Maria Beatriz Martins Linhares

Neonatal pain and developmental outcomes in children born preterm: a systematic review.

Background:Neonates cared for in neonatal intensive care units are exposed to many painful and stressful procedures that, cumulatively, could impact later neurodevelopmental outcomes. However, a systematic analysis of these effects is yet to be reported. Objectives:The aim of this research was to review empirical studies examining the association between early neonatal pain experiences of preterm infants and the subsequent developmental outcomes of these children across different ages. Methods:The literature search was performed using the PubMed, PsycINFO, Lilacs, and SciELO databases and included the following key words: “pain,” “preterm,” and “development.” In addition, a complementary search was performed in online journals that published pain and developmental studies to ensure all of the target studies had been found. The data were extracted according to predefined inclusion and exclusion criteria. Results:Thirteen studies were analyzed. In infants born extremely preterm (gestational age ⩽29 wk) greater numbers of painful procedures were associated with delayed postnatal growth, with poor early neurodevelopment, high cortical activation, and with altered brain development. In toddlers born very preterm (gestational age ⩽32 wk) biobehavioral pain reactivity-recovery scores were associated with negative affectivity temperament. Furthermore, greater numbers of neonatal painful experiences were associated with a poor quality of cognitive and motor development at 1 year of age and changes in cortical rhythmicity and cortical thickness in children at 7 years of age. Conclusions:For infants born preterm, neonatal pain-related stress was associated with alterations in both early and in later developmental outcomes. Few longitudinal studies examined the impact of neonatal pain in the long-term development of children born preterm.

Maternal anxiety in the pre- and postnatal period: a literature review

This study intended to present a systematic review to analyze the empirical studies published between 1998 and 2003 about maternal anxiety in the prenatal and postnatal periods, focusing on pre-term and term births. Nineteen studies were found; six of which evaluated maternal anxiety in the prenatal period, 12 studies evaluated anxiety in mothers in the postnatal period and only one study evaluated maternal anxiety in both periods. The results showed that high levels of maternal anxiety in the prenatal phase were associated with obstetric problems, emotional damages to fetal development, behavioral problems in childhood and adolescence. The mothers presented higher anxiety levels when compared with the fathers. The co-occurrence of maternal anxiety and depression was found. The maternal anxiety assessment is relevant to identify both maternal mental health and child development at risk.La finalidad de esta revision sistematica de la literatura fue analizar la produccion cientifica entre 1998 y 2003 de estudios empiricos en la tematica de ansiedad en las fases prenatal y postnatal, enfocando nacimientos del pre-termino o del termino. Se obtuvieron 19 articulos, de los cuales 6 evaluaron la ansiedad maternal en el periodo prenatal, 12 estudios evaluaron la ansiedad en madres en el periodo postnatal y solamente un estudio evaluo la ansiedad maternal en ambos periodos. Los resultados demostraron que altos niveles de ansiedad maternal en la fase prenatal fueron asociados a complicaciones obstetricas, danos al desarrollo fetal, problemas emocionales y comportamentales en la infancia y la adolescencia. Las madres habian presentaron niveles mayores de ansiedad en comparacion con los niveles presentados por los padres. Se verifico la co-ocurrencia entre los niveles de ansiedad maternal y la depresion. La evaluacion de la ansiedad maternal es relevante para identificar riesgos en la salud mental maternal y en el desarrollo del nino.

Is pain relief equally efficacious and free of side effects with repeated doses of oral sucrose in preterm neonates

&NA; The aim of the present study was to examine the efficacy and potential side effects of repeated doses of oral sucrose for pain relief during procedures in NICU. Thirty‐three preterm neonates were randomly allocated in blind fashion into two groups, the sucrose group (SG = 17) and the control group (CG = 16). The responses of neonates to pain and distress were assessed during blood collection on four consecutive assessment (ass.) days. For the first assessment, the neonates did not receive any solution before the blood collection procedure. During the next three days, the SG received oral sucrose (25%; 0.5 ml/kg) and the CG received sterile water, 2 min before each minor acute painful procedure. The neonates were evaluated during blood collection each morning. The assessment was divided into five phases: Baseline (BL), Antisepsis (A), Puncture (P), Dressing (D), and Recovery (R). The neonates’ facial activity (NFCS), behavioral state, and heart rate were evaluated. The data analysis used cut‐off scores for painful and distressful responses. No side effects of using sucrose were detected. There were significantly fewer SG neonates with facial actions signaling pain than CG neonates in P (ass.2) and in A (ass.3). We found significantly fewer SG neonates in the awake state than CG neonates in P (ass.2 and ass.4). There were significantly fewer SG neonates crying during A (ass.2), P (ass.2 and ass.4), and D (ass.3). There was no statistical difference between‐groups for physiological response. The efficacy of sucrose was maintained for pain relief in preterm neonates with no side effects.

