Risk factors associated with developmental abnormalities among high-risk children attended at a multidisciplinary clinic

Neuropsychomotor development in children born preterm at 6 and 12 months of corrected gestational age

Objective:

To assess the incidence of neuropsychomotor developmental delay at 6 and 12 months of corrected gestational age in children born at 32 gestational weeks or less.

Methods:

A descriptive and prospective study was carried out at two public maternity hospitals. Between April 2017 and January 2019, we assessed 133 children without any known risk factors for neuropsychomotor developmental delay. The Bayley III scale was used to evaluate cognitive and motor development. The p value of the numerical variables was calculated using the Mann-Whitney test, whereas proportions of categorical variables were compared using the Z-test.

Results:

The mean maternal age was 26±6.9 years,78.8% were from middle and lower economic classes, and 57.1% of the analyzed children were female. Children presented with a higher incidence of delay at 12 months than at 6 months (10.3 and 2.3% at 12 and 6 months, respectively, for the cognitive score; 22.7 and 12% at 12 and 6 months, respectively, for the composite motor score; and 24.7 and 8.4% at 12 and 6 months, respectively, for the fine motor score).

Conclusions:

Cognitive and motor developmental delays were significant, with the highest incidence at 12 months. The results of this study encourage further research on this topic, since the exclusion criteria were comprehensive and the delays in neuropsychomotor development were significant.

Iodine Deficiency during Preconception Period of Adolescent Girls Residing in a District of Rajasthan, India

Background:

In India, iodine deficiency (ID) still remains a serious concern even after five decades of enormous efforts. ID during the preconception period of adolescent girls may negatively affect future neonates, resulting in neonatal hypothyroidism. Hence, the present study was conducted to assess the prevalence of goiter and associated factors among adolescent girls in a poor socioeconomic district of Rajasthan.

Methodology:

A cross-sectional study was conducted during January–March 2015 in Tonk district of Rajasthan. A total of 1912 adolescent girls were selected from thirty schools using population proportionate to size sampling. Adolescent girls were clinically examined for thyroid using palpation method. Casual urine (n = 344) and salt samples (n = 370) were collected from a subgroup of girls for the estimation of urinary iodine concentration (UIC) and iodine content in salt, respectively.

Results:

The overall goiter prevalence was 15.3% (95% confidence interval 13.6%–16.9%) and the median UIC was 266 μg/l (interquartile range: 150–300 μg/l) among 1912 adolescent girls (age, 15.7 ± 1.4 years). Around 16.8% of the families of adolescent girls were consuming salt with inadequate iodine (<15 ppm). Goiter prevalence was statistically significantly different with respect to age groups (P = 0.03). There was no statistically significant difference in goiter prevalence with respect to iodine content of salt (P = 0.98) and UIC (P = 0.41). The median UIC increased with an increase in consumption of iodine content of salt from inadequacy to adequacy (P = 0.15).

Conclusion:

Adolescent girls, residing in an underdeveloped district, are in the transition phase from mild ID (goiter prevalence 15.3%) to iodine sufficiency (median UIC 266 μg/l).

Quality of life and neuropsychomotor development of infants between 4-18 months in daycare center

Quality of Life (QoL) is a predictor of development depending on multiple factors, being the QoL of infants still little studied, especially in permanent settings such as infants educational center or daycare centers. Correlate quality of life with age, family income and the neuropsychomotor development of infants between 4 and 18 months of age in daycare centers. Descriptive transverse study research, with clinical trials registration : RBR 2hd6sm on November 2, 2016. Quality of life was evaluated with interviews with the family through Pediatric Quality of Life Inventory-PedsQL™ (Brazilian version). The infants were evaluated in a playful way, through the use of Alberta Infant Motor Scale (AIMS) and Denver II test . 88 infants participated in the study. The infants evaluated had a good quality of life, with scores above 64%. AIMS presented the correlation with for physical functioning and total score of QoL. QoL of infants from 4 to 18 months of age is correlated with their neuropsychomotor development, which suggests the need for investigations between this theme and daycare centers.

