O nascimento de um recém-nascido prematuro é considerado de risco para o desenvolvimento infantil saudável. Levando-se em consideração o curso do desenvolvimento, no qual sua trajetória pode sofrer interferências pela prematuridade, este estudo foi delineado, com o objetivo de investigar e comparar o desempenho de crianças nascidas com prematuridade extrema, acentuada e moderada e nascidas a termo, quanto ao desenvolvimento nas áreas de linguagem, motora grossa, motora fina-adaptativa, pessoal social e visual, na faixa etária de 0 a 24 meses. Para as crianças nascidas prematuras foram considerados tanto a idade cronológica quanto o cálculo da idade corrigida. Cumpriram-se os aspectos éticos. Foram avaliadas 261 crianças nascidas prematuras e 87 crianças nascidas a termo. Os procedimentos experimentais foram: análise de prontuário, anamnese com familiares, aplicação do Critério de Classificação Econômica Brasil e dos instrumentos: Teste Screening do Desenvolvimento DENVER II e da Escala Early Language Milestone Scale ELM. Os procedimentos de análises foram Teste de Tukey, Teste do Qui-Quadrado e de Proporções, Independent Samples Test, Teste de Correlação de Pearson e o Teste Correlação de Ponto Bisserial (nível de significância p<0,05). Os resultados encontrados e as nossas conclusões foram: o desempenho nas habilidades comunicativas e do desenvolvimento na comparação das crianças nascidas prematuras com as crianças nascidas a termo, verificou-se diferença estaticamente significante para as habilidades Auditiva Expressiva, Pessoal-Social, Motor Fino Adaptativo, Linguagem e Motor Grosso, tanto para idade cronológica quanto para idade corrigida. Na comparação dos grupos de prematuros nas habilidades avaliadas, não foram verificadas diferenças estaticamente significante, considerando o critério idade corrigida. Os escores obtidos no critério passa ou falha, apresentou diferença estatisticamente significante na análise referente às porcentagens obtidas nas habilidades comunicativas da ELM, e nas habilidades do desenvolvimento do TSDD-II, entre os grupos de crianças nascidas prematuras e de crianças nascidas a termo, considerando a idade cronológica e idade corrigida. A influência dos fatores de risco e da idade gestacional correlacionados com o desempenho nas habilidades do desenvolvimento no TSDD-II, com resultados estatisticamente significantes apenas para o GP-I. / The birth of a preterm newborn is considered risky for healthy child development. This study was delineated considering the course of the child development, which may suffer interferences by prematurity. This study aimed at investigating and comparing the development of children who were late, very or extremely preterm, and children born at term, with regard to the development in the language, gross motor, adaptive fine motor, social-personal and visual areas, in subjects from 0 to 24 months old. For preterm children, we considered both chronological and corrected ages. The ethical aspects were met. We evaluated 261 children who were born preterm, and 87 children born at term. The experimental procedures were: analysis of records, anamnesis questionnaire answered by caregivers, and application of the Brazilian Economic Classification Criteria. In addition, the Development Screening Test DENVER II and the Early Language Milestone Scale ELM instruments were used. The analyses procedures were carried out by means of the Tukey test, Chi-Square test and Proportions, Independent Sample Tests, Pearson Correlation Coefficient, and the Point-Biserial Coefficient of Correlation (level of significance - p<0.05).The results approached the performance in communicative abilities and development by comparing preterm and born at term children. There was a statistically significant difference for the expressive auditory, social-personal, adaptive fine motor, language and gross motor abilities for both chronological and corrected ages. There were no statistically significant differences as for the corrected age criterion and the comparison among the preterm groups considering the assessed abilities. The scores obtained through the criterion of passes or fails indicated that there was a statistically significant difference in the analysis of the percentages for the communicative abilities in the ELM and for the development abilities in the TSDD II among the groups of preterm children and the group of children born at term, considering both chronological and corrected ages. The influence of the risk factors and the gestational age correlated with the performance in the abilities of development for the TSDD II, indicating statistically significant results only for the GP-1.

