Development and behavior of non-handicapped preterm children from a developing country

Body Structure, Function, Activity, and Participation in 3- to 6-Year-Old Children Born Very Preterm: An ICF-Based Systematic Review and Meta-Analysis

BACKGROUND

The World Health Organization's International Classification of Functioning, Disability, and Health framework, Children and Youth Version (ICF-CY), provides a valuable method of conceptualizing the multidomain difficulties experienced by children born very preterm (VP). Reviews investigating motor outcomes at preschool age across ICF-CY domains are lacking.

PURPOSE

The purpose of this review is to identify and compare motor outcomes of 3- to 6-year-old children born VP and children born full-term (FT) within the ICF-CY framework.

DATA SOURCES

Four electronic databases and reference lists of included and key articles were searched.

STUDY SELECTION

Studies comparing motor outcomes of 3- to 6-year-old children born VP (<32 weeks' gestation or birth weight <1500 g) with peers born FT were included.

DATA EXTRACTION

Two independent authors extracted data and completed quality assessments.

DATA SYNTHESIS

Thirty-six studies were included. Activity motor performance of children born VP was consistently poorer compared with peers born FT: standardized mean difference (SMD) was -0.71 (95% CI = -0.80 to -0.61; 14 studies, 2056 participants). Furthermore, children born VP had higher relative risk (RR) of motor impairment (RR = 3.39; 95% CI = 2.68 to 4.27; 9 studies, 3466 participants). Body structure and function outcomes were largely unable to be pooled because assessment tools varied too widely. However, children born VP had higher RR of any neurological dysfunction (Touwen Neurological Examination) (RR = 4.55; 95% CI = 1.20 to 17.17; 3 studies, 1363 participants). There were no participation outcome data.

LIMITATIONS

Limitations include the lack of consistent assessment tools used in VP follow-up at preschool age and the quality of the evidence.

CONCLUSIONS

Children born VP experience significant motor impairment across ICF-CY activity and body structure and function domains at preschool age compared with peers born FT. Evidence investigating participation in VP preschool-age populations relative to children born at term is sparse, requiring further research.

A gradient relationship between low birth weight and IQ: A meta-analysis

Multiple studies have reported that individuals with low birth weights (LBW, <2500 g) have a lower intelligence quotient (IQ) than those with normal birth weights (NBW, ≥2500 g). Based on 57 eligible individual studies including 12,137 participants, we performed a meta-analysis to estimate the association between low birth weight and individuals' IQ scores (IQs). The pooled weight mean difference (WMD) in IQs between NBW and LBW individuals was 10 (95% CI 9.26-11.68). The WMD was stable regardless of age. No publication bias was detected. The mean IQs of the extremely low birth weight (ELBW, <1000 g), very low birth weight (VLBW, 1000-1499 g), moderately low birth weight (MLBW, 1500-2499 g) and NBW individuals were 91, 94, 99 and 104, respectively. Additionally, the WMD in IQs with NBW were 14, 10 and 7 for ELBW, VLBW, and MLBW individuals, respectively. Two studies permitted estimates of the influence of social determinants of health to the discrepancy in IQs, which was 13%. Since IQ is inherited and influenced by environmental factors, parental IQs and other factors contribute to residual confounding of the results. As the conclusion was based on population studies, it may not be applicable to a single individual.

Survival, morbidity, growth and developmental delay for babies born preterm in low and middle income countries - a systematic review of outcomes measured

BACKGROUND

Premature birth is the leading cause of neonatal death and second leading in children under 5. Information on outcomes of preterm babies surviving the early neonatal period is sparse although it is considered a major determinant of immediate and long-term morbidity.

METHODS

Systematic review of studies reporting outcomes for preterm babies in low and middle income settings was conducted using electronic databases, citation tracking, expert recommendations and "grey literature". Reviewers screened titles, abstracts and articles. Data was extracted using inclusion and exclusion criteria, study site and facilities, assessment methods and outcomes of mortality, morbidity, growth and development. The Child Health Epidemiology Reference Group criteria (CHERG) were used to assess quality.

