Desenvolvimento neuropsicomotor nos primeiros 18 meses de vida de lactentes de alto risco




The aims of the present study were to describe the developmental outcome of high-risk infants during the first 18 months of age, investigate their association to the degree of risk for morbidity and verify the predictive power of three instruments of assessment of infant development. Fifty-six (56) high-risk infants were monitored through the application of the Bailey s Mental and Motor Scales and of the Alberta Infant Motor Scale (AIMS) up to their 18thmonth of corrected age. The POPRAS index was utilized to quantify the degree of risk for morbidity. At the 18thmonth of age, neurological examination and cerebral magnetic resonance imaging (MRI) were performed to investigate lesions and relate them to the findings of the Neonatal Cranial Ultrasound (CU) and neurological examination. At 18 months of corrected age, 39 infants underwent neurological examination, with 11 (28.2%) of them being classified as normal and 28 (71.8%) classified as abnormal. No significant relationship between MRI and CU (p=0.598) was found, or between MRI and the neurological examination at 18 months of age (p=0.613). Study population s low development was found at AIMS, mainly between 2 and 6 months of age. Even with the increasing evolution at AIMS gross scoring, the profile of development was one of instability and tendency of distancing of curves of centiles 25, 10, and 5 in regards to the curves of the superior centiles (50th, 75th, and 90th). Low performance and profile of instability were also found at the Bailey s Motor Scale, mainly between 2 and 6 months of age. The performance of the population at the Bailey s Mental Scale was more stable and within the normal limits for every age. Higher instability of performance was observed at the Bailey s Motor Scale and AIMS for the group with abnormal neurological examination. The scale showing the most association to the risk degree for morbidity was AIMS, with infants that suffered lesser intercurrences (POPRAS $; 90) seeming to have been more affected on the first 4 months of life, showing recovery and diverging from the high-risk ones (POPRAS >90) as of this period. At the analysis of the individual assessments, the 3rd, 4th, and 5th months of the Bailey s Motor Scale and the 4th, 5th, and 6th months of the AIMS were the most predictive of the neurodevelopmental outcome at 18 months of age of the study population. The best predictive values were found combining the findings of more than one assessment. The existence or not of two altered assessments at the Bailey s Motor Scale in consecutive or non-consecutive months during the first six months of life were the most adequate criteria for the prognostic of the neurodevelopmental outcome of high-risk infants at 18 months of age


neurologia pediatrica capacidade motora lactentes - desenvolvimento

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