Como estão sobrevivendo os pequenos prematuros: um olhar sobre a população do Instituto Fernandes Figueira

Abstract

The increasing survival of prernature newboms, following the better perinatal care. tumed the interest of the researchers towards the outcorne of these children, who are being discharged frorn the neonatal units. Neuro-motor and cognítive developrnent abnorrnalities are reported ln our country there are few studies on the outcorne of verv lo\\ birth weight prematures and no report of their cognitive developrnent and the most affected areas The objecríve of this study was to evaluate the cognitive developrnent of a group ofvery-low-birthweight premature newboms at pre-school age. verifying the most affected areas and íf there were neonatal predictors for the abnorrnalities found. A prognostic study was carried out and a cohort of prematures bom between january/1991 and september/1993 was enrolled in this research. A team of psychologists applied the \\'PPSI-R Scale to the children between 4 vears and 5 years 11 months. This research was accomplished in the Department of Neonatology of the lnstitute Fernandes Figueira, Fundação Oswaldo Cruz. Rio de Janeiro An inter-obser,er reliability study carried out at the beginning of this research showed an excelent inter-rater agreernent between the psychologists of the team, with an íntraclass correlation coefficíent of 0,82 for fui! score. 0,89 for verbal score and 0,91 for performance score. The 79 stud\· chíldren had a mean fui! score in the WPPSI-R Test below those reported in litterature. ln i7.2º-o ofthe children the full score was below 85 (J SD from the mean) and in 32,9°ó ir was below 70 (2 SD from the mean) Tne sub-tests with the worst results were those correspondent to viso-motor coordenation. perception and perceptive organization. spacial onentation. arythmetics. planning capacity, rernote mernory. These results are in agreement with the repons oflitterature. No neonatal factor was predictive of an abnormal fui! score in the WPPSI-R Test (1 SD from the mean). Neonatal sepsis was the unique predictor of abnormal performance score and small for gestational age was predictor for abnormal \·erbal score. The neonatal factors (abnormal cerebral l'S. SGA) were predictive offull scores below 70 (2 SD from the mean), as well as male sex. The comparison group had scores'means (fui!, performance and \erbal) at the inferior limit of normalin·. Comparing the results obtained bv the prematures with those of the childrens of the Rocinha slum. there was a striking difference between the two groups. with better performance of the childrens of the comparison group These results stress the importance of following premature newbom for long períods, to identify those children who would benefit of cognitive stimulatíon or even of an intervention by specialists