Avaliação do desenvolvimento de bebês pré-termo: influência da idade cronológica, idade corrigida, fatores neonatais e maternos
Carregando...
Data
2023-05-29
Autores
Montagner, Carolina Daniel
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
O percurso do desenvolvimento infantil pode ser impactado por diferentes fatores, sendo eles de origem congênita, biológica, ambiental e cultural. Esses fatores podem ser de proteção ou de risco, promovendo ou dificultando o desenvolvimento da criança. Entre eles está a prematuridade, um fator de risco que pode causar atrasos no desenvolvimento de bebês, mas com possibilidade de ser reversível, com acompanhamento precoce. Para isso é importante avaliar o desenvolvimento infantil utilizando instrumentos, se possível, padronizados, como as Escalas Bayley, considerada padrão ouro, empregada para identificação e planejamento de intervenções em diferentes domínios. Para avaliar o desenvolvimento de bebês pré-termo utiliza-se a idade cronológica ou corrigida. Esta tese teve como objetivos: analisar o uso das Escalas Bayley em estudos de intervenção precoce e, avaliar e comparar o desenvolvimento de bebês, tomando como base as idades cronológica e corrigida nas dimensões avaliadas pela Bayley-III em quatro avaliações durante o primeiro ano de vida, considerando a influência de variáveis maternas e neonatais. Foram conduzidos quatro estudos. No Estudo 1 foi analisado o uso das Escalas Bayley na avaliação do desenvolvimento de bebês no primeiro ano de vida, por meio de uma revisão de literatura. A síntese qualitativa contou com 14 artigos que foram analisados pelas características metodológicas e as relacionadas ao uso das escalas. Observou-se a prevalência de estudos experimentais, que utilizaram as Escalas Bayley para verificar o efeito de intervenções sobre o desenvolvimento de bebês. Dos estudos participaram até 50 bebês, avaliados aos 12 meses de idade, com base na idade corrigida, usando três dos domínios, de forma presencial, individual e em contexto hospitalar. Os dados dos Estudos 2, 3 e 4 foram coletados entre os anos de 2017 a 2020, com registros de 334 bebês pré-termos avaliados, durante o primeiro ano de vida. A coleta foi conduzida durante a realização de dois projetos de intervenção precoce realizados na cidade de Bauru – SP. Os bebês foram avaliados com os instrumentos: Questionário Sociodemográfico, Critério de Classificação Econômica Brasil – CCEB e com as Escalas Bayley-III. Os dados foram obtidos em avaliações trimestrais e analisados considerando a idade cronológica e a idade corrigida. No Estudo 2 dois foram testadas correlações entre as variáveis sociodemográficas maternas e neonatais com o desempenho dos bebês na Bayley nas quatro avaliações considerando idade cronológica e corrigida. Os resultados apontaram que a idade gestacional, o peso ao nascer, o tempo de internação e o número de filhos foram variáveis que se correlacionaram negativamente no desempenho dos bebês, principalmente quando utilizou-se a idade cronológica. No Estudo 3, considerou-se as pontuações ponderadas das idades corrigidas e cronológicas, analisando-as conforme classificação do instrumento em abaixo, na média e acima da média. Observou-se que quando era utilizado a idade corrigida a frequência maior eram as pontuações dentro e acima da média. Porém, quando se considerou a idade cronológica, as pontuações eram abaixo da média, apontando para uma subnotificação das necessidades dos bebês pré-termo com o uso da idade corrigida. No Estudo 4 comparou-se o desenvolvimento de bebês de três grupos diferentes (G1 – até 32 semanas, G2 – de 32 a 34 semanas e G3 – de 35 a 37 semanas), considerando, também, as idades cronológicas e corrigidas, nas quatro avaliações conduzidas. Os grupos diferiram nas pontuações, sendo o G1 com menores médias que o G3 na maioria das avaliações conduzidas, quando foi considerada a idade cronológica. Os resultados obtidos apontaram para a importância da utilização da idade cronológica em avaliações de desenvolvimento que visem o encaminhamento para serviços de intervenção precoce, uma vez que considerar a idade corrigida pode mascarar resultados atrasando o atendimento precoce que os bebês pré-termo necessitam
The path of child development can be impacted by different factors, including congenital, biological, environmental and cultural. These factors can be protective or risk factors, promoting or hindering the child's development. Among them is prematurity, a risk factor that can cause delays in the development of babies, but with the possibility of being reversible, with early monitoring. For this, it is important to assess child development using standardized instruments, if possible, such as the Bayley Scales, considered the gold standard, used to identify and plan interventions in different domains. Chronological or corrected age is used to assess the development of preterm babies. This thesis aimed to: analyze the use of the Bayley Scales in early intervention studies and evaluate and compare the development of babies, based on chronological and corrected ages in the dimensions evaluated by the Bayley-III in four assessments during the first year of life, considering the influence of maternal and neonatal variables. Four studies were conducted. In Study 1, the use of the Bayley Scales was analyzed in the assessment of the development of babies in the first year of life, through a literature review. The qualitative synthesis had 14 articles that were analyzed by methodological characteristics and those related to the use of scales. There was a prevalence of experimental studies, which used the Bayley Scales to verify the effect of interventions on the development of babies. Up to 50 babies participated in the studies, evaluated at 12 months of age, based on the corrected age, using three of the domains, face-to-face, individually and in a hospital context. Data from