Desenvolvimento global de crianças em idade escolar nascidas prematuras e acompanhadas no ambulatório de crianças de risco hospitalar das clínicas da UFMG (ACRIAR): habilidades motoras e fatores associados

Abstract

Introduction: The adverse results on the development associated with premature birth are a major concern in healthcare today. Despite the increased survival of these children due to the higher obstetric and neonatal support available in recent decades, preterm children are still more susceptible to development al problems when compared to their full term peers. Various aspects of the development can be harmed in the short, medium and long term, such as motor behavior, coordination, and attention and academic performance. In addition to the biological risk factors, preterm children may be exposed to multiple risks and the context in which they live can be decisive for positive or negative effects on their development. Objectives: Describe the prevalence of motor deficits in preterm children assessed at school age and to investigate the association bet ween risk conditions and motor development of preterm children. Methods: We conducted an observational cross-sectional study involving children born with gestational age <35 weeks and/or birth weight <1500 grams eight to 10 years old and their families recruited at the Follow up Clinic for Children at Risk (ACRIAR), Hospital das Clinicas UFMG. Parents answered a Structured Questionnaire (QE), the Inventory of Resources Environment Family (RAF) and the Strengths and Difficulties Questionnaire (SDQ). The QE data included a developmental history and degree of autonomy of children in activities of daily living. Neuropsychological function was assessed with the Token Test (TT), the SDQ was used as a behavioral index and school performance was assessed with the Academic Performance Test (TDE). The Movement Assessment Battery for Children (MABC-2) was used to assess motor development with the cut off criteria set at the 15th percentile. Chi-square, Fisher exact and Kruskal-Walliss tests were used to verify the association between the results of the MABC-2 and outcomes. We performed multivariate analysis (logistic regression) using a hierarchical model. We adopted a significance level of 0.05 in the final model of the multivariate analysis. Results: We evaluated 100 children "apparently normal" born with median weight of 1370g, who spent on average 30 days in hospital and use oxygen for five days. About 6% of children had intraventricular hemorrhage grade II or III and 80% were born by cesarean section. Over 60% of the children were breastfed for more than six months, 10% presented cephalic perimeter below expectation at the age of 2 and 16% were submitted to physiotherapy and/or occupational therapy during their lifetime. The mothers were, on average, 27 years old at the birth of the child, had two children and household per capita income of one minimum wage. At the time of interview over 60% of the mothers worked outside the home. Prevalence of motor deficits was 39%. Manual dexterity was the most affected subarea (49%), followed by balance (35%) and ball skills (26%). About 30% of children showed deficits in the TT and/or SDQ and/or TDE. The variables that have demonstrated an independent association with motor performance were "Resources Environment Family-RAF" (OR=0.95 and CI=0.91-0.99), "Mother's age at birth of the child" (OR=0.88 and CI=0.80-0.97), "Mother who works away from home today" (OR=4.07and CI=1.43-11.56) and "Birthweight" (OR=0.99 and CI=0.997-0.999). According to the regression model, the lower the birthweight, the mother´s age and the RAF score the higher the risk of getting an atypical score on the MABC-2. The odds of getting an atypical score on the MABC-2 was four times greater when the mother did not work outside the home. There was no significant association between outcome the MABC-2 and TDE (p=0.09), TT (p=0.47) and SDQ (p=0.45). There was, however, association between the MABC-2 and functional skills such as "Tying shoes"(p<0.001) and "Open and close zipper and/or buttons (p=0.01). Conclusion: The results of this study highlight the relevance of environmental factors for the motor performance of preterm children, in addition to factors already known such as birthweight. Despite the association between motor neuropsychological and school performance have not been demonstrated, it is important to consider the high prevalence of these disorders in "apparently normal" preterm schoolage children. It is important to offer further guidance to parents and professionals for early detection and timely intervention before school and social failure have installed. It was also found that functional tasks requiring greater manual dexterity (tying shoes and opening and opening and closing zipper and/or buttons) were associated with motor deficits. Standardized tests have proved to be useful to detect deficits in several areas of development.