Objetivo: Avaliar o impacto do nascimento pré-termo sobre a mortalidade neonatal numa série temporal de 2000 a 2014 no município de Porto Alegre. Métodos: Estudo de coorte retrospectivo de base populacional com a utilização dos registros oficiais de nascimento e de morte ligados de 2000 a 2014 de recém-nascidos com menos de 32 semanas de idade gestacional de Porto Alegre. Foram utilizadas como variáveis independentes idade e escolaridade maternas, número de consultas pré-natal, tipo de hospital, via de parto, idade gestacional (IG), sexo e peso do recém-nascido e ano de nascimento. O desfecho primário foi morte neonatal (morte ocorrida de 0 a 27 dias de vida). Foram excluídos recém-nascidos duplicados, com menos de 500 gramas ou com peso inconsistente, com IG menor de 22 semanas, com anomalias congênitas, gemelares e de partos extra hospitalares. Foi calculado razão de risco (hazard ratio-HR) ajustado para o risco de morte neonatal para todas as variáveis independentes através de análise de sobrevivência pela regressão de Cox para riscos proporcionais com nível de significância p<0,05. Posteriormente, foi realizado análise por quintil de peso de nascimento. Resultados: Foram analisados os registros de 3282 recém-nascidos com IG menor que 32 semanas de 2000 a 2014 dos quais, 643 foram ao óbito neonatal e 2639 sobreviveram. O risco de morte neonatal absoluto diminuiu de 25% no triênio 2000 a 2002 para 17% no período de 2012 a 2014. O mesmo risco ajustado foi significativamente menor para os recém-nascidos de menor peso (média de 673 ± 86 gramas) de parto cesáreo [HR 0,57 (IC95% 0,45-0,73)] enquanto que, para os de maior peso (média 1.834 ± 212 gramas) este risco inverteu-se e foi significativamente maior para esta via de parto [HR 8,44 (IC95% 1,86-38,22)]. Conclusão: Houve diminuição do risco absoluto de morte neonatal entre os recém-nascidos com IG menor de 32 semanas nos últimos anos em Porto Alegre e o aprimoramento do uso racional do parto cesáreo nos hospitais do município pode contribuir para uma redução ainda maior desse indicador. / Objective: Assess impact of prematurity on neonatal mortality from 2000 to 2014 in Porto Alegre through official information systems. Methods: Populational base retrospective cohort study with record linkage of birth and death database certificates. There were included records of birth and death from 2000 to 2014 of infants with less than 32 weeks of gestational age of Porto Alegre. There were used mother age and schooling, number of antenatal visits, delivery type, hospital type, gestational age, sex and birth weight and birth year of infant as independent variables. The primary outcome examined was neonatal death (death at 0-27 days of age). There were excluded infant records duplicate, with less than 500g or inconsistent birthweight, with gestational age less than 22 weeks, with congenital anomalies, twins and out-of-hospital births. Adjusted Hazard Ratio (HR) were calculated for the risk of neonatal death for all independent variables through Cox regression for survival analysis with p-value<0,05 for statistical significance. The analysis also was performed at quintiles of birthweight. Results: There were 3282 infant records of infants with less than 32 weeks of gestational age from 2000 to 2014 who progress to 643 neonatal deaths or 2639 survival. The neonatal death absolut risk decline from 25% at 2000-2002 period to 17% at 2012-2014 period. The adjusted neonatal death risk was significantly reduced for lightest preterm (mean birthweight 673g ± 86) born by C-section [HR 0.57 (CI95% 0.45-0.73)], while, for the heaviest ones (mean birthweight 1.834g ± 212) the risk was significantly increased for that delivery route [HR 8.44 (CI95% 1.86-38.22)]. Conclusion: The absolut risk of neonatal death in infants with less than 32 weeks of gestational age has been declining over the years and more rational use of C-section can contribute to further improving the neonatal survival.