Autoconceito de crianças com dificuldades de aprendizagem e problemas de comportamento

The aim of this study was to assess the self-concept of children with learning disability in comparison with children without learning disability. Fifty- eight school-age children were assessed, including: 32 Learning Disabled children, distinguished by behavior problems, and 26 No Learning Disabled children. The child self-concept was assessed by Piers Harris Self-Concept Scale and the child behavior was assessed by Rutter´s Child Behavior Scale-A2. Children with learning disability showed significantly more negative self-concept than children without it in both total and partial scale scores. No differences was found between learning disabled children distinguished by the presence of behavior problems.

A auto-eficácia e os aspectos comportamentais de crianças com dificuldade de aprendizagem

The aim of the present study was to assess the relationship among school performance, sense of self-efficacy, and behavioral aspects in 52 children of both sexes, aged from eight to 11 years and 11 months. The children were enrolled in the first to fourth grade and their intelligence level was assessed as of lower medium level at least. Subjects were divided in two groups: G1-26 children with learning difficulties referred to a Psychology Ambulatory of a School Hospital, and G2-26 children with good achievement, assessed by an academic performance test. The instruments used were: Self-Efficacy Assessment Form and Rutter Child Behavior Scale, as well as a school achievement test. G1 showed a significantly lower score for self-efficacy sense, compared to G2. A significant difference was also observed in the assessment made by parents, who characterized G1 children as having more behavioral difficulties. Academic performance was found to be related to self-efficacy sense and to indicators of behavioral problems.

Does Prone or Supine Position Influence Pain Responses in Preterm Infants at 32 Weeks Gestational Age

ObjectiveThe purpose of this study was to examine the influence of prone and supine position in preterm infants during acute pain of blood collection. SettingLevel III Neonatal Intensive Care Unit (NICU). Study DesignThirty-eight preterm infants (birthweight 1339 [590–2525] g, GA 29 [25– 32] wks) were in 2 groups depending on their position in the isolette prior to and during heel lance at 32 weeks post-conceptional age. The study design was a comparison between groups (Prone, Supine) during 2 events (Baseline, Heel lance). Outcome MeasurePain measures were multidimensional, including behavioral (sleep–wake state and facial activity) and physiological (heart rate) responses measured continuously prior to (Baseline) and during blood collection (Lance). ResultsBoth groups of infants displayed statistically significant shifts in sleep–wake state to greater arousal, and increased facial activity and heart rate, from Baseline to Lance. Prone position was associated with significantly more deep sleep during Baseline, compared with Supine position, but there were no differences in sleep-wake state during Lance. Minor increased facial activity was shown in some time segments of Baseline for infants in Supine compared with Prone, but did not differ overall between positions. Prone and Supine position did not affect heart rate significantly during Baseline or Lance events. ConclusionsProne position promotes deep sleep in preterm neonates at 32 weeks post-conceptional age when they are undisturbed. However, placement in prone position is not a sufficient environmental comfort intervention for painful invasive procedures such as heel lance for blood sampling in the NICU. Neonates require other environmental supports to promote coping with this stressful event.

