Desempenho motor, de linguagem e qualidade do sono em crianças prematuras
Data
2017-04-28
Autores
Dornelas, Lilian Maria Candido de Souza [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Crianças prematuras apresentam maior risco para atraso no desenvolvimento motor e de linguagem, bem como problemas do sono. Até onde temos conhecimento, esses três aspectos ainda não foram explorados em conjunto no contexto da prematuridade. O estudo teve como objetivo investigar o desempenho motor, de linguagem e aspectos do sono de crianças prematuras. Participaram 18 crianças prematuras, 11 do gênero masculino e 7 do gênero feminino, com idade cronológica de 4,3 a 34,3 meses. Também participaram 18 crianças nascidas a termo, semelhantes quanto à idade cronológica, gênero e nível socioeconômico dos prematuros. Os procedimentos incluíram anamnese para levantamento dos dados sociodemográficos, dados do nascimento e fatores neonatais de risco associados à prematuridade (grau de prematuridade, peso ao nascimento, condições de nascimento pelo APGAR, tempo de hospitalização e intercorrências pós-natais). Os instrumentos utilizados incluíram o Teste de Screening de Desenvolvimento - Denver II (TSDD-II), Early Language Milestone (ELM) e Breve Questionário sobre o Sono na Infância (BQSI). Prematuros com idade inferior a 24 meses tiveram o desempenho avaliado na idade cronológica e na idade corrigida para fins comparativos. A melatonina foi dosada por meio da saliva em intervalos de seis horas, por um período de 24 horas. Os resultados mostraram que prematuros apresentaram risco para o desenvolvimento “motor fino adaptativo” e da “linguagem” no TSDD-II e nas áreas “auditiva expressiva” e “auditiva receptiva” da escala ELM, sendo o nível expressivo o mais prejudicado. Houve aumento significativo no número de crianças com risco para atraso no domínio “linguagem” do TSDD-II, quando analisado pela idade cronológica. Prematuros apresentaram sinais indicativos de distúrbio do sono, com menor tempo de sono noturno e maior tempo para retornar ao sono após os despertares noturnos. Foi possível dosar a melatonina de seis prematuros. Dois destes apresentavam indicativos de distúrbio de sono e alteração na produção de melatonina. Prematuros “moderados a tardio” apresentaram menor risco para atraso no desenvolvimento pessoal-social e de linguagem expressiva, bem como mais facilidade para adormecerem a noite. Prematuros “baixo peso” apresentaram menor risco para alteração na linguagem expressiva”. Não foi encontrada associação entre o desempenho motor e de linguagem com os demais fatores de nascimento e intercorrências neonatais investigados. Correlação negativa foi encontrada entre o tempo de sono diurno e o número de despertares noturnos com o desempenho motor e de linguagem. A partir dos resultados apresentados foi possível concluir que as crianças prematuras deste estudo apresentaram desempenho motor e de linguagem inferior quando comparadas aos seus pares e também mais problemas de sono, e o uso da idade corrigida reduziu o número de prematuros de risco para o desenvolvimento da linguagem. A associação entre aspectos do sono e do desenvolvimento motor e de linguagem observadas neste estudo deve ser melhor investigada, incluindo a análise de produção da melatonina a fim elucidar como tais associações podem repercutir no desenvolvimento de crianças prematuras, já que tal associação ainda não está bem estabelecida.
