Pequeno para a idade gestacional : neurodesenvolvimento no primeiro ano de vida / Small-for-gestational age : neurodevelopment in the first year of age

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

Intrauterine malnutrition has been associated to long-term neurological morbidity and the small for gestational age infant is considered as a model for study this propose. The objective of this study was to evaluate the neurodevelopmental indicators according to Bayley Scales of Infant Development of full-term small-for-gestational age (SGA) infants compared with those born appropriate for gestational age (AGA), in the first year of life. The research design was a prospective study of two cohorts, one of full-term SGA group and other of control AGA group; with cross-sectional data analysis. A hundred and twenty five full-term neonates were selected at Neonatology Service in the Center of Integral Attention to the Woman s Health (CAISM) of the University of Campinas (UNICAMP), São Paulo, Brazil. Ethical permission was obtained from the Research Ethics Committee of the Medical Faculty of UNICAMP and the parents also gave the fully informed consent. They were selected on the following criteria: subjects living in the metropolitan area of Campinas; neonates considered in good health for going home within 2 days after birth; gestational age categorized as full-term (37-41 weeks) by Capurro postnatal method; expected birth weight for determined gestational age by Battaglia and Lubchenco method; birth weight less than the 10th percentile for the SGA group and between the 10th and the 90th percentile for the AGA group. Genetic syndromes, multiple congenital malformations and verified congenital infections (syphilis, toxoplasmosis, rubella, citomegalovirus, herpes) were excluded. The SGA group infants were classified according to body proportionality as symmetric SGA (S-SGA) and asymmetric SGA (A-SGA) for data analysis. All children were scheduled for developmental evaluation by the Bayley Scales of Infant Development II (Bayley, 1993) and two professionals who were unaware of the classification of the neonate s group performed the assessments of the infants, in the presence of their mothers, at 1, 2, 3, 6, 9 and 12 months of age. The infant s score for each item was registered in the Mental and Motor Scale Record Form. A total of 95 infants were performed. No differences were observed in Mental and Motor Scales performance, when classified as adequate (IS = 85) or inadequate (IS <85). In the Mental Scale, means comparison between the groups showed no statistical differences. Considering the Motor Scale the SGA group showed lower IS means in the 2nd and in the 12th months (p = 0,008 and 0,046, respectively, Mann-Whitney test) and the S-SGA group in the 2hd month of age (p = 0,016 Kruskal Wallis test). Considering the Behavior Rating Scale, the inadequate performance were associated in the 2nd month of life, 5,19 times in higher proportion to SGA group (IC95%: 1,03-29,12) and 8,89 times to S-SGA group (IC95%: 1,53-57,40). In the 3rd month of age, was 22,0 times in higher proportion to A-SGA infants. Considering the occipitofrontal circumference at birth, the microcephalic born infants demonstrated association with inadequate performance in higher proportion in the 1st month of life (p = 0,011 Exact Fisher test) in the Mental Scale. Analyzing the relationship between biologic and socio-demographic variables using the univariate analysis, there was no association with theses variables and mental and motor performances in any month of the first year of life.

ASSUNTO(S)

neurologia do desenvolvimento intrauterine growth retardation infant retardo do crescimento fetal desnutrição - complicações e sequelas child development desenvolvimento infantil lactantes - desenvolvimento developmental neurology malnutrition

Documentos Relacionados