Neurological assessment of newborns at risk admitted to a Neonatal Intermediate Care Unit

Abstract

Objective: To verify whether newborns (NBs) at risk for delayed motor development at a reference maternal-infant hospital had altered neuroimaging and neurological assessment during their stay at the Neonatal Intermediate Care Unit (NICU). Methods: Cross-sectional study, carried out in an intermediate neonatal care unit, in a public maternal and child hospital. The characterization of the sample and the neuroimaging tests were verified through data from the electronic medical records. The neuromotor development of NBs was assessed using the following scales: Hammersmith Neonatal Neurological Examination (HNNE) and General Movements Assessment (GMA). Results: Thirty-seven at-risk newborns were studied, of which the male gender, cesarean delivery and white race were predominant. Apgar median > 7, mean maternal age 25.1 years. Most parents live together, average of five prenatal visits, gestational age 35.8 weeks. Prematurity and congenital syphilis were the main diagnoses. 40.5% had neuroimaging exams, especially brain ultrasound with normal results. In the HNNE the score "altered" stood out and in the GMs the classification "suboptimal". The average HNNE for prematurity was adequate, but in congenital syphilis it indicated alterations. Apgar scores at the 1st and 5th minute were significantly lower in low birth weight. Congenital syphilis was associated with fewer prenatal visits. Physical therapy showed significant association with "optimal" classification in HNNE. Conclusion: NBs at risk present alterations in neurological assessments performed early. Physical therapy is associated with better neuromotor performance. Neuroimaging is a limited resource in the hospital studied.