Low-grade intraventricular hemorrhage and neurodevelopment at 24 months of age

Autores

  • Sara Peixoto Neonatal Intensive Care Unit - Neonatology Unit-B of the Centro Hospitalar e Universitario de Coimbra EPE. - Coimbra, Portugal http://orcid.org/0000-0003-0472-2425
  • Joana Amaral Neonatal Intensive Care Unit - Neonatology Unit-B of the Centro Hospitalar e Universitario de Coimbra EPE. - Coimbra, Portugal
  • Cristina Resende Neonatal Intensive Care Unit - Neonatology Unit-B of the Centro Hospitalar e Universitario de Coimbra EPE. - Coimbra, Portugal
  • Dolores Faria Neonatal Intensive Care Unit - Neonatology Unit-B of the Centro Hospitalar e Universitario de Coimbra EPE. - Coimbra, Portugal
  • Adelaide Taborda Neonatal Intensive Care Unit - Neonatology Unit-B of the Centro Hospitalar e Universitario de Coimbra EPE. - Coimbra, Portugal

DOI:

https://doi.org/10.15448/1980-6108.2018.3.29354

Palavras-chave:

hemorragia cerebral intraventricular, recém-nascido prematuro, transtornos do neurodesenvolvimento.

Resumo

***Hemorragia intraventricular de baixo grau e neurodesenvolvimento aos 24 meses de idade***

OBJETIVOS: Avaliar o impacto da hemorragia intraventricular  de baixo grau no neurodesenvolvimento de lactentes prematuros aos 24 meses de idade.

MÉTODOS: Foi conduzido um estudo de caso-controle retrospectivo em lactentes com idade gestacional inferior a 34 semanas, internados em uma Unidade de Terapia Intensiva Neonatal entre janeiro de 2006 e dezembro de 2015. Os casos foram definidos como aqueles com hemorragia intraventricular de baixo grau (graus I ou II), diagnosticada por ultrassonografia craniana. Para cada caso, foi selecionado um controle com a mesma idade gestacional, mas sem hemorragia intraventricular. A avaliação do neurodesenvolvimento foi realizada aos 24 meses de idade, em casos e controles, com a Escala de Desenvolvimento Mental de Griffiths. Paralisia cerebral, atraso no neurodesenvolvimento (quociente de desenvolvimento <2 desvios padrões abaixo da média para a idade), deficiência auditiva e/ou cegueira foram considerados comprometimento grave do neurodesenvolvimento.

RESULTADOS: O estudo incluiu 172 prematuros: 86 casos e 86 controles. Na análise univariada, identificou-se diferença entre os dois grupos para os seguintes achados clínicos: ciclo completo de corticosteroide pré-natal (57% nos casos vs. 80% nos controles; p=0,001; OR: 0,33; IC95% 0,17-0,64); sexo masculino (63% casos vs. 41% controles; p=0,004; OR: 2,45, IC95% 1,3-4,5); nascidos em outro hospital (26% casos vs. 9% controles; p=0,005; OR: 3,3 IC95% 1,4-8,0); Índice de Risco Clínico para Bebês acima de 5 (24% nos casos vs. 12% nos controles; p=0,029; OR: 2,4 IC95% 1,1-5,6); intubação na sala de parto (47% casos vs. 27% controles; p=0,007; OR: 2,38; IC95%: 1,3-4,5); e sepse neonatal (34% nos casos vs. 20% nos controlos; p=0,039; OR: 2,1 95% CI 1,03-4,1). Após a regressão logística, as diferenças foram mantidas apenas para o corticosteróide antenatal (p=0,005; OR 0,34, IC 95% 0,16-0,72) e sexo masculino (p=0,002; OR 2,9, IC95% 1,4-5,8). Um déficit grave de neurodesenvolvimento esteve presente em três casos (3,5%) e um controle (1,2%). Não houve diferenças estatisticamente significativas no desfecho entre casos e controles.

CONCLUSÕES: Nesta amostra, os prematuros com hemorragia intraventricular de baixo grau diagnosticados pela ultrassonografia craniana não apresentaram diferença no desenvolvimento neurológico precoce quando comparados aos controles.

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Publicado

2018-07-19

Como Citar

Peixoto, S., Amaral, J., Resende, C., Faria, D., & Taborda, A. (2018). Low-grade intraventricular hemorrhage and neurodevelopment at 24 months of age. Scientia Medica, 28(3), ID29354. https://doi.org/10.15448/1980-6108.2018.3.29354

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