Fatores relacionados ao alto risco de paralisia cerebral: desenvolvimento de um índice multicritério

Abstract

Cerebral palsy (CP) is one of the most common causes of physical disability in childhood. There are clinical practice guidelines that recommend criteria for the early detection of infants at high risk of CP, allowing for the prediction of CP diagnosis before 6 months of age, corrected if necessary. The tools with the highest predictive validity for detecting high risk of CP are the General Movements (GMs) assessment, the Hammersmith Infant Neurological Examination (HINE), and magnetic resonance imaging (MRI). However, in low- and middle-income countries like Brazil, the use of high-cost neuroimaging exams, such as MRI, is often infeasible. In most cases, the causal pathway of CP is not fully understood, but several factors related to CP risk can be identified. The analysis of risk factors associated with the occurrence of CP or high risk of CP has often been conducted individually. The aim of this study was to develop a multicriteria index with the main factors related to high risk of CP. This was an exploratory, observational, cross-sectional study that included preterm or term infants discharged from neonatal intensive care units (NICU). The independent variables were: infections from the TORCHSZ group (toxoplasmosis, rubella, cytomegalovirus, herpes, syphilis, and zika virus); prematurity; birth asphyxia; Apgar score at the 5th minute; seizures; duration of mechanical ventilation; use of corticosteroid and magnesium sulfate medications in the prenatal period; use of therapeutic hypothermia; and caffeine during the neonatal period. The dependent variable was the high risk of CP, operationalized by the presence of altered results in the GMs and HINE. To create the multicriteria index, a method based on multi-attribute utility theory was used. Pearson correlation was performed, followed by simple linear regression analysis between the multicriteria index and the high risk of CP. A one-way analysis of variance (ANOVA) with Tukey’s post hoc test was performed to verify differences between risk groups and the dependent variable values. Ninety-two infants participated in the study. The multicriteria index ranged from 0.01 to 0.79, with a mean of 0.19 ± 0.18. The combined outcome variable ranged from 0 to 1, with a mean of 0.19 ± 0.20. The multicriteria index was positively and moderately correlated with the outcome variable (r=0.445, p<0.001). Simple linear regression analysis showed that the multicriteria index explained 20% of the dependent variable (R2=0.20, β=0.45, p<0.0001), with a moderate association. There was a significant difference between the low-risk and high-risk groups (p<0.0001) and between the medium- and high-risk groups (p=0.005) of CP. The multicriteria index developed through the combination of clinical factors associated with the results of early detection tools allowed the identification of high-risk babies for CP with a history of NICU admission. These findings may help healthcare professionals in identifying babies at high risk of CP and referring them in a more careful manner for early intervention.