Comparison of neurological assessment and general movements of infants at risk at different time points
DOI:
https://doi.org/10.33233/fb.v24i6.5434Keywords:
Premature Newborn, Infant Development, Disability Assessment, Risk FactorsAbstract
Background: Brain development is a constant interaction between genetic, biological, and environmental factors. Its maturation process is extremely sensitive, and if it does not occur in sync, brain damage can occur in the immature brain, triggering a set of permanent movement and posture disorders. Thus, early diagnosis of developmental changes is essential for intervention to begin as soon as possible, optimizing results, improving functional skills, and reducing the damage to the future life of these babies, and serve as a basis for the actions of professional teams dedicated to stimulation and monitoring of child development. Objectives: To compare the neurological assessment and general movements of infants at risk at 40, 52, and 64 weeks of gestational age (GA). Methods: Infants at risk born in a reference maternal and child hospital were assessed for their neuromotor behavior using the "Hammersmith Neonatal Neurological Examination (HNNE)", "Hammersmith Infant Neurological Examination (HINE)" and "General Movements Assessment (GMA)" scales at 40, 52, and 64 weeks gestational age. Data will be correlated and analyzed descriptively. Results: 33 infants at risk were assessed at 40, 52 and 64 weeks, i.e., up to six months of corrected age. Male gender (75.8%), a cesarean delivery (51.5%), and white race (60.6%) predominated. The Median Apgar score was nine, mean of five prenatal visits, and a mean GA of 35.8 weeks. Prematurity and congenital syphilis were the main diagnoses found. 30.3% of the patients underwent neuroimaging exams, especially brain ultrasounds, with normal results. There was a predominance of "altered evaluation" in HNNE and HINE at the three evaluative moments for term babies, especially for babies with congenital syphilis, and "adequate" for premature babies. In the GMA evaluation and regarding the presence of fidgety, there was a higher frequency of the "suboptimal" classification and most presented fidgety. In the longitudinal comparison between the three moments assessed using the HNNE/HINE scales, it was found that there was a significant difference between the first and the third evaluative moment (p = 0.029), where babies improved their classification. There were positive associations of results between the HNNE/HINE scales with scores in different variables. Conclusion: Infants at risk had altered scores on neurological assessments, indicating developmental delay. Children at risk or with delayed neurological development may present restrictions in activities and participation with compromised quality of life and even school learning. Therefore, it is extremely important to include standardized scales during neonatal screening in the routine of the Neonatal Intermediate Care Unit (NICU), as they are highly reliable and low-cost, so that early identification of neurological changes can be enabled, and thus intervene early, enhancing development.
References
Hadders-Algra M. Early human brain development: Starring the subplate. Neurosci Biobehav Rev. 2018;92:27690. doi: 10.1016/j.neubiorev.2018.06.017.
Hadders-Algra M. Early human motor development: From variation to the ability to vary and adapt. Neurosci Biobehav Rev. 2018; 90:411-27. doi: 10.1016/j.neubiorev.2018.05.009
Pinheiro JM, Tinoco LS, Rocha AS, Rodrigues MP, Lyra CO, Ferreira MA. Childcare in the neonatal period: evaluation of neonatal mortality reduction pact in Rio Grande do Norte, Brazil. Cienc Saude Coletiva. 2016;21(1):243-52. doi: 10.1590/1413-81232015211.09912014
Brasil. Ministério da Saúde. Atenção à saúde do recém-nascido. Guia para profissionais da saúde. Cuidados Gerais. 2ª ed, volume 1. Brasília; 2014. [cited 2022 Oct 10]. Available from : http://bvsms.saude.gov.br/bvs/publicacoes/atencao_recem_nascido_%20guia_profission ais_saude_v1.pdf
Valdivieso MJT, Gómez E, Medina MC, Pallás CR. Programas de seguimiento para neonatos de alto riesgo. protocolos Asociación Española de Pediatría. 2008 [cited 2021 Mar 15];33:278-84. Available from: https://www.aeped.es/documentos/protocolos-neonatologia-en-revision
Raju TNK. The high-risk infant. Textbook of Clinical Pediatrics. Berlin: Springer Berlin Heidelberg; 2012. p. 177-186.
Pallás Alonso C, García González P, Jimenez Moya A, Loureiro González B, Martín Peinador Y, Soriano Faura J, et al. Protocolo de seguimiento para el recién nacido menor de 1.500 g o menor de 32 semanas de edad gestación. An Pediatr (Barc). 2018;88(4):229.e1- 229.e10. doi: 10.1016/j.anpedi.2017.12.010
Albaghli F, Church P, Ballantyne M, Girardi A, Synnes A. Neonatal follow-up programs in Canada: A national survey. Paediatr Child Health. 201929;26(1):e46-e51. doi: 10.1093/pch/pxz159
Almeida CS, Gerzson LR, Blesa NC. Seguimento do recém-nascido de risco. In: Christina Danielli Coelho de Morais Faria; Hércules Ribeiro Leite. (Org.). Programa de Atualização PROFISIO Fisioterapia Neurofuncional. 8 ed. Porto Alegre: Artmed Panamericana; 2020. p.107-163.