Submitted by Edineia Teixeira (edineia.teixeira@unioeste.br) on 2017-11-28T16:03:40Z No. of bitstreams: 2 Grasiely__Barreto 2017.pdf: 2476827 bytes, checksum: c6e0144bb7e27fed545f2b3be4e2b140 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-11-28T16:03:40Z (GMT). No. of bitstreams: 2 Grasiely__Barreto 2017.pdf: 2476827 bytes, checksum: c6e0144bb7e27fed545f2b3be4e2b140 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-03-13 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Prematurity is an emerging problem in global health, contributing to the infant mortality, specifically the neonatal mortality due to prenatal, maternal, fetal, and birth factors. From the advances occurred in recent decades in the maternal-fetal medicine and neonatal care have raised the survival of premature infants, increasingly with birth weight and gestational age (GA) progressively lower, this situation rise the risks of morbidity in the future. Thus, prematurity and low birth weight has been associated with changes in growth and in the metabolism of these children. In the literature, there is a gap on studies that address this issue in the population of premature infants (PT) related to the birth weight classification and it influences in their metabolic profile throughout the follow-up. It is important to investigate over the first few months of the child`s life that was born prematurely, its measures of body composition, as well as, detect the pattern of lipid, glucose and insulin metabolism of these preterm infants. In this sense, it seeks the relationship between the evolution of growth since birth and the metabolic conditions of preterm infants during their follow-up. In this context, it has as objective of the research, evaluating the growth of preterm infants from birth to six months corrected age and their lipid profile, blood glucose levels and insulin as the adequacy of birth weight. A quantitative study, observational, longitudinal, prospective study conducted in a Neonatal Intensive Care Unit and an outpatient follow-up of high risk of a University Hospital. In study 107 mothers and 115 PT was enrolled from 2015 May 1st to 2016 August 15th. 72 preterm infants have completed the follow-up at the six months of corrected age. Preterm infants were divided in two groups - Appropriate weight for gestational age (AGA) and Small for Gestational Age (SGA) and to correlate them with the results of blood glucose, triglyceride, cholesterol and insulin. Statistical analyzes were performed with the Statistica 7.0. Of the total number of preterm infants who completed the follow-up, the majority of mothers was Caucasian, with 10 to 12 years of study, annual income between 3300 to 6300 dollars, not alcoholics or smokers, the infection of urinary tract was the main morbidity during pregnancy, followed by hypertensive disease specifies of pregnancy. 88% of the PT were classified as AGA, 40% weighing between 1000 to 1499g and 45% with gestational age between 28 to 31 week. The growth of preterm newborns was linear over the follow-up, but the Z scores for weight, height and head circumference remained lower than expected for their GA. In the correlation between AGA and SGA infants and their metabolic profiles, no statistical difference between the groups were observed for cholesterol, blood glucose, and insulin, throughout the follow-up. However, the triglycerides showed ascending curve from birth, predominantly between SGA. Therefore, this group of premature constitute a population at high risk for potential cardiovascular changes in the future, as well as, delays in its growth from birth throughout the follow-up. The appropriate follow-up of these newborn babies is fundamental in order to retard, mitigate or avoid morbidities throughout their lives. / A prematuridade é problema emergente na saúde mundial, contribuindo com a mortalidade infantil, especificamente, a mortalidade neonatal decorrente de fatores pré-natais, maternos, fetais e do nascimento. Com os avanços ocorridos nas últimas décadas na medicina materno-fetal e neonatal, observa-se maior sobrevida de crianças prematuras com peso de nascimento e Idade Gestacional (IG) progressivamente menores, elevando riscos de morbidades futuras. Assim, a prematuridade e o baixo peso ao nascer têm sido associados a alterações do crescimento e no metabolismo dessas crianças. Identifica-se, então, como lacuna na literatura estudos que abordem essa temática na população de Recém-Nascidos Prematuros (PT) em relação a sua adequação de peso ao nascer e as influencias ao longo do seguimento no perfil metabólico. Faz-se premente investigar, ao longo dos primeiros meses de vida da criança nascida prematura, suas medidas de composição corporal, bem como detectar a evolução do perfil lipídico, glicêmico e da insulina desses PT. Neste sentido, busca-se a relação entre a evolução do crescimento desde o nascimento e as condições metabólicas do PT ao longo de seu seguimento. Neste contexto, tem-se como objetivo da pesquisa, avaliar o crescimento do PT do nascimento aos seis meses de idade corrigida e seu perfil lipídico, glicêmico e insulínico conforme a adequação de peso ao nascer. Estudo quantitativo, observacional, longitudinal, prospectivo, realizados em uma Unidade de Terapia Intensiva Neonatal e Ambulatório de Seguimento de Alto Risco de um Hospital Universitário. Arrolaram-se no estudo 107 mães e 115 PT, entre 01 de maio de 2015 a 15 de agosto de 2016. Desses, 72 PT concluíram o seguimento aos seis meses de Idade Corrigida (IC). Os PT foram divididos em grupo Adequado para Idade Gestacional (AIG) e Pequenos para Idade Gestacional (PIG) correlacionando-os com os exames de glicemia, triglicerídeo, colesterol e insulina. As análises estatísticas foram realizadas no programa Statistica 7.0. Do total de PT que finalizaram o seguimento, a maioria das mães era de etnia branca, com 10 a 12 anos de estudo, renda entre um a dois salários mínimos, não etilistas ou tabagistas, a infecção de trato urinário foi a principal morbidade na gestação, seguida da doença hipertensiva especifica da gestação. Quanto aos PT, 88% foi classificada como AIG, 40% com peso entre 1000 a 1499g e 32% com IG entre 28 a 31 semana. O crescimento dos PT foi linear ao longo do seguimento, mas o escore Z para peso, estatura e perímetro cefálico manteve-se abaixo do esperado para sua IC. Na correlação entre AIG e PIG e seus perfis metabólicos não se evidenciou diferença estatística entre os grupos ao longo do seguimento para colesterol, glicemia, insulina. Contudo, os triglicerídeos apresentaram curva ascendente desde o nascimento predominantemente entre PIG. PT PIG conformam uma população de risco para possíveis alterações cardiovasculares futuras, bem como atrasos em seu crescimento do nascimento ao longo do seguimento. O adequado acompanhamento desses recém-nascidos é fundamental a fim de retardar, atenuar ou evitar morbidades ao longo de suas vidas.

