Avaliação dos movimentos gerais de recém-nascidos pré-termo em unidade de terapia intensiva neonatal: um estudo longitudinal

Abstract

The present study aimed to describe the General Movements (GMs) trajectories of preterm infants during stay in the Neonatal Intensive Care Unit (NICU) and to explore the association between clinical variables with the presence of abnormal movements along the trajectories established in stay. A longitudinal, observational, prospective, exploratory study was carried out in the NICU of the Hospital das Clínicas of the Federal University of Minas Gerais (HCUFMG), Belo Horizonte, Minas Gerais. A total of 58 preterm infants participated in the study between July 2020 and March 2021, with the GMs recorded, assessedd and classified as normal and abnormal weekly from the third day of life until hospital discharge using the General Movements Assessment (GMA). Clinical variables were collected to characterize the sample and verify the association with the classification of GMs. Descriptive statistics were used for data analysis and the association between clinical variables and the weekly presence of abnormal GMs were tested using the Generalized Estimating Equations (GEE) model. Seventeen (29.3%) babies had a normal trajectory and eight (13.8%) had an abnormal trajectory during the period of hospitalization. Thirty-three (56.9%) babies had an unstable trajectory, with abnormal movements for at least one week during hospitalization, with a variation from 20% to 88.8% of abnormal movements during the trajectory. It was observed that the absence of periventricular hemorrhage (IVH) reduced by 77.3% (OR=0.23; p>0.0001) the chance of having an abnormal classification compared to those who presented IVH grades I and II. The absence of non-invasive ventilatory support and/or oxygen therapy on the day of the evaluation reduced the chance of having an abnormal classification by 64.3% (OR=0.36; p>0.0001) compared to those who used it. In addition, each day of increased invasive mechanical ventilation increased the chance of having an abnormal classification by 1.11 times (OR=0.025; p>0.0001). Considering that most preterm babies evaluated showed unstable trajectories of classification of GMs during their stay in NICU, the presence of grades I-II IVH, the time of use of invasive mechanical ventilation and the use of non-invasive respiratory support and /or oxygen therapy should be monitored throughout hospitalization, as they may interfere with GM outcomes. The results of this study reinforce the importance of longitudinal follow-up during this period, which can contribute to decision making about which babies will need to be followed up after hospital discharge.