The changing nature of work and its competitive characteristics are global phenomena and are mainly fuelled by ongoing technological advancement. This creates unique challenges for talent attraction and the retention of high performing individuals. In addition, the global workforce is becoming more diverse due to demographic, societal and cultural changes and companies are placing greater demands on employee competency and performance. Managing the human factor as a strategic asset in organisations remains a primary challenge in securing a competitive advantage. The road construction industry in South Africa is no different. There is growing competition between civil engineering contractors to secure tenders and to maximise profitability. This is only possible with a sufficient and sustainable labour force. Valid selection processes are therefore required to ensure that the most productive individuals are selected for the most suitable jobs. Reliable and valid performance predictors will assist employers in making appropriate selection decisions. Selecting high performing individuals will support and enhance overall organisational performance. ix In this study the investigation focused on whether psychomotor ability and learning potential are statistically significant predictors of work performance - with specific reference to drivers and machine operators in a road construction company. A quantitative approach was followed to investigate the relationships between variables, or then the prediction of one dependent variable (driver and machine operator performance) by means of two independent variables (psychomotor ability and learning potential). Results from the study did not indicate any statistically significant relationships between the variables. Only scientifically validated assessment instruments were used in the study - which means the findings led to a renewed focus on the importance of performance measurement and the psychometric quality (reliability and validity) of performance data. / Industrial and Organisational Psychology / M.A. (Industrial and Organisational Psychology)

Bien que l’imagerie motrice positive ait été bien étudiée et est utilisée en réhabilitation, l’effet de l’imagerie motrice négative est beaucoup moins connu. Le but de cette recherche était de définir si l’intention et/ou l’imagerie motrice négative serait en mesure de réduire l’effet d’une stimulation magnétique transcrânienne (SMT) sur le cortex moteur. Vingt participants ont reçu trente stimulations de SMT dans trois situations différentes : En restant passif, en portant une attention particulière aux sensations dans leur main ou en tentant de réduire l’effet de la SMT. La moitié des participants ont utilisé une stratégie d’imagerie motrice, l’autre moitié leur intention. Dans les deux cas, l’amplitude dans la condition de modulation n’a pas été réduite de façon significative. / Although positive motor imagery has been widely studied and is used in rehabilitation, the effect of negative motor imagery on our motor system is less well understood. Our goal was to ascertain whether intention and/or negative visual imagery is effective in decreasing the twitch resulting from transcranial magnetic stimulation (TMS) over the primary motor cortex. Twenty participants received 30 TMS stimulations in three different conditions: remaining passive, paying particular attention to the sensations in their hand, and attempting to modulate the amplitude of the resulting movement. To do this, half the participants used an imagery strategy, whereas the other half used an intention strategy. In both cases, amplitude in the modulation condition was not significantly reduced.

Les contraintes liées au système de signes véhiculés par le comportement humain multiplient les difficultés face à toutes les formes d‘analyses, particulièrement celles qui se fondent sur l‘observation. Par exemple, les jeux sportifs peuvent, par leur richesse et leur complexité, restreindre le jugement de l‘observateur, notamment lorsqu‘il s‘agit d‘étudier des conduites et des prises de décisions motrices in situ, là où le pratiquant évolue dans un rapport consubstantiel avec son environnement. C‘est à ce niveau que les recherches en praxéologie proposent l‘analyse de la logique interne des situations ludosportives à travers une démarche systémique et structurale et une classification de pratiques sportives et ludomotrices en huit domaines d‘action motrice distincts. Les poutres maîtresses de ces domaines d‘action sont : la nature du rapport du sujet avec le milieu physique (milieu certain ou incertain) ainsi que la présence d‘interaction motrice liée à la présence d‘adversaires et/ou de partenaires. Nous avons mené une méta-analyse de trois domaines d‘action motrice au coeur desquels les sportifs pratiquent dans un milieu domestiqué, dont un domaine psychomoteur (agir en solo) et deux domaines sociomoteurs (agir contre des adversaires et agir avec des partenaires et des adversaires). Nous avons adopté une démarche méthodologique qui fait appel à l‘outil de modélisation électronique et numérique. Ce travail s‘articule autour de la science de l‘action motrice, des sciences de l‘Éducation, de la didactique des APS et des sciences de l‘ingénierie électronique et numérique. La problématique tente de mettre en évidence les effets potentiels d‘une pratique motrice régulière de trois domaines d‘action distincts sur les conduites et les prises de décision motrices. Autrement dit, chaque domaine d‘action motrice comprend des activités ludomotrices homogènes au regard de leurs traits de logique interne, influençant ainsi certains schémas d‘actions spécifiques sur la conduite motrice du pratiquant, propices au façonnage d‘habitus moteurs. Les investigations se construisent autour d‘un modèle expérimental spécifique appelé « B-percept® », modèle créé à partir d‘un jeu ludomoteur traditionnel, le « jeu des Quatre coins ». Ce système de mesures innovant et évolutif est utilisé pour évaluer et comparer les conduites de sportifs des trois domaines précités et de non-sportifs. Le protocole B-percept® mesure la vitesse de réaction simple et complexe, tant visuelle que sonore des pratiquants. Par ailleurs, outre les observations des sportifs agissants, nous avons proposé des tests de prédictions de score et d‘estime de soi (PSPP) et un entretien post-test avec les sujets, ceci afin de mieux appréhender et comprendre les conduites motrices exécutées. Les résultats obtenus ont montré qu‘une pratique sportive influencerait de manière positive le temps de réaction simple et complexe des sportifs par rapport aux non-pratiquants de sports. De surcroit, elle pourrait développer significativement leur sentiment d‘auto-efficacité, ce qui se traduirait par une meilleure capacité de prédiction des scores dans les tests B-percept®. Globalement, on relève aussi des résultats plus tranchés entre les domaines sociomoteur et psychomoteur, notamment dans la prise de décision au cours des situations complexes. Ces résultats ont été vérifiés à travers une méta-analyse par domaines, par algorithme moteur et par habitus moteurs. Fort de ces résultats, le modèle B-percept® pourra trouver des extensions dans le domaine de l‘enseignement en éducation physique et sportive, de l‘entrainement sportif et dans les centres de formation des élèves à besoins spécifiques. Dans le champ de l‘EPS, notre objectif est de contribuer à la réflexion et à la conception des contenus et de la programmation des activités physiques et sportives en ciblant, de façon pertinente et cohérente, les choix des situations motrices selon les domaines d‘action ludomotrice. / In sports and physical activities, gestures often carry an affective connotation. However the constraints due to their complexity when used in the communication process as signs system produced by human behavior could multiply difficulties on the of scientific analyses and studies. Thus, methods used to interpret the human movements and gestures have evolved in last decades, due to an increasing use of quantitative data. