Prematuridade, muito baixo peso ao nascer e características do sono na primeira infância : correlação com desenvolvimento motor

Abstract

Objective: To correlate motor development with characteristics of sleep during infancy in premature children with very low birth weight. Methods: An observational, longitudinal, prospective study was performed with 41 children with <32 weeks of gestational age at birth and birthweight ≤ 1,500 g who did not present neurological complications. At 6 and 12 months of corrected age, this group was evaluated regarding motor development (Denver Developmental Screening Test II [Denver II] and Alberta Infant Motor Scale [AIMS]) and sleep characteristics (Infant Sleep Questionnaire [BISQ]). At 4/5 years of age, the group of preterm children was again assessed regarding these aspects (using the Pediatric Evaluation of Disability Inventory [PEDI] and the Sleep Disturbance Scale for Children [SDSC]) and compared to a control group of randomly selected term infants evaluated with PEDI and SDSC. Results: AIMS showed atypical development in 65.9% of premature infants at 6 months and 63.4% at 12 months. According to Denver II, suspected delay was present in 73.2% and 70.7% of the sample at 6 and 12 months respectively. At 6 months, suspected delay (Denver II) and atypical development (AIMS) were associated with not sleeping sideways, greater number of awakenings, and longer awake periods. For AIMS, there was also an association between atypical development and having the child's sleep considered a problem by the parents at 6 months. At 12 months, there were no significant correlations between BISQ findings and the results of motor evaluations. At 4/5 years, the results of 32 preterm and 30 term children were considered. Motor delays (PEDI) were detected in 36.1% of preterm infants and 41.9% of controls, with no difference between the groups (p = 0.481). Sleep disorders were also statistically similar, observed in 56.3% of preterm children vs. 63.3% of controls (p = 0.757). At this age, the preterm group had an association with favorable scores in the PEDI self-care motor development domain and higher SDSC scores in sleep arousal and hyperhidrosis. For term children, total SDSC score and higher drowsiness scores were associated with worse motor assessment in the mobility domain. Conclusion: Motor development correlated with sleep quality at 6 months of corrected age and at 4/5 years of age in very low weight preterm infants. The observed association between higher self-care scores and presence of sleep arousal/hyperhidrosis at 4/5 years deserves further investigation. At 4/5 years, premature children were similar to full-term children both in terms of sleep disturbances and motor delay.