FINDINGS

Of 197 eligible publications, few (10.7%) were high quality (CHERG). The majority (83.3%) report on the outcome of a sample of preterm babies at time of birth or admission. Only 16.0% studies report population-based data using standardised mortality definitions. In 50.5% of studies, gestational age assessment method was unclear. Only 15.8% followed-up infants for 2 years or more. Growth was reported using standardised definitions but recommended morbidity definitions were rarely used. The criteria for assessment of neurodevelopmental outcomes was variable with few standardised tools - Bayley II was used in approximately 33% of studies, few studies undertook sensory assessments.

CONCLUSIONS

To determine the relative contribution of preterm birth to the burden of disease in children and to inform the planning of healthcare interventions to address this burden, a renewed understanding of the assessment and documentation of outcomes for babies born preterm is needed. More studies assessing outcomes for preterm babies who survive the immediate newborn period are needed. More consistent use of data is vital with clear and aligned definitions of health outcomes in newborn (preterm or term) and intervention packages aimed to save lives and improve health.

Emergência dos esquemas simbólicos em crianças com síndrome de Down, prematuros muito baixo peso e crianças com desenvolvimento típico

OBJETIVO: verificar a emergência dos esquemas simbólicos simples e combinados e seus respectivos subtipos em 20 crianças prematuras muito baixo peso, 20 crianças com síndrome de Down e 20 crianças com desenvolvimento típico. MÉTODOS: todos os sujeitos foram acompanhados mensalmente durante seis meses, a partir da avaliação inicial em que estavam localizados no final da quinta fase do período sensório-motor. Para tanto, foi utilizado o Protocolo para Observação do Desenvolvimento Cognitivo e da Linguagem Expressiva - versão revisada (PODCLE-r). Os dados foram analisados de forma quantitativa e qualitativa. RESULTADOS: os resultados revelaram que os esquemas simbólicos simples e combinados emergiram de forma semelhante para todos os grupos, embora se tenha observado ritmo de desenvolvimento mais lento para as crianças prematuras muito baixo peso e crianças com síndrome de Down, quando comparadas às crianças com desenvolvimento típico. A análise qualitativa, referente à diversidade e complexidade dos esquemas simbólicos produzidos, mostrou que as crianças prematuras muito baixo peso apresentaram pior desempenho quando comparadas às crianças com síndrome de Down e às com desenvolvimento típico, apresentando também dificuldades específicas quanto ao uso de esquemas simbólicos aplicados a objetos não-figurativos, ou seja, quanto à construção da representação por meio de significantes arbitrários. CONCLUSÃO: estes dados reforçam a importância de se acompanhar a emergência e o desenvolvimento dos esquemas simbólicos simples e combinados nessas crianças, com o objetivo de monitorar e estimular esse desenvolvimento, com vistas a minimizar os efeitos da defasagem cognitiva e a favorecer o desenvolvimento da linguagem.

Construção da permanência do objeto em crianças nascidas pré-termo muito baixo peso

OBETIVO: descrever e comparar o processo de construção da permanência do objeto entre crianças com histórico de prematuridade e muito baixo peso e crianças nascidas a termo com desenvolvimento típico. MÉTODOS: participaram deste estudo 22 crianças, sendo 8 crianças nascidas pré-termo e muito baixo peso (grupo pesquisa - GP) e 14 crianças nascidas a termo (grupo controle - GC). Os sujeitos foram submetidos a avaliações mensais de cognição e linguagem, contendo a avaliação da noção de permanência do objeto. Todas as sessões foram registradas em vídeo e transcritas em protocolo específico. As crianças de ambos os grupos foram avaliadas dos 6 aos 12 meses, sendo considerada para o GP, a idade corrigida. Os dados foram analisados de forma quantitativa e qualitativa. RESULTADOS: observou-se diferença estatisticamente significante entre os dois grupos para todas as fases da construção da permanência do objeto, evidenciando o atraso (uma média de 2 a 3 meses de atraso) no desenvolvimento cognitivo, apresentado pelo GP, em relação ao GC, durante o período sensório-motor. CONCLUSÃO: os resultados reforçam a idéia de que as crianças nascidas pré-termo e muito baixo peso apresentam risco para alterações ou atrasos no desenvolvimento cognitivo e de linguagem, justificando a elaboração de programas de intervenção fonoaudiológica junto a essas crianças, já durante o primeiro ano de vida.