Submitted by Edineia Teixeira (edineia.teixeira@unioeste.br) on 2017-12-18T14:07:00Z No. of bitstreams: 2 alessandra_santos2017.pdf: 7767565 bytes, checksum: 0e4c6d512fc332357ecb23d4a631cb5b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-12-18T14:07:00Z (GMT). No. of bitstreams: 2 alessandra_santos2017.pdf: 7767565 bytes, checksum: 0e4c6d512fc332357ecb23d4a631cb5b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-08-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Preterm birth provides modifications for both the life of the Newborn (NB) as family. Among these changes has been hospitalization in Neonatal Intensive Care Units (NICU) due to the immaturity of organs and systems, generating the need for treatment and intensive care. Because of hospitalization, complications may occur or biological, psychological and social changes to the Newborn Preterm (PTN), which can lead to changes in Neuropsychomotor Development (DNPM). One way to minimize these complications is through proper body positioning premature procedure performed during routine care team in a NICU. However, a gap is evident as regards the PTN response during positioning correlating different positions during hospitalization, as well as the comparison between standard protocols and procedures routine in the NICU. Therefore, the main objective of this research was to compare the physiological, behavioral and pain responses presented by PTN subjected to a Standard Operating Procedure (SOP) body position with those in routine positioning of the NICU. Quantitative study, prospective, randomized clinical trial type, conducted from July 2015 to March 2016 with 30 preterm infants admitted to the NICU of a teaching hospital of the West of Paraná. The subjects were randomly separated into Unit Routine Decubitus group (URD) and Intervention Group (GI), on which it was subjected to previously validated positioning protocol and proposed in 2015. The variables analyzed in the study were: physiological characteristics (respiratory rate, heart rate and oxygen saturation); behavior (measured by the Scale of Brazelton Modified - EBM) and pain (scale verified by the Neonatal Infant Pain Scale - NIPS). The study sample consisted of preterm infants with gestational age for both groups predominantly between 28 and 32 weeks and birth weight between 1001 and 1499 grams, characterizing the sample as very premature and very low birth weight. Regarding the physiological variables it was observed throughout the procedure that the heart rate in URD remained lower compared to the values submitted by the IG; Respiratory Rate (RR) in the URD was higher when compared to IG and oxygen peripheral saturation values remained stable in both groups. The PTN behavior, by EBM and pain by NIPS, showed similar scores in both groups before the start of the procedure, however, significantly lower in IG during the intervention. It is pointed out then that the positioning SOP provided decrease in RR in scores of pain and behavior scales, when compared to the URD. It is believed that a standardized position in the long term hospitalization contribute to the proper DNPM. / O nascimento prematuro proporciona modificações tanto para a vida do Recém-Nascido (RN) quanto para a família. Dentre essas modificações tem-se o internamento em Unidades de Terapia Intensiva Neonatal (UTIN) devido à imaturidade de órgãos e sistemas, gerando a necessidade de tratamento e cuidados intensivos. Em virtude da hospitalização, podem ocorrer complicações ou alterações biológicas, psicológicas e sociais para o Recém-nascido Prematuro (RNPT), que podem levar a alterações no Desenvolvimento Neuropsicomotor (DNPM). Uma das maneiras de minimizar estas complicações é por meio do posicionamento corporal adequado do prematuro, procedimento realizado durante a rotina de cuidados da equipe de uma UTIN. Contudo, evidencia-se lacuna no que se refere à resposta do RNPT durante o posicionamento correlacionando os diferentes decúbitos durante a hospitalização, bem como a comparação entre protocolos padronizados e procedimentos de rotina da UTIN. Para tanto, o objetivo principal desta pesquisa foi comparar as respostas fisiológicas, comportamentais e à dor apresentadas pelos RNPT submetidos a um Procedimento Operacional Padrão (POP) de posicionamento corporal com aqueles sob posicionamento de rotina da UTIN. Estudo quantitativo, prospectivo, do tipo ensaio clínico randomizado, realizado no período de julho de 2015 a março de 2016 com 30 RNPT internados na UTIN de um hospital escola do Oeste do Paraná. Os sujeitos foram separados randomicamente em grupo Decúbito de Rotina da Unidade (DRU) e Grupo Intervenção (GI), em que este foi submetido a protocolo de posicionamento previamente validado e proposto no ano de 2015. As variáveis analisadas no estudo foram: características fisiológicas (frequência respiratória, frequência cardíaca e saturação periférica de oxigênio); comportamento (mensurado pela escala de Brazelton modificada - EBM) e dor (verificada pela escala Neonatal Infant Pain Scale - NIPS). A amostra do estudo constituiu-se por RNPT com idade gestacional para ambos os grupos predominantemente entre 28 e 32 semanas e o peso ao nascimento entre 1001 e 1499 gramas, caracterizando a amostra como muito prematuros e de muito baixo peso. Em relação às variáveis fisiológicas observou-se durante todo o procedimento que a frequência cardíaca no DRU manteve-se menor em relação aos valores apresentados pelo GI; a Frequência Respiratória (FR) no DRU apresentou-se maior quando comparada ao GI e os valores de saturação periférica de oxigênio mantiveram-se estáveis nos dois grupos. O comportamento do RNPT, pela EBM e a dor pela NIPS, apresentaram escores semelhantes em ambos os grupos antes do inicio do procedimento, porém, significativamente menor no GI durante a intervenção. Aponta-se então, que o POP de posicionamento proporcionou redução da FR, nos escores das escalas de dor e comportamento, quando comparadas ao DRU. Acredita-se que um posicionamento padronizado na hospitalização contribuirá em longo prazo para o DNPM adequado

