Repertório motor de prematuros no período de internação na unidade de terapia intensiva neonatal

Abstract

Currently, there is a significant increase in the number of premature births and with this, there is a growing need to identify possible neuromotor changes. Other tools available for early identification of these changes are reduction of the general movement assessment method (GMA), which has the best predictive values. The assessment can also be started at the Neonatal Intensive Care Unit (NICU) and progress to a later age, thus optimizing the referral of infants for intervention when needed. Objective: To describe the trajectory in the preterm (WT) and writhing movements (WM) of preterm infants and to verify which individual characteristics or factors and complications are most strongly associated with the GMA trajectory up to five weeks post term. Secondly, check the best moment or criterion based on the method classification for the most assertive prediction of fidgety movements (FM) period. Methods: This was a longitudinal study, including newborns with gestational age (GA) less than 34 weeks and without complications that affected spontaneous movement. The infants were followed by the NICU until the age of 5 weeks post term and subsequently at the ages of 9, 12, 15 and 17 weeks post term. Evaluations were started from the fourteenth day after birth and continued until the end of the WM period and later until the age of FM. For statistical analysis, tests for bivariate analysis were used, such as chi-square or Fisher's exact test, and then a binary regression analysis was performed to stratify a regression model. The assessment of each condition was performed with the GMA method to verify the predictive values. The level of statistical significance was set at p<0.05. Results: 52 infants were followed until the end of the study. The sample consisted of newborns with a mean gestational age of 31 weeks ± 2.2 and average birth weight of 1436 grams ± 568.50. 192 evaluations were performed, 72 in the PT period, 40 in the WM period and 80 in the FM period. A significant number of abnormal classification was evidenced in the PT period, with 44 (61.1%) poor repertoire (PR) ratings, 20 (27.7%) normal ratings and 8 (11.1%) cramped-synchronized (CS) ratings. In the WM period the following classifications were found: 20 (50%) PR, 17 (42.5%) normal classifications and 3 (7.5%) CS classifications. In the bivariate analysis, significant values were found in four factors: GI, in births before 32 weeks (p<0.003); birth weight when less than 1500 grams (p<0.004); early sepsis (p<0.004) length of stay, when greater than 34 days (p<0.006) and Clinical Risk Index for Babies, considering grade 2 (p<0.020). In the binary regression analysis, two models were evidenced, however, the final model included the variables gender, early sepsis and length of stay longer than 34 days, thus clearly explaining the chance of GMA modification in 31%. Predictive values before hospital discharge were found to be acceptable levels of sensitivity (89%), with a high negative predictive value (80%). At the age of 5 weeks post term we showed a sensitivity and specificity (respectively 86% and 58%) with a high negative predictive value (92%) and an increase in the hit ratio, with an accuracy of 69%. Conclusion: This study showed that several factors can interfere with the spontaneous movement trajectory and that the assessment with GMA near the discharge of the NICU has high power to select infants who need outpatient follow-up and cases that will have a good outcome for this classification (Normal FM).