La perception sensorielle est propre à chaque individu. Elle découle du patrimoine génétique (qui définit les récepteurs sensoriels), mais varie en fonction de la maturation et de l’expérience d’un individu. En ce sens, l’étude du bébé nous a permis de tester à la fois 1) l’effet de la maturation, en comparant la perception des bébés avec celle des adultes et 2) l’effet de l’expérience sensorielle précoce, en comparant la perception sensorielle de bébés nés à terme ou prématurés pour un même âge donné. Nos résultats ont souligné une perception sensorielle plus étendue chez le bébé que chez l’adulte, via la perception de stimulations tactiles très fines ou encore la perception d’ultrasons, qui ne sont plus perçus à l’âge adulte. Les mécanismes de maturation des organes sensoriels et de « recentrage sensoriel » envers les stimulations pertinentes, pouvant intervenir au cours du temps, ont été présentés. Nous avons également montré une réactivité particulièrement marquée des bébés prématurés, en comparaison avec les bébés nés à terme. Différents mécanismes sous-jacents potentiels tels qu’une adaptation de la sélectivité neuronale aux stimulations environnementales, une plasticité cérébrale conservée/retardée, ou encore le développement d’une hypersensibilité ont été discutés. En sus du cœur de cette thèse, nous nous sommes intéressés à l’ « Umwelt » social du bébé, en étudiant 1) ses capacités de perception et de discrimination des odeurs corporelles humaines et 2) sa capacité à s’exprimer sur sa perception sensorielle. Nous avons montré que le bébé est un être très réceptif à son monde social, capable de discriminer entre les odeurs de ses partenaires sociaux. De plus, le bébé est également très expressif sur sa perception sensorielle, notamment via l’utilisation d’un répertoire vocal complexe (au-delà des pleurs), dont certains types de vocalisations pourraient refléter son état de confort ou d’inconfort. Les résultats de cette thèse ouvrent de nombreuses pistes de réflexion en termes d’adaptations des pratiques néonatales. / Sensory perception is specific to each individual. It results from the gene pool (which defines the sensory receptors), but varies depending on maturation and experience. In this sense, the study of babies has enabled us to test both 1) the effect of maturation by comparing the babies’ sensory perception to those of adults and 2) the effect of early stage sensory perception by comparing the sensory perception of preterm and full-term infants at a same post-conception age (i.e. term-aged infants). Our results underlined a larger sensory perception in babies than in adults, through the perception of very subtle tactile stimulations, or else the perception of ultrasounds, that cannot be perceived by grown-ups. The mechanisms of the maturation of sensory organs and of ‘’sensory recentering‘’ towards relevant simulations that can happen in the course of time have been presented. We have also shown a particularly strong reactivity of preterm babies in comparison to full-term babies. Various potential subjacent mechanisms such as a neuronal selectivity adaptation to environmental stimulations, a maintained/ delayed cerebral plasticity or else the development of a hypersensitivity have been discussed. In addition to the core of this thesis, we have taken an interest in the baby’s social “Umwelt” and have studied 1) his abilities in perception and discrimination between human body odours and 2) his ability to express his sensory perception. We have shown that babies are very responsive to their social world, capable of discrimination between different social partners’ odours. Furthermore, babies also are highly expressive when it comes to their sensory perception, especially through the use of a complex vocal repertoire (beyond cries/tears). Indeed, some types of these vocalisations could reflect his state of comfort or discomfort. The results of this thesis open numerous grounds for thought in terms of neonatal care adaptations.

No description available.