Submitted by Rosangela Silva (rosangela.silva3@unioeste.br) on 2018-05-23T12:46:53Z No. of bitstreams: 2 Mírian Nara Lopes.pdf: 3764371 bytes, checksum: b8401093c2bf5c4a14d158bbf4664148 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-05-23T12:46:53Z (GMT). No. of bitstreams: 2 Mírian Nara Lopes.pdf: 3764371 bytes, checksum: b8401093c2bf5c4a14d158bbf4664148 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-02-22 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Faced with technological development and professional training, it has been possible to guarantee a higher survival rate of preterm newborns, reducing mortality and morbidity. However, premature born people often present changes in growth and metabolism that will have repercussions on their health throughout life. In this sense, premature born adolescents may have a greater chance of developing obesity and its comorbidities. Thus, the present study aims to identify the repercussions of prematurity on the blood pressure (BP), lipid, glycemic and anthropometric profiles in adolescents living in a neighborhood in the city of Cascavel, according to their socioeconomic conditions. For that, a quantitative cross-sectional descriptive study was carried out at a Basic Health Unit in Cascavel, considering 50 preterm adolescents from 10 to 19 years old. Data collection was performed through semi-structured interview, physical evaluation (physical examination and collection of exams) and information from the vaccination portfolios. Data were analyzed by descriptive statistics and the correlations by inferential statistics; level of significance of 5% (p> 0.05) and 95% confidence interval. Findings showed 52% male, mostly white (54%), born with gestational age from 32 to 36 weeks (80%) and with adequate weight for gestational age (70%). Most of them used to have their meals in front of the screens (78%), and only 18% practice physical activity three times a week. In their personal history, 62% report respiratory issues and 58% have some type of allergy. In physical examination, 30% were overweight, 10% had abdominal circumference (AC) in the 90th percentile, 34% had high blood pressure (BP), 41% presented high triglycerides (TG) and 22% had high total cholesterol TC); only one adolescent presented altered glycemia. An association between the degree of prematurity and the classification of BP (p-value = 0.027) and trend of association with TG (p-value = 0.05) was identified. Higher proportion of overweight is related to adolescents born extremely or very premature, and 60% of them presented elevated blood pressure. Among the big sized preterm during gestational age, 44,4% showed increased BP, TC and TG. The small sized prematures didn’t show elevated BP. An important statistical association was observed between blood pressure and the number of meals (p=0,01), total cholesterol and breastfeeding (p=0,03), and triglycerides with consumption of sausages (p=0,02) and products rich in carbohydrates (p=0,01). 72% were offered cow's milk before one-year-old and only 30% received exclusive breastfeeding until six months; no statistical difference was observed related to the breastfeeding type and the variables investigated. Among the 30% with overweight, 60% had elevated BP, 53% TG, 33% CT and 33% WC ≥ 90th percentile. TG rates showed a relation with the family income and maternal schooling. Thus, for those with incomes up to a minimum wage there was a higher concentration of elevated TG, while the highest TG values were found in those whose mothers had higher schooling. The present study showed that a significant proportion of preterm infants presented high blood pressure and lipid profile and excessive body weight, a situation that exposes them to a higher risk of developing metabolic syndrome in adulthood and to become part of the group of adults with health chronic conditions. / Frente ao desenvolvimento tecnológico e capacitação profissional, tem sido possível garantir maior sobrevida dos recém-nascidos Prematuros (PT), diminuindo a mortalidade e a morbidade ao longo da vida. Todavia, o indivíduo que nasce PT apresenta, muitas vezes, alterações no crescimento e no metabolismo que terão repercussões sobre sua saúde ao longo da vida. Nesse sentido, adolescentes nascidos PT podem ter maior chance de desenvolver obesidade e suas comorbidades. Assim, o presente estudo tem como objetivo descrever as repercussões da prematuridade no perfil pressórico, lipídico, glicêmico e antropométrico de adolescentes residentes em um bairro no município de Cascavel de acordo com suas condições socioeconômicas. Para tanto, realizou-se estudo de abordagem quantitativa, transversal, descritivo na Unidade Básica de Saúde Palmeiras com adolescentes de 10 a 19 anos nascidos PT. Coleta de dados por meio de entrevista semiestruturada, avaliação física (exame físico e coleta de exames) e dados em carteiras de vacinação. Os dados foram analisados por meio de estatística descritiva e as correlações por meio de estatística inferencial; nível de significância de 5% (p<0,05) e intervalo de confiança de 95%. Foram avaliados 50 adolescentes, sendo 52% do sexo masculino, 54% brancos, a maioria nascida com idade gestacional de 32 a 36 semanas (80%) e com peso adequado para a idade gestacional (70%). A maioria faz refeições em frente às telas (78%), apenas 18% fazem atividade física três vezes por semana. Em sua história pessoal, 62% relatam problemas respiratórios e 58% algum tipo de alergia. No exame físico, 30% apresentaram excesso de peso, 10% Circunferência Abdominal (CA) no percentil 90, 34% Pressão Arterial (PA) elevada, 41% apresentaram Triglicerídeos (TG) e 22% Colesterol Total (CT) elevados; somente uma adolescente apresentou glicemia alterada. Identificou-se associação entre o grau de prematuridade e a classificação da PA (p=0,02) e tendência de associação com TG (p=0,05). Os PT extremos ou muito PT tiveram maior proporção de excesso de peso e 60% deles apresentaram PA elevada. Entre os PT grandes para idade gestacional, 44,4% apresentaram PA, CT e TG elevados. Os pequenos para idade gestacional não apresentaram PA elevada. Observou-se associação estatisticamente significante entre PA e número de refeições (p=0,01), CT e aleitamento materno (p=0,03) e TG com consumo de embutidos (p=0,02) e produtos ricos em carboidratos (p=0,01). 