Nicolau CM, Costa APBM, Hazime HO, Krebs, VLJ. Desempenho motor em recém nascidos pré-termo de alto risco. Rev Bras Crescimento Desenvolv Hum. 2011;21(2):327-34. doi: 10.7322/jhgd.20020
Kimberly GL, Choherty JP. Identificação do recém-nascido de alto risco e avaliação da idade gestacional. Prematuridade, hipermaturidade, alto peso e baixo peso para idade gestacional. No Manual de Cuidados Neonatais. Edt Choherty JP, Eichenwald EC. Barcelona: Stark AR 4 Ed (Barc) 2005;3:50-66.
Chiquetti EMDS, Valentini NC, Saccani R. Validation and reliability of the test of infant motor performance for Brazilian infants. Phys Occup Ther Pediatr. 2020;40(4):470-85. doi: 10.1080/01942638.2020.1711843
Dubowitz L, Ricciw D, Mercuri E. The Dubowitz neurological examination of the full-term newborn. Ment Retard Dev Disabil Res Rev. 2005;11(1):52-60. doi: 10.1002/mrdd.20048
Spittle AJ, Walsh JM, Potter C, Mcinnes E, Olsen JE, Lee KJ, et al. Neurobehaviour at term-equivalent age and neurodevelopmental outcomes at 2 years in infants born moderate-to-late preterm. Dev Med Child Neurol. 2017;59(2):207-15. doi: 10.1111/dmcn.13297
Hadders-Algra M. General movements: A window for early identification of children at high risk for developmental disorders. J Pediatr. 2004;145(2 Suppl):S12-S18. doi: 10.1016/j.jpeds.2004.05.017
Hadders-Algra M. Early diagnostics and early intervention in neurodevelopmental disorders-age-dependent challenges and opportunities. J Clin Med. 2021;10(4):861. doi: 10.3390/jcm10040861
Dubowitz L, Mercuri E, Dubowitz V. An optimality score for the neurologic examination of the term newborn. J Pediatr. 1998;133(3):406-416. doi:10.1016/s0022-3476(98)70279-3
Dubowitz L, Ricciw D, Mercuri E. The Dubowitz neurological examination of the full-term newborn. Ment Retard Dev Disabil Res Rev. 2005;11(1):52-60. doi: 10.1002/mrdd.20048
Leite YSCO, Giuliano ECN, Dias Júnior SA, Silva MS, Terra FS, Ribeiro PM. Conhecimento de discentes do curso de graduação em medicina sobre vias de parto. Rev Bras Educ Med. 2020;44(4):1-12. doi: 10.1590/1981-5271v44.4-20200223
Ljungblad UW, Paulsen H, Mørkrid L, Pettersen RD, Hager HB, Lindberg M et al. The prevalence and clinical relevance of hyperhomocysteinemia suggesting vitamin B12 deficiency in presumed healthy infants. Eur J Paediatr Neurol.2021;35:137-146. doi:10.1016/j.ejpn.2021.10.008
Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A, et al. State of the evidence traffic lights 2019: systematic review of interventions for preventing and treating children with cerebral palsy. Curr Neurol Neurosci Rep. 2020;20(2):3. doi:10.1007/s11910-020-1022-z
Novak I, Morgan C, Adde L, Blackman J, Boyd RN, Brunstrom-Hernandez J, et al. Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA Pediatr. 2017;171(9):897–907.doi: 10.1001/jamapediatrics.2017.1689
Müller AB, Saccani R, Valentini NC. Impact of compensatory intervention in 6- to 18month-old babies at risk of motor development delays. Early Child Dev Care. 2017;187(11):1707-17. doi: 10.1080/03004430.2016.1185103
Padilha KB, Silva LF, Gerzson LR, Skilhan de Almeida C, Bombarda Müller A. Avaliação dos movimentos gerais dos recém-nascidos de risco internados em unidade de cuidados intermediários. Rev Neurocienc;30:1-22. doi: 10.34024/rnc.2022.v30.13032
Formiga CKR, Silva P, Linhares MBM. Identification of risk factors in infants participating in a Follow-up program. Rev CEFAC. 2018;20(3):333-41. doi: 10.1590/1982- 021620182038817
Mucha F, Franco SC, Silva GAG. Frequência e características maternas e do recémnascido associadas à internação de neonatos em UTI no município de Joinville, Santa Catarina - 2012 Rev Bras Saúde Matern Infant. 2015;15(2):201-8. doi: 10.1590/S1519- 38292015000200006
Brasil. Ministério da Saúde. Portaria nº 1.459, de 24 de junho de 2011: institui, no âmbito do Sistema Único de Saúde – SUS – a Rede Cegonha. Diário Oficial da União. [cited 2022 Oct 20]. Disponível em: https://bvsms.saude.gov.br/ bvs/saudelegis/gm/2011/prt1459_24_06_2011.html 17.
Tomasi E, Fernandes PAA, Fischer T, Siqueira FCV, Silveira DS, Thumé E. Qualidade da atenção pré-natal na rede básica de saúde do Brasil: indicadores e desigualdades sociais. Cad Saude Publica. 2017;33(3):e00195815. doi: 10.1590/0102-311x00195815.