<p>Stopa prematuriteta konstantno raste, a sve vi&scaron;e prevremeno rođenih beba koje prežive neonatalni i perinatalni period zahteva adekvatno sistemsko i oftalmolo&scaron;ko praćenje i tretman. Prematuritet sam po sebi, predstavlja rizik za razvoj vida. Taj rizik dodatno povećava prisustvo prematurne retinopatije i refraktivnih mana. Skrining i tretman promena na retini u sklopu prematuriteta, kao i optička korekcija refraktivnih mana obezbeđuju uslove za razvoj vida. Cilj ovog istraživanja je bio utvrditi promene biometrijskih karakteristika oka prematurusa, sa i bez prematurne retinopatije, tokom &scaron;estogodi&scaron;njeg praćenja, utvrditi refraktivni status ove dve grupe dece sa &scaron;est godina, te povezati promene biometrijskih karakteristika oka sa refrakcijom. U ispitivanje je uključeno 192 prevremeno rođena deteta (384 oka). Vr&scaron;ena su tri pregleda, u uzrastu od 3 meseca, 12 meseci i 6 godina starosti. Nakon prvog pregleda ispitivani uzorak je, u zavisnosti od nalaza na očnom dnu, podeljen na bebe sa prematurnom retinopatijom i bebe bez ovog oboljenja, a kako bi se uporedile proučavane karakteristike. U sva tri navedena uzrasta je pregledano očno dno i merene su tri glavne biometrijske karakteristike koje utiču na refraktivni status: aksijalna dužina oka, dubina prednje očne komore i debljina očnog sočiva. Sa &scaron;est godina je određena refrakcija, uključujući zakrivljenost rožnjače odnosno kornealni astigmatizam, vidna o&scaron;trina bez korekcije refraktivne mane, a zatim i nakon korekcije. Ostali neophodni podaci su dobijeni iz medicinske dokumentacije. Pokazano je da prematurna retinopatija utiče na refraktivni status i vidni ishod sa &scaron;est godina, pre svega uticajem na zakrivljenost rožnjače, aksijalnu dužinu oka i dubinu prednje očne komore, dok su promene debljine očnog sočiva bez posebnog značaja. Vidne o&scaron;trine oba oka u pred&scaron;kolskom uzrastu prevremeno rođene dece sa prematurnom retinopatijom su statistički značajno manje kada se uporede sa vidnim o&scaron;trinama prevremeno rođene dece bez retinopatije, ali razlika u ovim dvema vrednostima gubi statističku značajnost nakon optičke korekcije. Učestalost astigmatizma u prematurnoj populaciji sa 6 godina je visoka, a od onih koji imaju astigmatizam u tom uzrastu, vi&scaron;e od dve trećine je imalo prematurnu retinopatiju. Ukupna učestalost miopije, hipermetropije i emetropije u prematurnoj populaciji sa 6 godina je 18,9%, 54,7% i 13,2%, a preostalih 13,2% su anizometropi. U vi&scaron;e od trećine dece, sa prematurnom retinopatijom u najranijem uzrastu, sa &scaron;est godina postoji gubitak vidne sposobnosti, koji je najče&scaron;će blag, no može biti i potpun.</p> / <p>The number of babies born prematurely is constantly growing, so more and more of them need appropriate systemic and ophthalmologic monitoring and treatament. Prematurity itself, represents a risk for the development of vision. This risk further reinforces the presence of retinopathy of prematurity and refractive errors. Screening and treatment of retinopathy, as well as optical correction of refractive errors provide adequate conditions for the development of vision. The aim of this study was to determine changes of biometric features of eyes of the prematurely born infants, with and without retinopathy of prematurity, during the six-year follow-up. We also want to determine the refractive status of these two groups of children in the six year, and to link changes of biometric features with their eye refraction. The study included 192 prematurely born children (384 eyes). The examinations were performed at 3 months, 12 months and 6 years and they included fundus examination and measurements of the ocular axial length, anterior chamber depth and lens thickness. After dividing the subjects into two groups, based on the results of the fundus examination at 3 months, the results of the children with and without retinopathy were compared. At the age of six we also determine the refraction of eyes, including the curvature of the cornea and corneal astigmatism, visual acuity without correction of refractive error, and then after it. Other necessary data were obtained from medical documentation. It is shown that retinopathy of prematurity affects the refractive status and visual outcome at sixth year, primarily by the changes of curvature of the cornea, the axial length of the eye and the depth of the anterior chamber, while the change in the lens thickness has no significance. Visual acuity in both eyes in the preschool age preterm born children with retinopathy of prematurity are significantly less, when compared to visual acuity in preterm infants without retinopathy, but the difference in these two values lost statistical significance after optical correction. The rate of astigmatism in preterm population of six years is high, and of those who have astigmatism in this age group, more than two-thirds had retinopathy of prematurity. The overall incidence of myopia, hypermetropia and emetropia in the prematurely born, six years old children is 18.9%, 54.7% and 13.2%, and the remaining 13.2% have anisometropia. In more than a third of children with retinopathy of prematurity at an early age, with six years, there has been loss of visual acuity, which is usually mild, but it can be complete.</p>