72% receberam leite de vaca antes de completar um ano e 30% receberam aleitamento materno exclusivo até os seis meses de idade; não se observou diferença estatística significativa em relação ao tipo de aleitamento e as variáveis investigadas. Dos 30% com excesso de peso, 60% apresentaram PA elevada, 53% TG e 33% CT elevados e 33% percentil CA ≥90. Os TG apresentaram relação com renda familiar e escolaridade materna. Assim, para aqueles com renda até um salário mínimo houve maior concentração de TG elevados, enquanto os melhores valores de TG foram encontrados naqueles que as mães apresentaram maior escolaridade. O presente estudo mostrou que parcela significativa dos adolescentes nascidos prematuros apresentaram perfil pressórico e lipídico elevados e excesso de peso corporal, situação essa que os expõe a maior risco de desenvolver síndrome metabólica na idade adulta e vir a ser parte do grupo de adultos portadores de condições crônicas de saúde.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-07-21T17:23:01Z No. of bitstreams: 1 nataliatrindadedesouza.pdf: 4823947 bytes, checksum: 8345ed3734b172b065c7942b932ce3d7 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-07-22T15:33:22Z (GMT) No. of bitstreams: 1 nataliatrindadedesouza.pdf: 4823947 bytes, checksum: 8345ed3734b172b065c7942b932ce3d7 (MD5) / Made available in DSpace on 2016-07-22T15:33:22Z (GMT). No. of bitstreams: 1 nataliatrindadedesouza.pdf: 4823947 bytes, checksum: 8345ed3734b172b065c7942b932ce3d7 (MD5) Previous issue date: 2015-03-31 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O aumento da sobrevida de prematuros cada vez menores vem sendo acompanhado de um número maior de crianças expostas a esta condição. Estas crianças apresentam risco para desenvolverem alterações no desenvolvimento motor, dificuldades socioemocionais e comportamentais, o que pode influenciar negativamente sua qualidade de vida (QV). Objetivo: Comparar a QV de crianças nascidas prematuras e que se encontram inseridas no ambiente escolar com a QV de crianças que nasceram a termo e verificar sua associação com a funcionalidade, comportamento e nível econômico. Métodos: Estudo transversal, com a participação de 117 crianças de 5 a 7 anos e seus cuidadores. O Grupo prematuro (GPT) foi composto por 54 crianças e o grupo a termo (GAT) com 63. Para avaliar a QV das crianças foi utilizado o questionário Pediatric Quality of Life Inventory versão 4.0 (PedsQL). A funcionalidade foi avaliada com o Inventário de Avaliação Pediátrica de Incapacidade (PEDI). Para avaliar o comportamento foi utilizado o Questionário de Capacidades e Dificuldades (SDQ) respondido pelos pais. Para todas as análises estatísticas o nível de significância foi considerada como α=0,05. Resultados: As respostas das crianças em relação à sua QV foram significativamente inferiores às dos cuidadores e apresentaram baixa correlação e baixa concordância (r<0,040), exceto na dimensão emocional. A prematuridade de forma isolada não apresentou diferenças entre grupos na QV da criança, nem sob sua perspectiva e nem na do cuidador. Em relação ao desempenho funcional, de acordo com o grupo, não houve diferença na QV da criança. Em relação ao comportamento, de acordo com o grupo, na perspectiva do cuidador o GPT normal, no SDQ Hiperatividade, teve melhor QV que o GPT alterado e pior que o GAT Alterado. Na perspectiva da criança o GAT Alterado teve pior QV que o GPT Normal no domínio Físico do Peds QL em relação ao SDQ pró-social e domínio Social do Peds QL em relação ao SDQ Suplemento. Em relação ao NE, o GAT com alto NE apresentou pior QV que o GAT com baixo NE, no domínio escolar do Peds QL, na perspectiva da criança. Conclusão: Os resultados do presente estudo sugerem que a prematuridade de forma isolada não prejudica diretamente à QV da criança. Contudo, quando esta se encontra associada a alterações comportamentais as médias de QV da criança são inferiores tanto na perspectiva do cuidador quanto na perspectiva da criança. / The increased survival of even smaller preterm has been accompanied by an increasing number of children exposed to this condition. These children present risk to develop alterations in motor development, socioemotional and behavioral difficulties, which can negatively influence their quality of life (QoL). Objectives: Evaluate QoL of children at school age, and its association with prematurity and others factors. Methods: cross-sectional study including 117 children with age range of 5 to 7 years and their caregivers.Preterm Group (PTG), was composed of 54 children and the term group (TG) with 63. To assess the quality of life of children the Pediatric Quality of Life Inventory (Peds QL) in the version for child and the caregiver, was used. For the assessment of the functionality of the children, the Pediatric Evaluation of Disability Inventory (PEDI) was used. To evaluate the behavior the Strengths and Difficulties Questionnaire (SDQ) was answered by the parents. For all statistics analyzes the level of significance was considered α=0.05. Results: Children's responses in relation to their QoL were significantly lower than of the caregivers and showed low correlation and low reliability (r <0.040), except for the emotional dimension. Prematurity in an isolated way didn’t differ between groups in the child's QOL, neither from their perspective or the caregiver´s. When prematurity was associated with functional or behavioral performance, the altered PTG presented means significantly lower than in most domains of QoL in the caregiver's perspective. However, the school level of QoL in the child's own view, in relation to functional performance, the PTG had lower scores only in Functional Abilities part in the area of social function. In the SDQ, area of conduct, in the child's perspective, TG altered had lower than average PTG Normal; the prosocial SDQ normal, TG presented higher scores than the PTG Abnormal scores; the SDQ supplement difference was observed in the Social and Total PedsQL. The NE was not associated with the child's QOL, neither from their perspective and neither under the perspective of their caregivers. Conclusion: The results of this study suggests that prematurity in an isolated way wasn´t negative directly to the child's QOL. However, when it was associated with functional or behavioral changes the average child's QoL are lower in the child's perspective and caregiver perspective .