Characterization of neuropsychomotor and language development of children receiving care from groups at an extended Family Health Care Center: an interprofessional approach

ABSTRACT Purpose: to characterize the language and neuropsychomotor development of children referred for speech-language-hearing and physical therapy at an Extended Family Health Care Center (NASF) in Paranaguá, Paraná, Brazil. Methods: 36 children aged 3 to 13 (7.9 ± 2.3) years were assessed through anamnesis, speech-language-hearing assessment with a flipchart, and motor development scale (MDS). The analysis was made with the two-tailed Pearson correlation test. Results: 69% had no initial clinical diagnosis; 83% were referred by their school, due to suspected language difficulties (92%), which were confirmed. Children both at risk and with psychomotor delays represented 69% of the sample; 78% of the children had learning difficulties and overall motor age 16 months below their chronological age, on average. The psychomotor areas with the worst scores for motor age and motor quotient were temporal organization, body scheme, and spatial organization. School difficulties were related to delays in motor age (p = 0.03), MDS psychomotor profile classification (p = 0.01), overall motor quotient (p = 0.04), and psychomotor diagnosis (p = 0.001). Conclusion: it is concluded that children both at risk and with psychomotor delays pose a great demand. Most of them present language delays, and have difficulties in other areas as well, confirming the need for health professionals’ multi- and interdisciplinary actions. NASF is an option for promoting follow-up and intervention.

Factors affecting sustainable iodine deficiency elimination in Pakistan: A global perspective

Iodine deficiency remains a considerable challenge worldwide, even after decades of efforts to address the problem. The aim of this review is to present the current situation in historically iodine-deficient Pakistan regarding iodine nutritional status and place it in a global perspective. We collected relevant articles from online bibliographic databases and websites of concerned organizations that addressed prevalence of goiter/iodine deficiency and barriers to sustainable control. We divided the studies into pre- and post-1994, a landmark year when Pakistan formally adopted the universal salt iodization (USI) programme. Overall, 56 studies reported goiter/iodine deficiency prevalence in Pakistan. Before 1994, six studies (30%) reported a goiter prevalence ≥70%, while nine studies (45%) reported a goiter prevalence between 30% and 70%. Only five studies (25%) found a goiter prevalence less than 30%, of which only two studies reported prevalence <10%. From 1994 onwards, 15 studies (41.7%) reported a goiter/iodine deficiency (ID) prevalence ≥50%, of which seven studies reported prevalence ≥70%, while three studies (8.3%) found a goiter prevalence of 30%-49%, nine studies (25%) found a goiter prevalence of 10%-29%, and five studies (13.9%) reported prevalence of <10%. Four studies (11.1%) reported lower goiter prevalence but higher prevalence of iodine deficiency. The efforts in the past two decades resulted in up to a 50% decline in iodine deficiency disorders (IDD). Variable remaining factors and the recent results, however, indicate that this decline may be non-uniform and even over-estimated. Coordinated and regionally adopted efforts for eradication of IDD from all stakeholders should be pursued. Policy makers should take steps to protect future generations and alert concerned organizations about the importance of careful assessments and estimates of iodine nutritional status.

Care needs of children with disabilities – Use of the Pediatric Evaluation of Disability Inventory

Objective:

Methods:

Results:

Conclusions:

Functional development of preterm infants: an integrative literature review

Abstract Introduction: Prematurity is a public health problem. Despite many studies that aim to characterize the effects of premature birth on the various dimensions of child development, there is still little systematic evidence on the functional dimension. Objective: To characterize the functional development of preterm infants in early infancy. Methods: Searches were conducted in PubMed, Science Direct, Scopus, Cochrane, Joana Briggs Institute, Embase, Lilacs and SciELO databases, with the following key words in English and Portuguese and their combinations: preterm, functional performance, functional outcomes, functional limitations, functional skills, activities of daily living and disability. Inclusion criteria were articles published in the last seven years on the investigated subject. Results: The five articles in the sample were organized, analyzed and categorized, reaching up to three empirical categories of analysis: Functional Performance of Preterm, Cumulative Effects on Functional Development, and Environmental Context and Attitudes of Care. Conclusion: It was concluded that before age 6, children born premature have developmental delays in functional areas of self-care, mobility and social function. Their functional development suffers cumulative effects of various different factors and may be related to care practices and context.

Care needs of children with disabilities - Use of the Pediatric Evaluation of Disability Inventory

OBJECTIVE

To describe the care needs reported by caregivers of children with disabilities going through the school inclusion process using the Pediatric Evaluation of Disability Inventory.

METHODS

Cross-sectional study with 181 children aged 7 to 10 years with physical or mental disabilities, undergoing the inclusion process in Elementary school in 2007.

LOCATION

31 schools of the Regional Education Board - District of Penha, East Side the city of São Paulo. The children's care needs according to the caregivers were assessed in three areas - self-care, mobility and social function, using the Pediatric Evaluation of Disability Inventory, according to the following score: 5, Independent; 4, Supervision; 3, Minimum Assistance; 2, Moderate Assistance; 1, Maximum Assistance and 0, Total Assistance. For statistical analysis, we used Student's t-test and analysis of variance (ANOVA), with p<0.05 being statistically significant.

