NEUROBEHAVIOR OF PRETERM, SMALL AND APPROPRIATE FOR GESTATIONAL AGE NEWBORN INFANTS

Silva, Inalu Barbosa da; Cunha, Paola Andrade Gomes da; Linhares, Maria Beatriz Martins; Martinez, Francisco Eulógio; Camelo Júnior, José Simon

doi:10.1590/1984-0462/;2018;36;4;00006

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Revista Paulista de Pediatria

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Original Article • Rev. paul. pediatr. 36 (04) • Oct-Dec 2018 • https://doi.org/10.1590/1984-0462/;2018;36;4;00006 copy

NEUROBEHAVIOR OF PRETERM, SMALL AND APPROPRIATE FOR GESTATIONAL AGE NEWBORN INFANTS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To compare the neurobehavioral development of preterm infants with postconceptional age between 32 and 36 weeks and 6 days, according to the adequacy of the weight for the gestational age at birth.

Methods:

A cross-sectional study was performed comparing two independent groups. The 55 preterm infants who were included in the sample were hospitalized in a neonatal intermediate care unit and were evaluated using the Neurobehavioral Assessment of the Preterm Infant (NAPI) at the postconceptional age between 32 and 36 weeks and 6 days and compared according to the adequacy of the weight for the gestational age. In addition to the comparison between the groups, infants who were born small for gestational age (SGA) and those ones adequate for gestational age (AGA) were also compared, considering the type of intrauterine growth. The following instruments were used: NAPI, anamnesis script, Brazilian Economic Classification Criteria, and medical records.

Results:

Infants were born with mean gestational age of 32.0 weeks, with the postconceptional age and postnatal age of 34.8 weeks and 19.5 days, respectively. The sample consisted of 55% of female infants. The results did not show any differences in NAPI domains between SGA and AGA groups, neither in the subgroups of SGA babies with symmetric or asymmetric growth.

Conclusions:

There was no difference between SGA and AGA babies in relation to neurobehavioral development evaluated before reaching term.

Keywords:
Infant, premature; Infant, small for gestational age; Child development

Characteristics of the babies	Total sample (n=55)	SGA (n=32)	AGA (n=23)	p-value	Test
Weight at birth (grams)
Média±DP	1491±393	1379±409	1647±317	0,010	Student’s t test
Median (min-max)	1535 (640-2510)	1433 (640-2280)	1565 (1045-2510)	0,010	Student’s t test
Gestational age (weeks)
Mean±SD	32.0±2.0	32.3±2.4	31.7±1.3	0,080	Mann-Whitney U
Median (min-max)	32 (27-36)	33 (27-36)	32 (29-34)	0,080	Mann-Whitney U
Post-conceptional age (weeks)
Mean±SD	34.8±1.3	35.4±1.2	34±1.1	<0,001	Mann-Whitney U
Median (min-max)	35 (32-37)	35.5 (33-37)	34 (32-36)	<0,001	Mann-Whitney U
Post-natal age (days)
Mean±SD	19.5±15.1	21.6±18.3	16.5±8.3	0,970	Mann-Whitney U
Median (min-max)	16 (5-67)	15 (5-67)	16 (6-42)
Twin pregnancy - f (%)	8 (15)	5 (16)	3 (13)	1,000	Fisher’s Exact test
Sex - f (%*)
Female	30 (55)	18 (56)	12 (52)	0,790	Fisher’s Exact test
Male	25 (45)	14 (44)	11 (48)	0,790	Fisher’s Exact test
Apgar at 5 minutes (score)
Mean±SD	9.3±1.1	9.5±1.1	9.1±1.0	0,070	Mann-Whitney U
Median (min-max)	10 (5-10)	10 (5-10)	9 (7-10)	0,070	Mann-Whitney U
CRIB I (score)
Mean±SD	1.5±2.3	1.8±2.8	1.0±1.3	0,500	Mann-Whitney U
Median (min-max)	1 (0-12)	1 (0-12)	1 (0-5)	0,500	Mann-Whitney U
NMI (score)
Mean±SD	2.3±1.1	2.3±1.0	2.4±1.2	0,540	Mann-Whitney U
Median (min-max)	2 (1-5)	2 (1-5)	3 (1-5)	0,540	Mann-Whitney U
Time of hospitalization (days)
Mean±SD	29.0±17.9	31.8±21.2	25.0±11.1	0,540	Mann-Whitney U
Median (min-max)	25 (5-80)	25 (5-80)	26 (7-51)	0,540	Mann-Whitney U

