Desempenho motor, processamento sensorial e autocuidado em crianças pré-termo e a termo na idade escolar: estudo exploratório

Abstract

Introduction: In Brazil, more than 12% of babies are born prematurely, before 37 weeks of gestation. With the advance of neonatal care, the survival rate of preterm babies has increased over the last few decades, but as prematurity is a risk factor for child development, care should also focus on the development of preterm child. There are several studies on the impact of prematurity on various areas of child development. However, most of these studies have been carried out in high-income countries, and there is little data on the development of preterm in low- and middle-income countries, where children are exposed to less favorable care and conditions. This makes it necessary to carry out more studies on the impact of prematurity on the development of children in low- and middle-income countries, which can help direct care for this population. This study is part of an ongoing project aimed at assessing the impacts of prematurity on child development and investigating the perceptions of mothers and children about prematurity, the Born Ahead of Time Project. Objectives: To investigate the impacts of prematurity on motor skills, sensory processing and self-care by comparing children born preterm and full-term at ages 6 to 8 years old. An additional objective was to recalculate the sample size and evaluate the characteristics of the sample with a view to concluding the Birth Before Agead of Time project. Methods: Quantitative, cross-sectional, observational and descriptive study, in which the following instruments were used for data collection: sample characterization form, which included the Brazil Economic Classification Criterion, the Assessment of Coordination and Motor Dexterity (ACOORDEM), Sensory Profile 2-Abbreviated (PS2-A), Pediatric Disability Assessment Inventory - Computerized Adaptive Testing (PEDI-CAT) and Kaufman Brief Intelligence Test - 2nd edition (KBIT-2). Seventy-three children were assessed, of whom 42 were preterm (gestational age - GA = 29.67 ±2.44 weeks and birth weight - BW = 1260.85 ±356.78g) and 31 were born at term (GA = 38.95 ±1.36 weeks, BW = 3264.00 ±477.85g). The data from the groups was submitted to the Student's t-test to compare the mean scores on the assessment instruments and the chi-square test for categorical variables, when applicable. The effect size, Cohen's d, as well as the statistical power of the sample were calculated to assess the adequacy of the sample size defined for the original project. Spearman's correlation was used to investigate the relationship between GA and the variables under study. Results: There were no significant differences between the groups in terms of age, gender and maternal educational level, but the term group had higher economic level. Significant differences were found between the preterm and term groups in motor performance (ACOORDEM), sensory processing (PS2-A) and self-care skills (PEDI-CAT), with worse performance in the preterm group. High effect size for the main variables, with good static power, resulted in smaller sample size estimates than calculated a priori. Correlation coefficients ranging from 0.41-0.61 indicate a reasonable to good association between gestational age and motor, functional and sensory processing performance. Conclusion: The preterm group performed worse in all the areas assessed. The effect sizes were large, which may be related to the fact that these are children who, although they attend follow-up programs, have less access to intervention services. Part of the effect may also be related to the higher economic level of the full-term group, which should be considered in the continuity of the Birth Before Ahead of Time Project. The sample size was adequate, which suggests that the project can be completed with a smaller sample than expected, and that it is necessary to invest in the equivalence of the economic level of the groups. Although the study has limitations, the results reinforce both the need for follow-up and to improve access to intervention programs aimed at supporting the development of children born prematurely.