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23078号 / 医博第4705号 / 新制||医||1049(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 稲垣 暢也, 教授 万代 昌紀, 教授 小杉 眞司 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Advances in neonatology have led to increased numbers of high-risk neonates surviving and intensified interest in the developmental outcomes of this population. In the South African context prematurity and low birth weight are the most common causes of death in the perinatal period and the same risk factors that contribute to infant mortality also contribute to the surviving infants’ increased risk for developmental delays. As a result of the interacting biological and environmental risk factors of prematurity, low birth weight, poverty and HIV and AIDS in the South African context Kangaroo Mother Care (KMC) has been developed as best practice to promote infant survival and to facilitate mother-infant attachment. Mother-infant attachment may lead to synchronous interaction patterns between the mother and infant which forms the basis of early communication development. Early communication intervention (ECI) services are recommended as early as possible as high-risk infants are especially at risk for feeding difficulties and communication developmental delays. It is, however, not clear what the content of an ECI programme should be and how it should be implemented according to the changing communication and feeding developmental needs of the infant while receiving KMC. There appears to be a dearth of research on the earliest stages of communication development in high-risk neonates, which should form the foundation of such a programme. A descriptive survey was conducted to describe the development of 25 high-risk infants and their mothers’ changing needs from admission to discharge from a KMC unit. Each participant and mother dyad was followed up over an average of 11 days of data collection with three to four data collection sessions. Data was collected by means of direct observation during routine care-giving activities. The different developmental subsystems of the participants’ feeding, communication, neuro-behavioural organization and mother-neonate interaction were described. The results demonstrated that subtle, but definite changes could be observed in the participants’ development. Development in all the different areas occurred over time as the participants progressed through the three developmental states of the in-turned state, coming-out state and reciprocity state. As the participants progressed during the 11 days of data collection and were increasingly able to attend to their environment, they also developed the ability to regulate and organize their own behaviour in order to develop more complex communication, feeding and interaction skills with their mothers. The functioning of the participants’ sensory systems developed in a specific order namely tactile, auditory and then visual. Although the participants developed consistently throughout their stay in the KMC unit, mother-neonate interaction never reached optimal levels. The importance of an individualized training programme for each mother is reflected in the finding that the neonate’s developmental level and progress needs to be considered when implementing the ECI programme. The need for speech-language therapy involvement in KMC is emphasized in the light of a shortage of practicing speech-language therapists in South Africa. It is therefore imperative that the prevention of communication delays and feeding difficulties in high-risk neonates as well as parent training assume priority. / Dissertation (MCommunication Pathology)--University of Pretoria, 2008. / Speech-Language Pathology and Audiology / unrestricted

Thesis (M.Med. (Paediatrics and Child Health)) -- University of Limpopo, 2019 / Objectives To determine the prevalence and survival rate; and to assess the maternal risk factors as well as complications of prematurity, associated with the mortality of very low and extremely low birth weight infants in the Neonatal Intensive Care Unit (NICU) of Mankweng Hospital. Materials and Methods A retrospective descriptive study was conducted at the NICU of Mankweng Hospital for a 7-month period from 1st January to 31st July 2015. The patient medical records and the Perinatal Problem Identification Programme (PPIP) data were used for the study. Results Prevalence of prematurity was 23%, Infants weighing between 500g-1499g represented 6.3% of the total live births and 25% of the admissions to the NICU; of which 4.9% were classified as extremely low birth weight (ELBW). Overall 77% of the study population survived until discharge. From the medical records, the survival to discharge of infants with weight 500g - 999g was 52%; and 84% for those with weight 1000g-1499g. Multivariable analysis found that improved survival was associated with an increase in gestational age (p <0.001), as well as birth weight (p <0.001) and prolonged length of stay. Variables associated with poor survival were spontaneous preterm labour (p = 0.031), low Apgar score at 1 and 5 minutes (p <0.001), sepsis (p = 0.001), respiratory distress syndrome (p <0.001), pulmonary hemorrhage (p <0.001), hypothermia (P = 0.005), resuscitation at birth (p = 0.002) and necrotising enterocolitis (p =0.044). Antenatal steroids were not associated with survival (p =0.111), however this was not documented in 53%(134/252) of the records, so the non-significance to outcome in this study may not be a true reflection. The use of NCPAP or SiPAP only was associated with improved survival of up to 69% and high mortality rates were recorded in babies who required invasive ventilator support. Multi-organ immaturity was found to be the most common cause of death, followed by sepsis. Conclusion: The prevalence and survival rates of very low and extremely low birth weight, found in this study are comparable to those found in other tertiary hospitals in South Africa. The survival rate of ELBW babies is low and must be improved. Reliable data and further research should address effective steps to prevent preterm labour, extreme prematurity and hypothermia. The documentation and provision of antenatal steroids is encouraged. KEY CONCEPTS: Prematurity, Extremely low and Very low birth weight, Risk factors, Prevalence, Survival, Neonatal mortality rate.

