Desenvolvimento neuropsicomotor e fatores contextuais de nascidos prematuros com idades entre 3 e 24 meses

Abstract

INTRODUCTION: Premature birth is associated with a high prevalence of neuromotor disorders and the current literature indicates that it is possible to identify these conditions before 6 months of corrected age using reliable tools. OBJECTIVES: To describe the neurological, motor, socio-emotional and adaptive behavior development of premature infants aged between 3 and 24 months and verify their correlation and/or association with the results of the GMA method and the affordancesin the home environment. METHODS: Observational, longitudinal and prospective study, which evaluated born preterm infants who were hospitalized in Neonatal Intensive Care Units (NICUs) of the HMTJ and HRJP hospitals, in Juiz de Fora - MG. Those who had been evaluated with the GMA method in the referred NICUs were included. Those with other conditions that affect global movements were excluded. Were used tools to assess the neurological (HINE), motor (Alberta Infant Motor Scale - AIMS), socio-emotional (SE) (Bayley III) and adaptive behavior (AB) (BayleyIII) development, also the Affordances in the Home Environment for Motor Development – AHEMD) and General Movements (GMA). Data were stored in a secure database and for all analyzes a significance level of α = 0.05 was considered, with values below or equal to 0.1 as differentiation trends. RESULTS: The sample consisted of 49 preterm infants and the neurological assessment (HINE) indicated a suboptimal score for more than ¼ of them. Motor development (AIMS) was lower than cut-off-point in 43% and 40% of the sample between 3 and 4 months and 5 and 6 months, respectively. Respectively, 100% and 88.9% of the sample showed normal performances in SE and AB development between 3 and 6 months, but 45% of the infants evaluated between 12 and 24 months had altered AB (Bayley III). Differentiation trends were found between opportunities present in the home environment and the HINE and AB from 12 to 24 months, with very good (significant) agreement between these classifications (Kappa = 1.00, P-value = 0.025). Moderate agreement was found between FM ratings and Bayley SE (Kappa = 0.500, P-value = 0.248) and good agreement between FM ratings and Bayley AB (Kappa = 0.615, P-value = 0.136) between 12 and 24 months. There were strong correlations between opportunities present in the home environment (AHEMD) between 3 to 5 months with the AB at 3 to 6 months (r= 0.975; p= 0.005) and SE development at 12 to 24 months (r= 0.816; p = 0.184). Considering the AHEMD from 6 to 10 months, a strong correlation was found with the AB from 12 to 24 months (r= 0.900; p= 0.037). CONCLUSIONS: There was a high prevalence of delays or abnormal neurological, motor, socio-emotional development and adaptive behavior between 3 and 24 months of born preterm infants who were hospitalized in the NICU, with the worst outcomes occurring in wich ones under unfavorable conditions in the home environment and/or FM absent or abnormal between 3 and 4 months.