Desenvolvimento de linguagem e sono em crianças com a Síndrome Congênita do Zika Vírus
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2024-03-22
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Universidade Estadual Paulista (Unesp)
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O vírus Zika é um teratógeno humano recentemente reconhecido, e as consequências clínicas desta infecção pré-natal no desenvolvimento da prole de mães infectadas ainda estão sendo delineadas. Os casos mais graves compõem a chamada Síndrome Congênita do Zika Vírus (SCZ), na qual os bebês apresentam, ao nascimento, microcefalia com alterações cerebrais, além de alterações oftalmológicas, musculares, articulares, entre outras. Como o surto da infecção ocorreu no nordeste brasileiro em 2015, as crianças que sobreviveram estão agora na faixa etária de 7 a 8 anos, e seu acompanhamento é essencial para a descrição do curso temporal da Síndrome. Para avançarmos na compreensão do fenótipo e no desenvolvimento de abordagens terapêuticas para crianças afetadas pela Síndrome Congênita do Zika Vírus, propusemos um estudo longitudinal focado em duas importantes características do neurodesenvolvimento: a linguagem e o sono. Nosso objetivo foi investigar suas trajetórias ao longo do tempo e suas possíveis inter-relações, visando contribuir para um melhor entendimento da condição e para aprimorar as estratégias de intervenção. Metodologia: Participaram desta pesquisa 93 bebês e crianças, de ambos os sexos, cujos dados foram coletados em mutirões semestrais realizados desde 2016 no Instituto Caviver (Fortaleza-CE). Em cada seção desta tese, está descrito o número de crianças avaliadas em cada faixa etária para atingir cada um dos três objetivos. O desenvolvimento da linguagem foi avaliado por meio da Escala de Aquisições Iniciais de Linguagem (ELM) e das Escalas Bayley de Desenvolvimento do Bebê e da Criança Pequena – 3ª edição (Bayley III); a qualidade do sono, por meio do Breve Questionário sobre Sono na Infância (BQSI) e da Escala de Distúrbios de Sono em Crianças (EDSC). Resultados: 100% das crianças no grupo etário de 12 a 36 meses apresentaram habilidade auditiva expressiva e receptiva abaixo do esperado para a idade cronológica. Todas as crianças responderam à presença de sons, mas apenas 2,4% foram capazes de acatar ordens simples. Não houve correlação significativa entre perímetro cefálico e linguagem em nenhuma faixa etária. Ao comparar as habilidades de linguagem da ELM entre os diferentes grupos, não houve melhora no desempenho das crianças nos grupos etários mais avançados. Quanto aos dados da Bayley III, foram encontradas diferenças na comunicação receptiva, com melhora entre 19-24 meses e 25-30 meses, e piora no desempenho entre 25-30 meses e 31-36 meses. Houve diferença significativa na habilidade cognitiva, com pior desempenho entre 12-18 meses e 19-24 meses, e melhor desempenho entre 19-24 meses e 25-30 meses. Na habilidade motora fina, houve diferença entre 19-24 meses e 25-30 meses, representando discreta melhora no desempenho motor. Já na habilidade social, a diferença encontrada foi entre 25-30 meses e 31-36 meses, o que representa diminuição das habilidades sociais nesta faixa etária. Em relação à análise qualitativa da duração do sono, aproximadamente 80% das crianças apresentaram tempo total de sono abaixo das diretrizes recomendadas. A análise longitudinal dos parâmetros de sono não revelou diferenças significativas entre as crianças nos quatro grupos etários examinados. As análises de correlação revelaram que, de zero aos 12 meses de idade, há uma relação negativa entre a habilidade auditiva expressiva e o horário de dormir, assim como com os despertares noturnos, e uma relação negativa entre a habilidade visual e os despertares noturnos. As análises de correlação mostraram que a linguagem expressiva e receptiva apresentou relação com outras habilidades do neurodesenvolvimento. Não foram encontradas correlações entre os dados de sono do BQSI e as habilidades de linguagem a partir da Bayley III. Conclusões: As crianças com SCZ chegaram aos 36 meses de idade com um desempenho nas escalas de desenvolvimento de linguagem equivalente a uma faixa etária de 2 a 3 meses. Não houve evolução nos parâmetros da linguagem receptiva e expressiva durante os primeiros 36 meses de idade. Não houve evolução nos parâmetros de sono durante os primeiros 36 meses de idade. Quanto mais tarde o horário de dormir e quanto maior o número de despertares, pior foi a habilidade auditiva expressiva das crianças. Quanto mais tempo a criança demorou para dormir e quanto menor a duração do sono, pior a habilidade auditiva receptiva. Quanto maior a duração do sono, melhor foi o desempenho na habilidade visual.