Alkiaat A, Hutchinson M, Jacques A, Sharp MJ, Dickinson JE. Evaluation of the frequency and obstetric risk factors associated with term neonatal admissions to special care units. Aust N Z J Obstet Gynaecol. 2013;53(3):277-282. doi:10.1111/ajo.12070
Salvagni K, Gerzson LR, Almeida CS. Avaliação do desenvolvimento motor de recém-nascidos prematuros extremos e moderados em uma unidade de terapia intensiva neonatal. Rev Ter Ocup Univ 2019;30(2):77-85. doi: 10.11606/issn.2238-6149.v30i2p77-85
Aires LCDP, Santos EKAD, Costa R, BorckM, Custódio ZADO. Baby follow-up in primary care: interface with the third stage of the kangaroo method. Rev Gaúcha Enferm. 2015;36(esp):224-32. doi: 10.1590/1983-1447.2015.esp.56805
Klumb MM, Milbrath VM, Gabatz RIB, Aguiar JRV de, Silva LL da, Vaz VG, Nunes NJ da S. Profile of the newborn admitted to the Neonatal Intensive Care Unit: an integrative review. RSD Journal. 2022;11(13):e416111335799. doi: 10.33448/rsd-v11i13.35799
Brasil. Boletim Epidemiológico. Secretaria de Vigilância em Saúde. Sífilis 2021. Número Especial. Outubro de 2021. [cited 2022 Oct 20]. Available from: https://www.gov.br/saude/pt-br/media/pdf/2021/outubro/14-1/boletim_sifilis-2021_internet.pdf.
Saldir M, Sarici SU, Bakar EE, Ozcan O. Neurodevelopmental status of preterm newborns at infancy, born at a tertiary care center in Turkey. Am J Perinatol. 2010;27(2):121-128. doi:10.1055/s-0029-1224863
Pizzardi A, Romeo DM, Cioni M, Romeo MG, Guzzetta A. Infant neurological examination from 3 to 12 months: predictive value of the single items. Neuropediatrics. 2008;39(6):344-346. doi:10.1055/s-0029-1214423
Bosanquet M, Copeland L, Ware R, Boyd R. A systematic review of tests to predict cerebral palsy in young children. Dev Med Child Neurol. 2013;55(5):418-426. doi: 10.1111/dmcn.12140
Haataja L, Cowan F, Mercuri E, Bassi L, Guzzetta A, Dubowitz L. Application of a scorable neurologic examination in healthy term infants aged 3 to 8 months. J Pediatr. 2003;143(4):546. doi: 10.1067/S0022-3476(03)00393-7
Romeo DM, Brogna C, Sini F, Romeo MG, Cota F, Ricci D. Early psychomotor development of low-risk preterm infants: Influence of gestational age and gender. Eur J Paediatr Neurol. 2016;20(4):518-523. doi: 10.1016/j.ejpn.2016.04.011
Romeo DM, Cowan FM, Haataja L, Ricci D, Pede E, Gallini F, et al. Hammersmith Infant Neurological Examination in infants born at term: Predicting outcomes other than cerebral palsy. Dev Med Child Neurol. 2022;64(7):871-880. doi: 10.1111/dmcn.15191
Freitas LS, Padilha KB, Gerzson LR, Almeida CS. Avaliação neurológica de recém-nascidos de risco internados em Unidade de Cuidado Intermediário Neonatal. Fisioter Bras. 2022;23(2):247-264. doi: 10.33233/fb.v23i2.5024
Olsen JE, Allinson LG, Doyle LW, Brown NC, Lee KJ, Eeles AL, et al. Preterm and term-equivalent age general movements and 1-year neurodevelopmental outcomes for infants born before 30 weeks' gestation. Dev Med Child Neurol. 2018;60(1):47-53. doi: 10.1111/dmcn.13558
Brasil. Conselho federal de fisioterapia e terapia ocupacional. Acórdão nº 472, de 20 de maio de 2016. Dispõe sobre o trabalho do Fisioterapeuta no período de 24 horas em CTIs. Brasília: COFFITO; 2016. [cited 2022 Nov 12. Available from: https://www.coffito.gov.br/nsite/?p=5069
Oliveira AM, Soares GA, Cardoso TF, Monteiro BS, Peres RT, Santos RS, et al. Benefits of inserting the physical therapist on the profile of low-risk premature infants admitted to an intensive care unit. Fisioter Pesqui. 2019;26(1):51-7. doi: 10.1590/1809-2950/18002226012019
Gabbard C. Windows of opportunity for early brain and motor development. Journal of Physical Education, Recreation & Dance.1998;69(8):54-55. doi: 10.1080/07303084.1998.10605614
Published
Issue
Section
License
Copyright (c) 2023 Caroline Silveira Morinel, Carla Skilhan de Almeida, Lais Gerzson
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors are authorized for non-exclusive distribution of the version of the work published in this journal (eg, publishing in an institutional repository or as a book chapter), with acknowledgment of authorship and initial publication in this journal.
