Denise Campos

Agreement between scales for screening and diagnosis of motor development at 6 months

OBJECTIVE: To ascertain the degree of agreement between a score for screening and another for diagnosis of motor development in 6-month old infants and to define the most appropriate cutoff point for screening. METHODS: A sectional study, enrolling asymptomatic full term newborns with gestational ages from 37 to 41 weeks, who were discharged from the maternity unit 2 days after birth and are resident in the Campinas area. Infants were excluded if they presented genetic syndromes, malformations, congenital infections, intensive care admission or low birth weight. The assessment instruments investigated were the Alberta Infant Motor Scale (AIMS) and the Bayley Scales of Infant Development II (BSID-II). Two cutoff points were evaluated for the AIMS, the 5th and 10th percentiles, and for the BSID-II infants were classified according to its motor index score (IS) as having inadequate (IS 85, above the mean minus 1 standard deviation). RESULTS: The study sample comprised 43 infants. Six infants (14.00%) exhibited inadequate motor performance. Using the BSID-II motor classification and the 5th percentile AIMS cutoff, sensitivity was 100%, specificity 78.37%, accuracy 81.39%, kappa index 0.50 and p < 0.001; whereas, using the BSID-II motor classification and the 10th percentile AIMS cutoff, sensitivity was 100%, specificity 48.64%, accuracy 55.81%, kappa index 0.20 and p 0.025. CONCLUSIONS: The results suggest that concordance between the two 6-month assessment scales is good. The parameters employed are best combined using the 5th percentile AIMS cutoff point.

Motor performance of infants born small or appropriate for gestational age: a comparative study.

Purpose: To compare the motor performance of infants born small for gestational age (SGA) with those appropriate for gestational age (AGA) at 1, 2, 3, and 6 months. Methods: A prospective cross-sectional study was conducted including infants born full-term, with birth weight under the 10th percentile for the SGA group and between the 10th and 90th percentiles for the AGA group. The Motor Scale of Bayley Scales of Infant Development-II was used to document motor performance. Results: The SGA group presented a mean motor index score lower than the AGA group at 2 and 6 months, with the SGA group presenting fewer infants that successfully accomplished “makes crawling movements,” “turns from side to back,” “balances head,” “sits alone momentarily,” and “sits alone for 30 seconds.” Conclusions: Data analysis suggested that infants who are SGA present greater risk of adverse outcomes that are detectable in motor performance measures at 2 months.

Comparison of motor and cognitive performance in infants during the first year of life.

Purpose: To compare motor and cognitive performance in infants with typical development in the 1st, 2nd, 3rd, 6th, 9th, and 12th months after birth. Methods: This was a repeated-measures study with unequal sample sizes in the follow-up periods, comprising 94 infants born at term. Infants with genetic syndromes, malformations, congenital infections, or hospitalized in intensive care units were excluded. The Bayley Scales of Infant Development II were used for evaluation of cognitive and motor performance. Results: There were significant differences between motor and cognitive performance at 1, 2, and 3 months. However, at 6, 9, and 12 months, there was no difference between domains. Conclusion: This study suggests that during the first year, development can be synchronous in the 2 areas evaluated by the Bayley Scales of Infant Development II, especially from the sixth month of age onward.

Twin-twin transfusion syndrome: neurodevelopmental screening test

OBJECTIVE To assess the neurodevelopmental functions (cognition, language and motor function) of survivors of twin-twin transfusion syndrome (TTTS). METHOD Observational cross-sectional study of a total of 67 monochorionic diamniotic twins who underwent fetoscopic laser coagulation (FLC) for treatment of TTTS. The study was conducted at the Center for Investigation in Pediatrics (CIPED), Universidade Estadual de Campinas. Ages ranged from one month and four days to two years four months. Bayley Scales of Infant and Toddler Development Screening Test-III, were used for evaluation. RESULTS Most children reached the competent category and were classified as having appropriate performance. The preterm children scored worse than term infants for gross motor subtest (p = 0.036). CONCLUSION The majority of children reached the expected development according to their age. Despite the good neurodevelopment, children classified at risk should be monitored for development throughout childhood.

Twin-twin transfusion syndrome: neurodevelopment of infants treated with laser surgery

OBJECTIVE To assess the neurodevelopmental functions of survivors of twin-twin transfusion syndrome (TTTS) treated by fetoscopic laser coagulation (FLC), during the first year of life, comparing them to a control group; and to verify the influence of specific variables on neurodevelopment. METHOD This was a prospective, longitudinal study. The sample comprised 33 monochorionic diamniotic twins who underwent FLC for treatment of TTTS and 22 full-term infants of single-fetus pregnancies. Bayley Scales of Infant and Toddler Development Screening Test were used for evaluation. Prenatal, perinatal and postnatal information were obtained. RESULTS There was an increased frequency of infants in the TTTS group with inadequate performance compared to the control group. The identified variables (fetal donor, low economic income and cardiorespiratory disease) negatively impacted expressive communication and fine motor skills. CONCLUSION Although through follow-up is recommended in all TTTS survivors, particular attention is required for the high-risk group as defined in this study.