Problématique : Entre 25 et 45% des enfants nés entre 29 et 36 semaines de gestation présenteront un retard de développement (RD) à 2 ans d'âge corrigé (AC). Les enfants nés entre 29 et 36 semaines de gestation ne bénéficient d’aucun suivi systématique structuré, tel que celui retrouvé dans les Cliniques de suivi néonatal, qui permet une identification précoce des RD. Des facteurs tels que les caractéristiques périnatales, environnementales et le statut neurologique à l’âge équivalent du terme (AET) ont été étudiés comme marqueurs potentiels du RD, mais leur capacité à prédire les manifestations précoces du RD, lorsque combinés, demeure mal comprise. Objectif : Déterminer le modèle de prédiction le mieux ajusté pour la prédiction du retard moteur à 3,5 mois AC par la combinaison des facteurs périnataux, environnementaux et du statut neurologique à l’AET chez les enfants nés entre 29 et 36 semaines de gestation. Méthode: Étude prospective incluant 129 enfants nés entre 29 et 36 semaines de gestation et admis ≥48h à l’unité de soins intensifs néonatale (USIN). À l’AET, les facteurs périnataux et environnementaux ont été collectés. Un examen neurologique standardisé de l’enfant a été complété. À 3,5 mois AC, une évaluation motrice a été réalisée avec le Alberta Infant Motor Scale (AIMS): le retard était défini comme un score <10e percentile. Des régressions logistiques ont permis d’identifier les facteurs associés au RD à 3,5 mois AC et de créer un modèle de prédiction. Résultats : Les facteurs qui sont demeurés significatifs dans le modèle multivarié à 3,5 mois AC sont : consommation de tabac par la mère, présence de diabète gestationnel, score à l’Échelle de dépression postnatal d’Édimbourg, indice de risque néonatal et indice de risque environnemental. Le modèle final avait une sensibilité de 76% et une spécificité de 84% pour la prédiction du RD à 3,5 mois. Conclusion : Le modèle statistique élaboré permet une identification suffisamment sensible et spécifique pour être utilisé en clinique à des fins d’identification précoce du risque de RD auprès des enfants nés entre 29 et 36 semaines de gestation et ce, dès l’AET. / Background: Between 25 and 45% of children born prematurely between 29 and 36 weeks of gestation will present with developmental delay by 2 years of corrected age (CA). Children born between 29 and 36 weeks of gestation do not systematically benefit from specialized follow-up, which allows the early identification of developmental delay. Factors such as perinatal characteristics, environmental characteristics and neurological status have been studied as potential markers of developmental delay. However, their capacity for predicting an early manifestation of developmental delay remains poorly understood. Aims: To determine the best-fitting model for the prediction of motor delay at 3.5 months CA by the combination of perinatal factors, environmental factors, and neurological status at term equivalent age (TEA) in children born between 29 and 36 weeks' gestation. Methods: This prospective observational cohort study included 129 infants born between 29 and 36 weeks of gestation and admitted for >48h in the Neonatal Intensive Care Unit (NICU). At TEA, perinatal and environmental factors were collected, and a standardized neurological examination of the child was also performed. At 3.5 months CA, a motor assessment was performed using the Alberta Infant Motor Scale: delay was defined as a score <10th percentile. Logistic regressions were used in order to identify factors associated with motor delay at 3.5 months CA and to create a prediction model. Results: Factors that remained significant in the multivariate model at 3.5 months CA were maternal smoking, gestational diabetes, Edinburgh Postnatal Depression Scale score, neonatal risk index, and environmental risk index. The final model had a sensitivity of 76% and a specificity of 84% for predicting motor delay at 3.5 months. Conclusion: The statistical model developed demonstrated a sensitivity and specificity strong enough to support its use in a clinical context for the early identification of the risk of motor delay in children born between 29 and 36 weeks of gestation.