Preterm infant are at increased risk for delayed motor and language development, as well as sleep problems. To the best of our knowledge, these three aspects have not yet been explored together in the context of prematurity. The aim of the study was to investigate motor performance, language and sleep aspects of premature infants. Participants were 18 premature children, 11 males and 7 females, with a chronological age of 4.3 to 34.3 months. Eighteen fullterm children, like the chronological age, gender, and socioeconomic status of preterm infants were also enrolled. The procedures included anamnesis to collect sociodemographic data, birth data and neonatal risk factors associated with prematurity (prematurity, birth weight, apgar score birth conditions, hospitalization time and postnatal intercurrences). The instruments used included the Denver Developmental Screening Test - II (DDST-II), Early Language Milestone (ELM) and Brief Infant Sleep Questionnaire (BISQ). Premature infants under the age of 24 months had their performance evaluated in chronological age and corrected age for comparative purposes. Melatonin was dosed by saliva at six hour intervals for a period of 24 hours. The results showed that premature infants presented a risk for the "fine motor adaptive" and "language" development in DDST-II and in the "auditory expressive" and "auditory receptive" areas of the ELM scale, being the expressive level the most impaired. There was a significant increase in the number of children at risk of delay in the "language" domain of DDST-II when analyzed by chronological age. Premature infants presented signs indicative of sleep disturbance, with shorter nocturnal sleep time and longer time to return to sleep after nocturnal awakenings. It was possible to dose the melatonin of six premature infants. Two of these presented indicatives of sleep disturbance and altered melatonin production. "Moderate to late" preterm infants had a lower risk of delayed “personal-social” development and expressive language, as well as a greater ability to fall asleep at night. "Low-weight" preterm infants had a lower risk of altered expressive language. There was no association between motor and language performance with the other factors of birth and neonatal intercurrences investigated. Negative correlation was found between daytime sleep time and the number of nocturnal awakenings with motor and language performance. From the results presented, it was possible to conclude that premature children in this study had lower motor and language performance when compared to their peers and also had more sleep problems, and the use of corrected age reduced the number of preterm infants at risk for development of language. The association between sleep and motor development and language aspects observed in this study should be further investigated, including the melatonin production analysis to elucidate how such associations may affect the development of premature infants, since such association is still not well established.
Preterm infant are at increased risk for delayed motor and language development, as well as sleep problems. To the best of our knowledge, these three aspects have not yet been explored together in the context of prematurity. The aim of the study was to investigate motor performance, language and sleep aspects of premature infants. Participants were 18 premature children, 11 males and 7 females, with a chronological age of 4.3 to 34.3 months. Eighteen fullterm children, like the chronological age, gender, and socioeconomic status of preterm infants were also enrolled. The procedures included anamnesis to collect sociodemographic data, birth data and neonatal risk factors associated with prematurity (prematurity, birth weight, apgar score birth conditions, hospitalization time and postnatal intercurrences). The instruments used included the Denver Developmental Screening Test - II (DDST-II), Early Language Milestone (ELM) and Brief Infant Sleep Questionnaire (BISQ). Premature infants under the age of 24 months had their performance evaluated in chronological age and corrected age for comparative purposes. Melatonin was dosed by saliva at six hour intervals for a period of 24 hours. The results showed that premature infants presented a risk for the "fine motor adaptive" and "language" development in DDST-II and in the "auditory expressive" and "auditory receptive" areas of the ELM scale, being the expressive level the most impaired. There was a significant increase in the number of children at risk of delay in the "language" domain of DDST-II when analyzed by chronological age. Premature infants presented signs indicative of sleep disturbance, with shorter nocturnal sleep time and longer time to return to sleep after nocturnal awakenings. It was possible to dose the melatonin of six premature infants. Two of these presented indicatives of sleep disturbance and altered melatonin production. "Moderate to late" preterm infants had a lower risk of delayed “personal-social” development and expressive language, as well as a greater ability to fall asleep at night. "Low-weight" preterm infants had a lower risk of altered expressive language. There was no association between motor and language performance with the other factors of birth and neonatal intercurrences investigated. Negative correlation was found between daytime sleep time and the number of nocturnal awakenings with motor and language performance. From the results presented, it was possible to conclude that premature children in this study had lower motor and language performance when compared to their peers and also had more sleep problems, and the use of corrected age reduced the number of preterm infants at risk for development of language. The association between sleep and motor development and language aspects observed in this study should be further investigated, including the melatonin production analysis to elucidate how such associations may affect the development of premature infants, since such association is still not well established.
Descrição
Palavras-chave
Prematuro, Habilidades motoras, Linguagem, Sono, Desenvolvimento infantil