Studies 2, 3 and 4 were collected between 2017 and 2020, with records of 334 preterm babies evaluated during the first year of life. Data collection was carried out during two early intervention projects carried out in the city of Bauru - SP. The babies were evaluated using the instruments: Sociodemographic Questionnaire, Brazil Economic Classification Criteria – CCEB and the Bayley-III Scales. Data were obtained in quarterly evaluations and analyzed considering chronological age and corrected age. In Study 2, two correlations were tested between maternal and neonatal sociodemographic variables with the performance of babies on the Bayley in the four assessments considering chronological and corrected age. The results showed that gestational age, birth weight, hospitalization time and number of children were variables that negatively correlated with the babies' performance, especially when chronological age was used. In Study 3, we considered the weighted scores of the corrected and chronological ages, analyzing them according to the instrument's classification as below, on average and above average. It was observed that when the corrected age was used, the highest frequency was the scores within and above the average. However, when chronological age was considered, the scores were below average, pointing to underreporting of the needs of preterm babies using corrected age. In Study 4, the development of babies from three different groups was compared (G1 – up to 32 weeks, G2 – from 32 to 34 weeks and G3 – from 35 to 37 weeks), also considering chronological and corrected ages in the four assessments conducted. The groups differed in scores, with G1 having lower means than G3 in most of the assessments conducted, when chronological age was considered. The results obtained point to the importance of using chronological age in developmental assessments aimed at referral to early intervention services, since considering the corrected age can mask results by delaying the early care that preterm babies need.
The path of child development can be impacted by different factors, including congenital, biological, environmental and cultural. These factors can be protective or risk factors, promoting or hindering the child's development. Among them is prematurity, a risk factor that can cause delays in the development of babies, but with the possibility of being reversible, with early monitoring. For this, it is important to assess child development using standardized instruments, if possible, such as the Bayley Scales, considered the gold standard, used to identify and plan interventions in different domains. Chronological or corrected age is used to assess the development of preterm babies. This thesis aimed to: analyze the use of the Bayley Scales in early intervention studies and evaluate and compare the development of babies, based on chronological and corrected ages in the dimensions evaluated by the Bayley-III in four assessments during the first year of life, considering the influence of maternal and neonatal variables. Four studies were conducted. In Study 1, the use of the Bayley Scales was analyzed in the assessment of the development of babies in the first year of life, through a literature review. The qualitative synthesis had 14 articles that were analyzed by methodological characteristics and those related to the use of scales. There was a prevalence of experimental studies, which used the Bayley Scales to verify the effect of interventions on the development of babies. Up to 50 babies participated in the studies, evaluated at 12 months of age, based on the corrected age, using three of the domains, face-to-face, individually and in a hospital context. Data from Studies 2, 3 and 4 were collected between 2017 and 2020, with records of 334 preterm babies evaluated during the first year of life. Data collection was carried out during two early intervention projects carried out in the city of Bauru - SP. The babies were evaluated using the instruments: Sociodemographic Questionnaire, Brazil Economic Classification Criteria – CCEB and the Bayley-III Scales. Data were obtained in quarterly evaluations and analyzed considering chronological age and corrected age. In Study 2, two correlations were tested between maternal and neonatal sociodemographic variables with the performance of babies on the Bayley in the four assessments considering chronological and corrected age. The results showed that gestational age, birth weight, hospitalization time and number of children were variables that negatively correlated with the babies' performance, especially when chronological age was used. In Study 3, we considered the weighted scores of the corrected and chronological ages, analyzing them according to the instrument's classification as below, on average and above average. It was observed that when the corrected age was used, the highest frequency was the scores within and above the average. However, when chronological age was considered, the scores were below average, pointing to underreporting of the needs of preterm babies using corrected age. In Study 4, the development of babies from three different groups was compared (G1 – up to 32 weeks, G2 – from 32 to 34 weeks and G3 – from 35 to 37 weeks), also considering chronological and corrected ages in the four assessments conducted. The groups differed in scores, with G1 having lower means than G3 in most of the assessments conducted, when chronological age was considered. The results obtained point to the importance of using chronological age in developmental assessments aimed at referral to early intervention services, since considering the corrected age can mask results by delaying the early care that preterm babies need.
Descrição
Palavras-chave
Desenvolvimento infantil, Bebês pré-termo, Idade corrigida, Escalas Bayley, Child development, Preterm babies, Corrected age, Bayley scales