Associação do início, duração e frequência da posição canguru e a relação mãe-criança pré-termo aos 12 e 18 meses de idade corrigida

Abstract

Introduction: The attachment-related brain structure develops mainly in the first year of life. However, most premature newborns (PTNBs) stay at a hospital during the critical period of brain growth. Biological issues associated with premature birth and early adaptation to the extrauterine environment, in addition to damage and adverse situations in the perinatal and neonatal period, expose the PTNB brain to numerous adversities that can interfere with the mother-child interaction. However, physical contact favors maturation of the somatosensory system through neuronal plasticities, such as skin-to-skin contact (SSC), which can give benefits stimuli and even attenuate noxious ones that can cause damage to the mother-PTNB dyad. However, there still needs to be a consensus on the onset duration and frequency of SSC to achieve desirable interactive behavior in children with this practice. Objective: To summarize the evidence present in the literature to date and to investigate the quantitative parameters, whether onset, duration, and frequency of skin-to-skin contact are associated with interactive skills at 12 and 18 months of corrected age (CA) in RNPT public maternity hospitals in Belo Horizonte. Methodology: The first article was a systematic review carried out under the registry CRD42020222006 on the PROSPERO platform. This second article was a prospective observational study with preterm infants ≤32 weeks evaluated at 12 and 18 months of CA. The mother-PTNB dyads were monitored during hospitalization, and SSC onset, duration, and frequency were recorded. Maternal socioeconomic status, anxiety, and depression were assessed. The children's interactive abilities were assessed through a direct approach with the filming of free play between mother and child at 12 and 18 months of CA and the Dyadic Interaction Assessment Protocol (characteristic, non-characteristic, and not observed) for analysis. During follow-up, maternal anxiety and socioeconomic classification questions were reassessed, in addition to maternal stress, maternal perception of interaction, and child neurodevelopment. SPSS (version 22) was used, and multivariate ordinal logistic regression and Poisson regression models with a robust covariance matrix were constructed. A significance level of 5% was adopted. Results: Seven articles evaluated PTNB for up to 12 months of CA in the systematic review article. In the qualitative analysis, it was possible to verify that the minimum time of onset of the SSC was 45 min of life until the first week, provided that the PTNBs were stable. After that, the duration varied from 1-2 hours per day for about 15 days. SSC was associated with improved contact initiative, responsiveness, reciprocity, gaze, vocalization, and children's negative mood. In the original article, 107 children were followed up at 12 months and 81 children at 18 months CA. There was no association between SSC and interactive behavior at 12 months (p>0.05). On the other hand, when evaluated at 18 months of CA, it was verified that anticipating the onset of SSC one day increased 2.37 times more chances of showing better positive affect (p=0.010) to every hundred minutes/day of SSC; the child had 1.20 times more chances of better child engagement (p=0.045), to each hour of performance of SSC in the NICU, there was a 1.07-fold increase in the chances of the child presenting better child interaction (p=0.015). Conclusions: An association was found between the beginning, minutes/day, and time of SSC in the NICU and infant involvement, interaction, and positive affect at 18 months in children born with gestational age ≤32 weeks. This study adds more data for better knowledge about children's interactive behavior since, in the literature review, no studies associated SSC and children's interactive behavior at 18 months with this study methodology.