Dans le monde, une naissance sur 10 est prématurée, se produisant avant 37 semaines de gestation, et environ 1% sont très prématurées (<30 semaines de gestation). La prématurité est associée à des altérations de la structure et fonction cardiovasculaire qui persistent à l’âge adulte et sont liées aux maladies cardiovasculaires. Il n’y a cependant pas de recommandations cliniques pour le suivi de la santé cardiovasculaire chez les jeunes adultes nés très prématurément. Cette thèse porte sur la prévention des maladies cardiovasculaires dans cette nouvelle population à risque. Ses objectifs principaux sont de décrire les effets à long terme de la prématurité sur la santé adulte et de présenter les avenues de prévention et d’intervention permettant de mitiger ces effets. Son premier chapitre présente une revue de la littérature pertinente alors que son second détaille les méthodes employées pour obtenir les résultats présentés dans les chapitres suivants. Brièvement, la cohorte HAPI (Health of Adults born Preterm Investigation) est constituée de jeunes adultes nés entre 1986 et 1996 au Québec soit prématurément (<30 semaines de gestation) ou à terme (>37 semaines de gestation). C’est la population étudiée dans les chapitres 3 à 5. Le chapitre 3 présente une diminution de la capacité aérobie à l’effort chez les sujets nés prématurément et explore les facteurs y contribuant, incluant des paramètres hémodynamiques cardiaques. Le chapitre 4 examine la perception de la santé et l’utilisation des services de santé dans cette cohorte et comment ceux-ci sont influencés ou non par les paramètres de santé objectifs identifiés précédemment dans le cadre de l’étude HAPI. Le chapitre 5 présente un plaidoyer en faveur d’un suivi médical à long terme des individus nés très prématurément dont les arguments proviennent de témoignages des participants de l’étude HAPI. Enfin, le chapitre 6 présente les résultats de l’étude HAPI Fit qui avait pour but d’évaluer les effets chez de jeunes adultes nés très prématurément d’une intervention de 14 semaines en activité physique principalement sur la capacité aérobie maximale et secondairement sur les paramètres de santé cardiovasculaire. L’ensemble de ces résultats permet de brosser un portrait des conséquences cardiovasculaires à long terme de la prématurité et des moyens disponibles pour les mitiger. La dissémination de ces résultats à la population ciblée et à ses soignants constitue la base sur laquelle pourront se bâtir de futurs programmes de prévention dans cette population à risque. / Worldwide, one in ten births is preterm, occurring before the 37th week of gestation, and approximately 1% are very preterm (<30 weeks of gestation). Preterm birth is associated with alterations of cardiovascular structure and function that persist into adulthood and are linked to cardiovascular disease. There are, however, no clinical guidelines regarding long term cardiovascular monitoring for adults who are born very preterm. This thesis’s focus is the prevention of cardiovascular disease in this new at-risk population. Its main objectives are to describe the long-term effects of prematurity on adult health and to present prevention and intervention avenues for mitigating those effects. Its first chapter presents a review of the pertinent literature while its second describes the methods that were employed to obtain results that are presented in subsequent chapters. Briefly, the HAPI (Health of Adults born Preterm Investigation) cohort recruited young adults born between 1986 and 1996 in the province of Quebec either prematurely (<30 weeks of gestation) or at term (>37 weeks of gestation). This is the population studied in chapters 3 to 5. Chapter 3 presents a diminished maximal aerobic capacity in subjects born preterm and explores contributing factors, including cardiac hemodynamic parameters. Chapter 4 examines health perception and healthcare use in the cohort and how these are influenced or not by objective health measurements previously performed in the HAPI study. Chapter 5 advocates for long-term medical follow-up in young adults born preterm, using testimonials from participants in the HAPI cohort. Finally, chapter 6 presents results from the HAPI Fit study which aimed to evaluate the effects in young adults born very preterm of a 14-week exercise intervention on their maximal aerobic capacity and cardiovascular health parameters. Overall, these results allow us to paint a global picture of long-term cardiovascular consequences of prematurity and of possible ways to mitigate them. Dissemination of these results to the target population and their healthcare providers constitute the basis of future prevention programs in this new at-risk population.