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / INTRODUCTION: The proper integrity and functioning of the central structures are important for the linguistic and cognitive development and the Long Latency Auditory Evokes Potentials (LLAEP) allow the evaluation of the hearing information processing, considered as indicator of cognitive development, mainly in preterm infants, that present risks to alterations of hearing and language processing. The preterm infants are also vulnerable to cellular alterations. These alterations may cause several diseases during the neonatal period. The research of the oxidative metabolism through the Micronucleus Essay allows the identification of these alterations in cellular level. PURPOSE: To evaluate the LLAEPs and the oxidative metabolism of term and premature infants. MATERIAL AND METHODS: This study consisted of newborns with no more than one month old that came to the Hospital Universitário de Santa Maria (HUSM) to the Neonatal Hearing Screening (NHS). The infants were divided in control group (CG) and study group (SG), with term and premature infants, respectively. The sample consisted of 15 individuals in each group for the oxidative metabolism evaluation and 15 term infants and 10 premature infants for the LLAEP evaluation. For the micronucleus test, epithelial cells of the mouth mucosa were collected, with acytobrush. The cells were analyzed in a laboratory. The LLAEPs were researched in binaural form, through insertion earphones, with frequent speech stimulation /ba/ and rare /ga/, analyzing only the exogenous potentials (P1, N1, P2 e N2). RESULTS: In general, for the oxidative metabolism research, there was statistically significant difference between the groups in the analysis of the Micronucleus Test. The number of altered micronucleus and cells was higher for the group of premature infants when compared with the group of term infants. For the LLAEPs there was no statistically significant difference for the latencies of the members P1 and N1. CONCLUSIONS: After this study, it was concluded that premature infants present higher index of cellular damage in nuclear level when compared with term infants. In the electrophysiological evaluation of the cortical potential, it was possible to observe the exogenous components P1 and N1, but there was no difference between the groups. More studies in this area are necessary in order to better understand the characteristics of these potentials in newborn and young infants. / INTRODUÇÃO: A integridade e funcionamento adequado das estruturas centrais são importantes para o desenvolvimento cognitivo e linguístico, e os Potenciais Evocados Auditivos de Longa Latência (PEALL) permitem avaliar o processamento da informação auditiva, sendo considerados como indicadores do desenvolvimento cognitivo, principalmente em prematuros, os quais são de risco para alterações do processamento auditivo e de linguagem. Os recém-nascidos prematuros também são vulneráveis à alterações celulares, sendo que as mesmas podem causar diversas doenças no período neonatal. A pesquisa do metabolismo oxidativo por meio do Teste de Micronúcleos permite a identificação dessas alterações em nível celular. OBJETIVO: Avaliar os PEALL e o metabolismo oxidativo em recém-nascidos a termo e prematuros. MATERIAL E MÉTODO: Participaram do estudo recém-nascidos com até um mês de vida que compareceram ao Hospital Universitário de Santa Maria (HUSM) para realização da Triagem Auditiva Neonatal (TAN). Os neonatos foram divididos em grupo controle (GC) e grupo estudo (GE), sendo constituídos por recém-nascidos a termo e prematuros, respectivamente. A amostra foi constituída por 15 indivíduos em cada grupo para avaliação do metabolismo oxidativo, e 15 recém-nascidos a termo e 10 prematuros para avaliação dos PEALL. Para o teste de micronúcleos foram coletadas células epiteliais da mucosa oral, por meio do esfregaço da mucosa oral, com uma escova cytobrush. As células foram analisadas em laboratório. Os PEALL foram pesquisado de forma binaural, por meio de fones de inserção, com estímulo de fala frequente /ba/ e raro /ga/, sendo analisados apenas os potenciais exógenos (P1, N1, P2 e N2). RESULTADOS: De maneira geral, para a pesquisa do metabolismo oxidativo, houve diferença estatisticamente significante entre os grupos para as análises do Teste de Micronúcleos, sendo que o número de micronúcleos e de células alteradas foi maior no grupo de prematuros quando comparados com o grupo de recém-nascidos a termo. Para os PEALL não houve diferença estatisticamente significante para as latências dos componentes P1 e N1. CONCLUSÕES: A partir desse estudo pode-se concluir que os recém-nascidos prematuros apresentaram um índice maior de danos celulares a nível nuclear quando comparados com os recém-nascidos a termo. Na avaliação eletrofisiológica dos potenciais corticais, foi possível observar os componentes exógenos P1 e N1, porém não houve diferenças entre os grupos. São necessários mais estudos nessa área, a fim de se conhecer melhor as características desses potenciais em recém-nascidos e crianças pequenas.