RESULTS

The lower means, with statistically significant differences, were observed for the items related to social function (55.8 to 72.0), followed by self-care functions (56.0 to 96.5); for all types of disabilities, except for children with physical disabilities, who had lower means for self-care (56.0) and mobility (63.8).

CONCLUSIONS

Social function was the area referred to as the one that needed a higher degree of assistance from the caregiver and the Pediatric Evaluation of Disability Inventory is a tool that can help identify these needs and develop a more targeted intervention.

Continuing education on child development for primary healthcare professionals: a prospective before-and-after study

CONTEXT AND OBJECTIVE

Children's developmental disorders are often identified late by healthcare professionals working in primary care. The aim of this study was to assess the impact of a continuing education program on child development, on the knowledge and practices of these professionals.

DESIGN AND SETTING

Prospective single-cohort study (before-and-after study), conducted in the city of Belém, Pará , Brazil.

METHODS

Two hundred and twenty-one professionals working in primary healthcare (82.2%) participated in a continuing education program on child development and were assessed before and after implementation of the program through tests on their knowledge of child development, consisting of 19 questions for physicians and 14 for nurses, and questionnaires on their professional practices.

RESULTS

One to three years after the program, the mean number of correct answers in the tests had increased from 11.5 to 14.3 among physicians in the Healthy Family Program (Programa Família Saudável, PFS); 13.0 to 14.3 among physicians in Municipal Health Units (Unidades Municipais de Saúde, UMS); 8.3 to 10.0 among PFS nurses; and 7.8 to 9.4 among UMS nurses. In interviews with mothers attended by these professionals before the program, only 21.7% reported that they were asked about their children's development, 24.7% reported that the professional asked about or observed their children's development and 11.1% received advice on how to stimulate them. After the program, these percentages increased to 34.5%, 54.2% and 30.3%, respectively.

CONCLUSIONS

Professionals who participated in the program showed improved performance regarding child development knowledge and practices.

The socioeconomic and biological risk factors for developmental delay in early childhood

To investigate the biological and socioeconomic factors associated with developmental attainment in socioeconomically disadvantaged children. This study was performed at the Dr. Sami Ulus Children's Health and Diseases Training and Research Hospital, between January and December 2010. The effects of biological, socioeconomic risk factors on developmental delay were investigated in 692 children (3 months-5 years) using the Denver II. Low-level maternal education (odds ratio [OR], 11.118; 95 % CI, 4.211-29.351), low-level paternal education (OR, 2.107; 95 % CI, 1.333-3.331), low-level household income (OR, 2.673; 95 % CI, 1.098-2.549), and ≥ 3 children in the family (OR, 1.871; 95 % CI, 1.206-2.903) were strongly associated with abnormal on Denver II; biological risk factors, including birth weight, gestational age at birth, and maternal age at birth <20 years, were correlated with suspect on Denver II results based on univariate analysis. Low-level maternal education (OR, 6.281; 95 % CI, 2.193-17.989), premature birth (32-36 weeks of gestation; OR, 0.535; 95 % CI, 0.290-0.989) were strongly associated with abnormal on Denver II results, and low-level paternal education (OR, 3.088; 95 % CI, 1.521-6.268), low-level household income (OR, 1.813; 95 % CI, 1.069-3.077), low birth weight (<1,500 g; OR, 3.003; 95 % CI, 1.316-6.854), premature birth (27-31 weeks of gestation; OR, 2.612; 95 % CI, 1.086-6.286), and maternal age at birth <20 years (OR, 3.518; 95 % CI, 1.173-10.547) were strongly associated with suspect on Denver II results based on multivariate analysis.

CONCLUSION

Socioeconomic risk factors were observed to be as important as biological risk factors in the development of children aged 3 months-5 years.

Psychomotor development of preterm infants aged 6 to 12 months

CONTEXT AND OBJECTIVE

The immaturity of preterm infants' organ systems may lead to difficulties in adapting to different environmental stimuli. The aim was to compare the psychomotor development of preterm infants (with corrected age) and term infants aged 6 to 12 months and to investigate associated factors.

DESIGN AND SETTING

Cross-sectional analytical study conducted at Hospital das Clínicas, Universidade Federal de Pernambuco.

METHODS

The sample consisted of 135 infants (45 preterm and 90 full-term) aged 6 to 12 months. Neuropsychomotor development was assessed using the Bayley III cognitive, language and motor subscales. Biological, socioeconomic and demographic data were gathered from medical records and through interviews with mothers.