Problématique : Entre 25 et 45 % des enfants nés entre 29-36 semaines de gestation (PT) présenteront un retard de développement persistant (RD) à l’âge corrigé (AC) de 2 ans. Dans la première année de vie, le retard moteur peut représenter une déviation transitoire de la trajectoire développementale, en raison de la prématurité, ou être le premier signe d’un RD. Afin de suivre le développement moteur des enfants à risque, le General Movement Assessment (GMA), l’Alberta Infant Motor Scale (AIMS) et le Neuro-Sensory Motor Developmental Assessment (NSMDA) sont parmi les outils les plus recommandés, mais la trajectoire neuromotrice spécifique des enfants PT n’est pas connue sur ces outils. Objectifs : Le présent mémoire visait à décrire la trajectoire neuromotrice entre l’âge-équivalent du terme (AET) et 8 mois AC des enfants nés entre 29-36 semaines de gestation à l’aide du GMA, du AIMS et du NSMDA. Un objectif secondaire visait à déterminer la capacité du GMA à l’AET et 3,5 mois AC à prédire le devenir neuromoteur évalué à l’aide du AIMS et du NSMDA à 8 mois AC. Méthodologie : Une étude prospective incluant 173 PT admis ≥ 48h à l’unité des soins intensifs néonatale a été réalisée pour atteindre les objectifs principal et secondaire. Le développement neuromoteur a été évalué à 3 reprises : à l’AET (GMA), à 3,5 mois AC (GMA, AIMS et NSMDA) et à 8 mois AC (AIMS et NSMDA). Des analyses descriptives et des calculs de validité prédictive ont été effectués. Résultats : Entre l’AET et 8 mois AC, 21 % des enfants sont demeurés avec des évaluations normales, 19 % des enfants sont demeurés avec des évaluations anormales, 56% ont évolué d’un résultat anormal à un résultat normal, alors que 4 % ont évolué d’un résultat normal à un résultat anormal. À l’AET, le GMA de base présentait une sensibilité de 67 % et une spécificité de 38 %. À 3,5 mois AC, le GMA détaillé a identifié 85 % des enfants avec un résultat anormal à 8 mois AC, mais la spécificité était basse (22 %). Conclusion : La tendance principale est une normalisation avec l’âge, observée chez plus de 50 % des enfants. Le GMA aide à identifier un nombre significatif d’enfants qui pourraient bénéficier de services d’interventions précoces, et ce dès l’AET. En contrepartie, la spécificité demeure faible, pouvant mener à des sur-références pour ces services. / Background : Between 25 and 45 % of infants born between 29-36 weeks of gestation (PT) will have a significant developmental delay (DD) by 2 years corrected age (CA). During the first year of life, motor delay could either be a transient deviation in neurodevelopmental trajectory, in the context of preterm birth, or the first sign of significant DD. The General Movement Assessment (GMA), the Alberta Infant Motor Scale (AIMS) and the Neuro-Sensory Motor Developmental Assessment (NSMDA) are three of the most recommended tools for at-risk infants to follow motor development, but have been rarely used with PT to describe neuromotor trajectory. Aims : This paper aimed to describe the neuromotor trajectory between term-equivalent age (TEA) and 8 months CA of infants born from 29 to 36 weeks of gestation with the GMA, the AIMS and the NSMDA. A second goal aimed to determine the ability of the GMA at TEA and 3,5 months CA to predict neuromotor outcome at 8 months CA on the AIMS and the NSMDA. Methods : A prospective study including 173 PT admitted for ≥ 48h in the neonatal intensive care unit was realised to achieve primary and secondary goals. Neuromotor development was evaluated at three timepoints: at TEA (GMA), at 3,5 months CA (GMA, AIMS and NSMDA) and at 8 months CA (AIMS et NSMDA). Descriptive statistics and calculation of predictive validity were performed. Results : Between TEA and 8 months CA, 21% of infants remained with normal results, 19% of infants remained with abnormal results, 56% progressed from abnormal results to normal results, while 4% progressed from normal results to abnormal results. The basic GMA had the best sensitivity and specificity at TEA (67 % and 38 %). The detailed GMA at 3,5 months CA identified 85 % of infants with abnormal results at 8 months CA, but specificity was low (22 %). Conclusion : Motor development tends to normalize with age. The GMA is helpful to identify a significant number of infants as soon as TEA who would benefit from early interventions, to the detriment of over-referrals due to low specificity.