Le devenir des très grands prématurés est marqué par la survenue de complications pouvant retentir sur la qualité de vie des enfants et de leurs familles. Si des données de qualité de vie sont disponibles dans la littérature internationale, il n’y en a pas sur la qualité de vie des très grands prématurés nés dans nos maternités. La qualité de vie est un concept récent proposé comme critère d’évaluation des stratégies de soins mais dont l’utilisation reste limitée. Peu de travaux explorant les facteurs explicatifs de cette limitation sont rapportés. Dans le domaine précis de la médecine périnatale et en particulier celui de la très grande prématurité, aucune donnée explorant ces freins n’est rapportée.L’absence de données à la fois sur la réalité de la qualité de vie des enfants nés très grands prématurés et sur la perception qu’en ont les professionnels soignant ces patients, nous a amenés à examiner le positionnement des médecins décideurs face à cet aspect qualitatif de la santé ainsi que la place de la qualité de vie dans la réflexion éthique en médecine périnatale.Notre recherche s’articule autour de trois axes : 1. L’évaluation de la qualité de vie d’une cohorte marseillaise d’enfants prématurés français, âgés de 6 à 10 ans, à partir d’une approche parentale. 2. L’étude de la perception des médecins experts de périnatalité et des médecins impliqués dans le suivi de ces enfants vis-à-vis de la prise en compte de la qualité de vie. 3. L’approche éthique de la qualité de vie à partir de la perception des médecins. / Extremely preterm children oucome is marked by the development of severe complications than can affect the quality of life of the children and their families. The coverage of these children brings decisional dilemma to physicians. While international data on preterm children quality of life are available, French preterm children quality of life remains unexplored. Quality of life is nevertheless a part of the ethical reflection of the professionals of perinatal period.Quality of life is a recent concept proposed as a criterion for evaluating care strategies but its use remains limited. Few published works have investigated the reasons for this limited use. In the field of prematurity, no data exploring these obstacles have been reported.Because of the lack of data on French preterm children quality of life and on the perception of physicians who manage preterm children, we decide to explore physicians’ perspective on the health related quality of life of extremely preterm children and the place of quality of life in ethical reflection in perinatal medicine.Our study consists in three parts: 1. A study describing health related quality of life of a cohort of French preterm children aged 6-10 years. 2. The study of physicians’ perception on health related quality of life assessment in preterm children. 3. The ethical approach of quality of life from the physicians’ perception.

In recent years, concern about a new epidemic of retinopathy of prematurity (ROP) has focused attention on the increasing incidence of the disease and the factors responsible for its most severe consequences. Two studies designed to address these issues were done using data from three sources: the B.C. Health Surveillance Registry (Registry), Physicians's Notices of Livebirth (PNOB), and the Vancouver General Hospital (VGH). In the first study, Registry and PNOB records were used to determine crude annual birth weight-specific incidence rates for ROP in infants liveborn in the Province of British Columbia (B.C.) in the period 1952-1983. These rates showed that, in B.C., the original epidemic of the disease ended in 1954. Linear regression lines fitted for each of four birth weight categories showed that, in the 29 year period after 1954, there was a significant increase in the incidence of ROP-induced blindness in infants weighing less than 1000 grams at birth. To refine this observation, the data were sub-divided: the 29 year period, to two smaller periods, 1955-1964 and 1965-1983; the less than 1000 gram birth weight category to two sub-categories, 500-749 and 750-999 grams. Since the inter-period incidence should have been similar if the birth weight-specific incidence had not changed since the end of the original epidemic, the crude weight-specific rates for ROP-induced blindness in the early period were used to calculate the expected number of cases in the later period. When weight-standardized incidence ratios (SIR's) and 95% confidence limits were calculated, the results showed that, in the 750-999 gram sub-category, the SIR was significantly increased. Infants born in the period 1965-1983 were 3.07 times more likely to be ROP: blind than their equal weight counterparts in the earlier period. In infants weighing 500-749 and 1000 grams or more, there was no evidence to suggest an increase in incidence after 1954. The second study was done to determine the cofactors that differentiate infants who are blinded by ROP from those who are not. Infants were included if (i) they were born in B.C. between 1955 and 1983, (ii) they were known to the Registry as being ROP: blind (cases) or not blind (controls), and (iii) they were born in or admitted to the VGH within 28 days of birth. When the data from all three data sources were dichotomized and analyzed using univariate techniques, two variables, respiratory distress syndrome (RDS) and neonatal weight loss, showed a significantly protective effect. The effect of RDS disappeared when the data were stratified by birth interval indicating that the observed association was confounded by time. When the variables were reanalyzed in continuous form, none were significantly associated with visual outcome. However, since the power of the cofactor study was extremely low, none of the variables that were included can be eliminated as potential cofactors for the induction of blindness in infants with ROP. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