The Zika virus is a recently recognized human teratogen, and the clinical consequences of this prenatal infection on the development of the offspring of infected mothers are still being delineated. The most serious cases make up the so-called Congenital Zika Virus Syndrome (CZS), in which babies present microcephaly with brain alterations at birth, as well as ophthalmologic, muscular and joint alterations, among others. As the outbreak of the infection occurred in northeastern Brazil in 2015, the children who survived are now aged between 7 and 8, and their follow-up is essential for describing the time course of the Syndrome. To advance our understanding of the phenotype and the development of therapeutic approaches for children affected by Congenital Zika Virus Syndrome, we proposed a longitudinal study focused on two important neurodevelopmental characteristics: language and sleep. Our aim was to investigate their trajectories over time and their possible interrelationships, in order to contribute to a better understanding of the condition and to improve intervention strategies. Methodology: Ninetythree babies and children, of both sexes, took part in this research. The data was collected during the six-monthly workshops held at the Caviver Institute (Fortaleza-CE) since 2016. Each section of this thesis describes the number of children assessed in each age group in order to achieve each of the three objectives. Language development was assessed using the Early Language Acquisition Scale (ELM) and the Bayley Scales of Infant and Young Child Development - 3rd edition (Bayley III); sleep quality was assessed using the Brief Questionnaire on Sleep in Childhood (BQSI) and the Sleep Disorders in Children Scale (EDSC). Results: 100% of the children in the 12-36 month age group had expressive and receptive hearing skills below those expected for their chronological age. All the children responded to the presence of sounds, but only 2.4% were able to follow simple commands. There was no significant correlation between head circumference and language in any age group. When comparing the language skills of the ELM between the different groups, there was no improvement in the performance of the children in the more advanced age groups. As for the Bayley III data, differences were found in receptive communication, with improvement between 19-24 months and 25-30 months, and worsening performance between 25-30 months and 31-36 months. There was a significant difference in cognitive ability, with worse performance between 12-18 months and 19-24 months, and better performance between 19-24 months and 25-30 months. In fine motor skills, there was a difference between 19-24 months and 25-30 months, representing a slight improvement in motor performance. As for social skills, the difference was found between 25-30 months and 31-36 months, which represents a decrease in social skills in this age group. With regard to the qualitative analysis of sleep duration, approximately 80% of the children had a total sleep time below the recommended guidelines. The longitudinal analysis of sleep parameters revealed no significant differences between the children in the four age groups examined. Correlation analyses revealed that, from zero to 12 months of age, there was a negative relationship between expressive listening skills and bedtime, as well as with night-time awakenings, and a negative relationship between visual skills and night-time awakenings. The correlation analyses showed that expressive and receptive language were related to other neurodevelopmental skills. No correlations were found between sleep data from the BQSI and language skills from the Bayley III. Conclusions: The children with SCZ reached 36 months of age with a performance on the language development scales equivalent to an age group of 2 to 3 months. There was no progress in receptive or expressive language parameters during the first 36 months of age. There was no evolution in sleep parameters during the first 36 months of age. The later the bedtime and the greater the number of awakenings, the worse the children's expressive listening skills. The longer the child took to fall asleep and the shorter the duration of sleep, the worse the receptive hearing ability. The longer the duration of sleep, the better the performance in visual skills.