RESULTS

The mean cognitive, language and motor indices were within the range of normality for the sample as a whole. No significant difference in the development of infants born preterm and full-term was observed, except for expressive communication, in which preterm infants presented a lower index. Motor development was influenced by biological factors, and the poorest performances were observed in male infants; birth weight birth weight < 1500 g; Apgar score at five minutes < 7; weight-, length- and head circumference-for-age < -1 Z-score; and exclusively breastfeeding for < two months.

CONCLUSIONS

Prematurity did not influence the psychomotor development of infants in this study population. Motor development was the most affected domain in the sample as a whole, especially due to biological factors. Investigations on child neuropsychomotor development should try to identify many determinant factors because of its multifactorial nature.

Conhecimentos e práticas de profissionais sobre desenvolvimento da criança na atenção básica à saúde

OBJETIVO: Avaliar o conhecimento e as práticas sobre desenvolvimento infantil de médicos que atuam em Unidades Básicas de Saúde (UBS). MÉTODO: Estudo transversal, descritivo, realizado nas UBS de Embu (SP). Procedimentos do estudo: 1) avaliação do conhecimento por teste contendo 20 questões de múltipla escolha sobre desenvolvimento da criança aplicado a 31 médicos (universo) que prestam assistência pediátrica em UBS; 2) avaliação das práticas - entrevista semiestruturada aplicada para uma amostra de 154 mães/cuidadores que acompanhavam crianças com idade menor ou igual a 36 meses em consulta médica agendada em UBS do município. Para comparação de variáveis categóricas (avaliação/orientações sobre desenvolvimento em consultas de crianças de diferentes faixas etárias), utizou-se o qui-quadrado. RESULTADOS: A média de acertos dos médicos foi de 14,8 questões; sete questões apresentaram índices de erros superiores a 30% (desenvolvimento sensorial, aquisição de linguagem, fisiologia do sistema nervoso, diagnóstico clínico e laboratorial de infecções congênitas, erros inatos do metabolismo) e quatro questões apresentaram acertos acima de 85% (marcos do desenvolvimento motor, pessoal-social, fatores de risco e síndrome genética). Quanto às práticas, em 69 (45%) consultas o médico perguntou a opinião da mãe/cuidador sobre o desenvolvimento da criança, em 80 (52%) a mãe/cuidador referiu que o médico fez alguma pergunta e/ou avaliou o desenvolvimento e em 64 (42%) orientou sobre como estimular a criança. CONCLUSÕES: Identificaram-se falhas de conhecimento e nas práticas dos profissionais referentes ao desenvolvimento da criança, o que indica a necessidade de implementar educação permanente.

Características neuromotoras e biopsicossocias de lactentes com histórico de risco biológico

INTRODUÇÃO: Os avanços tecnológicos têm permitido maior sobrevivência de recém-nascidos de risco. No entanto, os fatores de risco biológico aos quais essas crianças foram expostas fazem com que tenham maior chance de apresentar atrasos no desenvolvimento. OBJETIVO: O presente estudo objetivou avaliar as características neuromotoras e biopsicossociais de lactentes com histórico de risco biológico. METODOLOGIA: A amostra foi constituída de 25 lactentes com idade desde o nascimento a dois meses de vida, com registro de nascimento na cidade de Fraiburgo, SC. Os fatores de risco biológicos presentes foram: prematuridade, baixo peso, incompatibilidade sanguínea, necessidade de reanimação, intubação, permanência em O2, hipertensão pulmonar leve, icterícia, desconforto respiratório, infecção neonatal, anemia neonatal, tabagismo materno, trauma durante o parto, cardiopatia e má-formação de traqueia. Foram utilizados os seguintes instrumentos: cartão de saúde da criança, formulário biopsicossocial e Neonatal Behavioral Assesment Scale. RESULTADOS: Foi possível constatar, em relação às condições biopsicossociais, prevalência de mães casadas, primigestas, com ensino superior completo, exercendo atividade extra-lar e com idade média de 28 anos na ocasião do parto. Verificou-se casos de exposição do feto ao tabagismo materno, mães acometidas por anemia, hipertensão e hipotensão durante o período gestacional. Em relação ao desenvolvimento neuromotor, os lactentes apresentaram desempenho esperado para crianças de risco em relação à habituação, regulação e reflexos. Em relação à socialização, organização e sistema autônomo, constatou-se desempenho inferior ao de demais crianças de risco. CONCLUSÃO: Os achados deste estudo demonstram que crianças com histórico de risco biológico podem apresentar comprometimento em relação a aspectos do desenvolvimento neuromotor.