-up occurred between discharge and 1 month (an increase of 0.81 in the Z score). There was a positive correlation between head circumference and Bayley scores at 18 months. There was also a positive correlation between head circumference at discharge and at 5 months with the three domains of the Bayley. CONCLUSION: Serial measurements of head circumference provide knowledge of the trajectory of growth, with early catch-up between discharge and 1 month, as well as its association with neurodevelopment. Head circumference is therefore a valuable clinical marker for neurodevelopment, especially in very preterm newborns.

High-risk children and social isolation: the importance of family functioning.

High-risk newborns are exposed to neonatal conditions such as prematurity, very low birth weight, and congenital malformations that can affect development and behavior. Coronavirus disease 2019 (COVID-19) restraint and control measures have been identified as important stressor events and cumulative risk factors for behavioral changes in these children. This study examined social isolation-related factors that contribute to internalizing and externalizing behavior problems in children already at risk for neurodevelopmental disorders. This cross-sectional, multicenter study included 113 children (18 months to 9 years) who were followed in reference services for neonatal follow-up in tertiary units of the public health system in the city of Rio de Janeiro, Brazil. Behavior was assessed using the child behavior checklist, and a structured questionnaire was used to assess sociodemographic aspects. In the bivariate analysis, prematurity was associated with externalizing problems and change in eating habits with internalizing problems. The logistic model indicated that both parents having completed high school and both sharing care of the child were protective factors for behavioral problems; however, reports of sleep problems and living with another child were risk factors. In conclusion, the study identified internalizing and externalizing behavior problems related to prematurity and aspects of family structure and routine in children at risk. The findings confirm the importance of family functioning for child health and family-centered interventions.

Mental performance of very low birth weight preterm infants: assessment of stability in the first two years of life and factors associated with mental performance.

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.

Desempenho mental de bebês pré-termo de muito baixo peso ao nascer: avaliação da estabilidade nos dois primeiros anos de vida e fatores associados ao desempenho mental / Mental performance of very low birth weight preterm infants: assessment of stability in the first two years of life and factors associated with mental performance

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.

Concurrent validity and reliability of the Alberta Infant Motor Scale in premature infants.

OBJECTIVE: To verify the concurrent validity and interobserver reliability of the Alberta Infant Motor Scale (AIMS) in premature infants followed-up at the outpatient clinic of Instituto Fernandes Figueira, Fundação Oswaldo Cruz (IFF/Fiocruz), in Rio de Janeiro, Brazil. METHODS: A total of 88 premature infants were enrolled at the follow-up clinic at IFF/Fiocruz, between February and December of 2006. For the concurrent validity study, 46 infants were assessed at either 6 (n = 26) or 12 (n = 20) months' corrected age using the AIMS and the second edition of the Bayley Scales of Infant Development, by two different observers, and applying Pearson's correlation coefficient to analyze the results. For the reliability study, 42 infants between 0 and 18 months were assessed using the Alberta Infant Motor Scale, by two different observers and the results analyzed using the intraclass correlation coefficient. RESULTS: The concurrent validity study found a high level of correlation between the two scales (r = 0.95) and one that was statistically significant (p < 0.01) for the entire population of infants, with higher values at 12 months (r = 0.89) than at 6 months (r = 0.74). The interobserver reliability study found satisfactory intraclass correlation coefficients at all ages tested, varying from 0.76 to 0.99. CONCLUSIONS: The AIMS is a valid and reliable instrument for the evaluation of motor development in high-risk infants within the Brazilian public health system.

Validade concorrente e confiabilidade da Alberta Infant Motor Scale em lactentes nascidos prematuros / Concurrent validity and reliability of the Alberta Infant Motor Scale in premature infants

OBJETIVO: Verificar a validade concorrente e a confiabilidade interobservador da Alberta Infant Motor Scale (AIMS) em lactentes prematuros acompanhados no ambulatório de seguimento do Instituto Fernandes Figueira, Fundação Oswaldo Cruz (IFF/Fiocruz). MÉTODOS: Foram avaliados 88 lactentes nascidos prematuros no ambulatório de seguimento do IFF/Fiocruz entre fevereiro e dezembro de 2006. No estudo de validade concorrente, 46 lactentes com 6 (n = 26) ou 12 (n = 20) meses de idade corrigida foram avaliados pela AIMS e pela escala motora da Bayley Scales of Infant Development, 2ª edição, por dois observadores diferentes, utilizando-se o coeficiente de correlação de Pearson para análise dos resultados. No estudo de confiabilidade, 42 lactentes entre 0 e 18 meses foram avaliados pela AIMS por dois observadores diferentes, utilizando-se o intraclass correlation coefficient (ICC) para análise dos resultados. RESULTADOS: No estudo de validade concorrente, a correlação encontrada entre as duas escalas foi alta (r = 0,95) e estatisticamente significativa (p < 0,01) na população total de lactentes, alcançando valores mais altos aos 12 meses (r = 0,89) do que aos 6 meses (r = 0,74). A confiabilidade interobservador apresentou valores satisfatórios de ICC em todas as idades avaliadas, variando de 0,76 a 0,99. CONCLUSÃO: A AIMS é uma escala válida e confiável para ser utilizada na avaliação do desenvolvimento motor de lactentes de risco na população da rede pública de saúde brasileira.

OBJECTIVE: To verify the concurrent validity and interobserver reliability of the Alberta Infant Motor Scale (AIMS) in premature infants followed-up at the outpatient clinic of Instituto Fernandes Figueira, Fundação Oswaldo Cruz (IFF/Fiocruz), in Rio de Janeiro, Brazil. METHODS: A total of 88 premature infants were enrolled at the follow-up clinic at IFF/Fiocruz, between February and December of 2006. For the concurrent validity study, 46 infants were assessed at either 6 (n = 26) or 12 (n = 20) months' corrected age using the AIMS and the second edition of the Bayley Scales of Infant Development, by two different observers, and applying Pearson's correlation coefficient to analyze the results. For the reliability study, 42 infants between 0 and 18 months were assessed using the Alberta Infant Motor Scale, by two different observers and the results analyzed using the intraclass correlation coefficient. RESULTS: The concurrent validity study found a high level of correlation between the two scales (r = 0.95) and one that was statistically significant (p < 0.01) for the entire population of infants, with higher values at 12 months (r = 0.89) than at 6 months (r = 0.74). The interobserver reliability study found satisfactory intraclass correlation coefficients at all ages tested, varying from 0.76 to 0.99. CONCLUSIONS: The AIMS is a valid and reliable instrument for the evaluation of motor development in high-risk infants within the Brazilian public health system.