The Zika virus is a recently recognized human teratogen, and the clinical consequences of this prenatal infection on the development of the offspring of infected mothers are still being delineated. The most serious cases make up the so-called Congenital Zika Virus Syndrome (CZS), in which babies present microcephaly with brain alterations at birth, as well as ophthalmologic, muscular and joint alterations, among others. As the outbreak of the infection occurred in northeastern Brazil in 2015, the children who survived are now aged between 7 and 8, and their follow-up is essential for describing the time course of the Syndrome. To advance our understanding of the phenotype and the development of therapeutic approaches for children affected by Congenital Zika Virus Syndrome, we proposed a longitudinal study focused on two important neurodevelopmental characteristics: language and sleep. Our aim was to investigate their trajectories over time and their possible interrelationships, in order to contribute to a better understanding of the condition and to improve intervention strategies. Methodology: Ninetythree babies and children, of both sexes, took part in this research. The data was collected during the six-monthly workshops held at the Caviver Institute (Fortaleza-CE) since 2016. Each section of this thesis describes the number of children assessed in each age group in order to achieve each of the three objectives. Language development was assessed using the Early Language Acquisition Scale (ELM) and the Bayley Scales of Infant and Young Child Development - 3rd edition (Bayley III); sleep quality was assessed using the Brief Questionnaire on Sleep in Childhood (BQSI) and the Sleep Disorders in Children Scale (EDSC). Results: 100% of the children in the 12-36 month age group had expressive and receptive hearing skills below those expected for their chronological age. All the children responded to the presence of sounds, but only 2.4% were able to follow simple commands. There was no significant correlation between head circumference and language in any age group. When comparing the language skills of the ELM between the different groups, there was no improvement in the performance of the children in the more advanced age groups. As for the Bayley III data, differences were found in receptive communication, with improvement between 19-24 months and 25-30 months, and worsening performance between 25-30 months and 31-36 months. There was a significant difference in cognitive ability, with worse performance between 12-18 months and 19-24 months, and better performance between 19-24 months and 25-30 months. In fine motor skills, there was a difference between 19-24 months and 25-30 months, representing a slight improvement in motor performance. As for social skills, the difference was found between 25-30 months and 31-36 months, which represents a decrease in social skills in this age group. With regard to the qualitative analysis of sleep duration, approximately 80% of the children had a total sleep time below the recommended guidelines. The longitudinal analysis of sleep parameters revealed no significant differences between the children in the four age groups examined. Correlation analyses revealed that, from zero to 12 months of age, there was a negative relationship between expressive listening skills and bedtime, as well as with night-time awakenings, and a negative relationship between visual skills and night-time awakenings. The correlation analyses showed that expressive and receptive language were related to other neurodevelopmental skills. No correlations were found between sleep data from the BQSI and language skills from the Bayley III. Conclusions: The children with SCZ reached 36 months of age with a performance on the language development scales equivalent to an age group of 2 to 3 months. There was no progress in receptive or expressive language parameters during the first 36 months of age. There was no evolution in sleep parameters during the first 36 months of age. The later the bedtime and the greater the number of awakenings, the worse the children's expressive listening skills. The longer the child took to fall asleep and the shorter the duration of sleep, the worse the receptive hearing ability. The longer the duration of sleep, the better the performance in visual skills.
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Palavras-chave
Síndrome Congênita do Zika Vírus, Qualidade de sono, Desempenho de linguagem, Congenital Zika Syndrome, Sleep quality, Language performance
Como citar
SILVA, Nathani Cristina da. Desenvolvimento de linguagem e sono em crianças com a Síndrome Congênita do Zika Vírus. 2024. 68 f. Tese (Doutorado em Fonoaudiologia) - Faculdade de Filosofia e Ciências, Universidade Estadual Paulista (Unesp), Marília, 2024.