NAPI domains	Total sample (n=55)	SGA (n=32)	AGA (n=23)	p-value	Test
Scarf sign
Mean±SD	41.2±14.3	42.7±15.3	39.1±12.9	0.36	Mann-Whitney U
Median (min-max)	33.3 (33.3-66.7)	33.3 (33.3-66.7)	33.3 (33.3-66.7)	0.36	Mann-Whitney U
Motor and vigor
Mean±SD	49.5±14.3	52.7±14.6	45.1±13.0	0.05	Student’s t test
Median (min-max)	49.2 (19.6-87.5)	50.9 (24.7-87.5)	42.6 (19.6-68.1)	0.05	Student’s t test
Popliteal angle
Mean±SD	60.5±30.4	63.5±33.2	56.1±26.0^a	0.29	Mann-Whitney U
Median (min-max)	66.7 (0.0-100.0)	66.7 (0.0-100.0)	50.0 (33.3-100.0)	0.29	Mann-Whitney U
Alert and orientation
Mean±SD	62.7±13.9	62.9±13.9	62.5±14.2	0.94	Mann-Whitney U
Median (min-max)	67.0 (29.3-80.4)	66.6 (29.3-80.4)	67.8 (31.9-79.3)	0.94	Mann-Whitney U
Irritability
Mean±SD	42.3±19.6	42.7±19.2	41.8±20.5	0.84	Mann-Whitney U
Median (min-max)	36.9 (0.0-71.5)	43.5 (0.0-64.3)	36.9 (0.0-71.5)	0.84	Mann-Whitney U
Cry
Mean±SD	39.4±34.5	37.5±35.0^b	42.1±34.4^c	0.64	Mann-Whitney U
Median (min-max)	50.0 (0.0-100.0)	50.0 (0.0-100.0)	50.0 (0.0-100.0)	0.64	Mann-Whitney U
Sleep percentage
Mean±SD	48.2±24.0	47.3±27.0	49.4±19.5	0.76	Student’s t test
Median (min-max)	50.0 (0.0-100.0)	50.0 (0.0-100.0)	50.0 (0.0-100.0)	0.76	Student’s t test

	Estimation of the effect	95%CI	p-value
SGA × AGA groups	-6.33	-15.36-2.69	0.17
Post-conceptional age	0.95	-2.48-4.38	0.58

Characteristics of the babies	Symmetrical SGA (n=5)	Asymmetrical SGA (n=27)	AGA (n=23)	p-value (sim SGA × asym)	p-value (sym SGA × AGA)	p-value (asym SGA × AGA)
Weight at birth (grams)
Mean±SD	1665±252	1326±413	1647±317	0.08	0.88	0.01
Median (min-max)	1630 (1430-2065)	1350 (640-2280)	1565 (1045-2510)	0.08	0.88	0.01
Gestational age (weeks)
Mean±SD	33.8±1.3	32.0±2.5	31.7±1.3	0.10	0.01	0.26
Median (min-max)	34 (32-35)	33 (27-36)	32 (29-34)	0.10	0.01	0.26
Post-conceptional age (weeks)
Mean±SD	35.4±1.5	35.4±1.1	34.0±1.1	0.79	0.04	0.00
Median (min-max)	36 (33-37)	35 (33-37)	34 (32-36)	0.79	0.04	0.00
Post-natal age (days)
Mean±SD	9.8±3.8	23.8±19.1	16.5±8.3	0.05	0.06	0.57
Median (min-max)	9 (6-16)	16 (5-67)	16 (6-42)	0.05	0.06	0.57
CRIB I (score)
Mean±SD	0.4±0.5	2.0±2.9	1.0±1.3	0.17	0.35	0.29
Median (min-max)	0 (0-1)	1 (0-12)	1 (0-5)	0.17	0.35	0.29
NMI (score)
Mean±SD	1.4±0.5	2.4±1.0	2.4±1.2	0.03	0.05	0.96
Median (min-max)	1 (1-2)	2 (1-5)	3 (1-5)	0.03	0.05	0.96
Number of respiratory complications
Mean±SD	0.6±0.5	1.7±1.7	1.5±0.9	0.21	0.03	0.64
Median (min-max)	1 (0-1)	1 (0-7)	2 (0-3)	0.21	0.03	0.64
Time of hospitalization in NICU (days)
Mean±SD	1.4±2.2	12.9±18.2	6.7±6.7	0.05	0.06	0.67
Median (min-max)	0 (0-5)	6 (0-60)	4 (0-27)	0.05	0.06	0.67

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[1] *Corresponding author. E-mail: jscamelo@fmrp.usp.br (J.S. Camelo Júnior).