La rupture prématurée des membranes avant terme (RPMAT) est une complication de la grossesse responsable d’une importante morbi-mortalité périnatale. La prise en charge anténatale vise à réduire les conséquences délétères de cette pathologie, liées à l’inflammation intra-utérine et à la prématurité, à la fois pour la mère et pour l’enfant. L’objectif de cette thèse était d’étudier les déterminants obstétricaux du pronostic de L’enfant prématuré né dans un contexte de RPMAT, à partir des données de la cohorte EPIPAGE 2. Nous avons d’abord évalué l’impact de la durée de latence, comprise entre la RPMAT et l’accouchement, sur le pronostic néonatal. Nos résultats montrent que pour un âge gestationnel de naissance donné, la durée de latence après une RPMAT entre 24 et 32 SA n’est pas associée à la survie ou à la survie sans morbidité sévère. Le principal déterminant du pronostic néonatal est l’âge gestationnel à la naissance. Nous avons ensuite étudié la tocolyse, un traitement médicamenteux largement utilisé après une RPMAT dans le but de prolonger la grossesse. L’administration d’une tocolyse après une RPMAT n’est associée ni à l’amélioration de la survie sans morbidité du prématuré, ni à la prolongation de la grossesse. Enfin, une analyse descriptive des cas de RPMAT entre 22 et 25 SA montre qu’à ces âges gestationnels extrêmes, la RPMAT est associée à un risque élevé de mortalité périnatale et de morbidité à court et à long terme, avec de grandes variations selon l’âge gestationnel à la rupture. Nos travaux fournissent des informations pertinentes pour les équipes médicales et les femmes enceintes et questionnent certaines pratiques obstétricales, notamment l’administration d’une tocolyse après une RPMAT. Ils soulèvent des questions qui feront l’objet de nouveaux projets de recherche, en particulier un essai contrôlé randomisé sur la tocolyse après RPMAT, financé par le PHRC-N 2016 (essai TOCOPROM). / Preterm premature rupture of membranes (PPROM) is a complication of pregnancy responsible for significant perinatal mortality and morbidity. Antenatal management aims to reduce adverse consequences, relating to intrauterine inflammation and prematurity, for both mother and child. This thesis aimed to study obstetric determinants impacting the outcome of preterm babies born following PPROM, using data from the EPIPAGE 2 cohort. We first evaluated the impact of latency duration, i.e. the time from PPROM to delivery, on neonatal prognosis. For a given gestational age at birth, latency duration after PPROM at 24-32 weeks' gestation was not associated with survival or survival without severe morbidity. The principal determinant of neonatal prognosis was gestational age at birth. We then studied tocolysis, a treatment widely used after PPROM to prolong pregnancy. Administration of tocolysis after PPROM was not associated with either improved survival without morbidity of the preterm infant or prolongation of pregnancy. Finally, a descriptive analysis of cases of PPROM occurring at 22-25 weeks’ gestation demonstrated that, at these extreme gestational ages, PPROM was associated with high risks of perinatal mortality and short- and long-term morbidity, with large variations according to gestational age at rupture. Our work provides relevant information for medical teams and pregnant women and questions some obstetric practices, particularly the use of tocolysis after PPROM. They raise issues that will be the subject of future research projects, specifically a randomized controlled trial on tocolysis after PPROM, already funded by PHRC-N 2016 (TOCOPROM trial).

The purpose of this study was to explore differences in movement initiation and execution, and their associations with amount of physical activity (PA) and cognitive abilities, in 6 to 8 year old children born PT compared to peers born at term. The sample consisted of in total 78 children divided in subgroups, 16 born very preterm (VPT), 24 born moderate preterm (MPT) and 38 age matched controls born at term (FT) with no diagnosed cognitive or motor impairments. Three-dimensional (3D) kinematic recordings of wrist movements during two bimanual tapping tasks (horizontal and vertical) were finalized and kinematic outcome measures were investigated in relation to PA and performance on WISC-IV. Children born VPT showed significantly longer Latency times and longer Duration of movement execution compared to children born MPT and FT. No significant within group correlations between PA and movement performance were found. Duration of movement execution and Total duration of movement execution were negatively associated with Full-scale intelligence quotient (FSIQ) and processing speed index (SI) in the PT group. Early school aged children born VPT need longer planning time to initiate and execute goal directed bimanual movements, compared to peers born MPT and FT. Kinematic performance did not evidently associate with amount of PA, although kinematics, by means of longer Latency time and Duration of movement execution, negatively associated with SI. / Syftet med denna studie var att undersöka skillnader i initiering och utförande av en rörelse samt deras associationer med fysisk aktivitet och kognitiv förmåga hos förtidigt födda barn i åldrarna 6 till 8 år samt åldersmatchade fullgångna jämnåriga barn. Urvalet bestod av total 78 barn uppdelade i subgrupper, 16 väldigt förtidigt födda, 24 moderat förtidigt födda och 38 åldersmatchade fullgångna kontroller utan några kända kognitiva eller motoriska nedsättningar. Tredimensionella (3D) kinematiska registreringar av handledsrörelser under två bimanuella knapptrycksuppgifter (horisontell och vertikal) genomfördes. Utfallet av rörelsemätningarna studerades i association till fysisk aktivitet och resultat på WISC-IV. Väldigt förtidigt födda barn visade längre latenstid och längre duration av rörelse jämfört med moderat förtidigt födda och fullgångna barn. Inga signifikanta inom grupps korrelationer mellan fysisk aktivitet och rörelseutförande hittades. Utförandets duration samt hela utförandets duration associerade negativt med IQ kvot och processhastighet (SI) hos för tidigt födda barn. Väldigt förtidigt födda barn i tidig skolålder behöver mer tid till rörelseplanering, initiering och utförande av viljestyrda målinriktade rörelser jämfört med jämnåriga barn födda senare i graviditeten. Kinematiskt utfall associerade inte signifikant med fysisk aktivitet, däremot associerade kinematiskt utfall, i form av längre latenstid och duration av utförande, negativt med kognitiv processhastighet.