Risk factors for infant developmental problems

Este estudo descritivo-correlacional teve por objetivo detectar riscos para problemas do desenvolvimento da crianca nos quatro primeiros anos, identificar recursos protetores no ambiente familiar e verificar as melhores variaveis preditoras do desenvolvimento em risco, em amostra nao-clinica composta por 120 criancas cadastradas em um Programa de Saude da Familia. Utilizaram-se instrumentos de avaliacao do desenvolvimento global, da linguagem expressiva da crianca e do ambiente familiar. A analise de regressao logistica indicou que quanto menor a escolaridade do pai, maior a chance de risco para problemas de desenvolvimento. A historia do estado nutricional abaixo do normal aos seis meses de idade e o risco psicossocial no ambiente familiar aumentava a probabilidade de problemas de linguagem expressiva. Conclui-se que a triagem de riscos para problemas de desenvolvimento da crianca e a analise dos fatores psicossociais do contexto familiar devem ser incluidas como procedimento de intervencao preventiva em Programas de Saude da Familia.This descriptive-correlational study aimed to detect risks for child developmental problems in the first four years of age, to identify the protective resources in the familiar environment, and to verify the best predictive variables of the development at risk. The non-clinical sample was composed by 120 children registered in a Family Health Program. The assessment instruments for global development, expressive language and familiar environment were used. The logistic regression analysis indicated that the lower the fathers educational level, the higher the risk for developmental problems. Both the history of low nutritional state at six months of age and the psychosocial risk in the family environment increased the chances of having expressive language problems. It is concluded that screening tests of risk for developmental problems and the analysis of the psychosocial factors in the familiar context should be considered as preventive intervention procedure in the Family Health Programs.

Pain and distress reactivity and recovery as early predictors of temperament in toddlers born preterm

BACKGROUND Pain reactivity may reflect underlying mechanisms of constitutional aspects of temperament. AIM To examine whether the neonatal biobehavioral reactivity and recovery responses from pain and distress, as well as the gestational age, the illness severity and the amount of painful procedures undergone the Neonatal Intensive Care Unit (NICU) stay, predict temperament later in toddlerhood, in vulnerable children born preterm. STUDY DESIGN Prospective-longitudinal study. SUBJECTS Twenty-six preterm and very low birth weight infants followed from birth to toddlerhood. OUTCOME MEASURES Illness severity was assessed with the Clinical Risk Index for Babies (CRIB) score. The medical charts were reviewed prospectively for obtaining the amount of pain exposure in NICU. For assessing the behavioral and cardiac reactivity and recovery from pain and distress, the neonates were evaluated during routine blood collection in the NICU in the first 10 days of life. Pain and distress reactivity and recovery was measured using the Neonatal Facial Coding System score, the duration of crying, and the magnitude of average heart rate. At toddlerhood, mothers answered the Early Childhood Behavior Questionnaire. RESULTS Higher biobehavioral reactivity to pain and distress predicted higher temperamental Negative Affect, above and beyond gestational age, illness severity and amount of pain exposure in NICU. However, we did not find a predictive relation between gestational age, CRIB score and number of painful procedures undergone NICU and toddlers temperament. CONCLUSIONS The findings highlight the relevance of the neonatal individual characteristics of reactivity for identifying more vulnerable infants for future problems in biobehavioral regulation.

Desenvolvimento psicológico na fase escolar de crianças nascidas pré-termo em comparação com crianças nascidas a termo

O presente estudo objetivou avaliar indicadores do desenvolvimento psicologico na fase escolar de criancas nascidas pre-termo com muito baixo peso e compara-los aos de criancas nascidas a termo, quanto as areas intelectual, emocional e comportamental. A amostra foi composta por 40 criancas de 8 a 10 anos, subdivididas em 2 grupos: Pre-termo (PT), 20 criancas nascidas 2.500g. Foram utilizados o Raven, o Desenho da Figura Humana e a Escala Comportamental Infantil. As criancas PT apresentaram mais frequentemente nivel intelectual inferior a media e problemas comportamentais em comparacao as AT. Nao houve diferenca entre os grupos quanto aos aspectos emocionais. Os problemas de enurese, medo, tiques, impaciencia e dificuldade de permanencia nas atividades foram significativamente mais frequentes no PT do que no AT. Verificou-se que, no grupo PT, quanto menor o nivel intelectual das criancas, mais problemas de comportamento elas apresentavam.

Motor development curve from 0 to 12 months in infants born preterm

Aim:  To trace a reference curve for motor development from birth up to 12 months of corrected chronological age in infants born preterm and low birth weight.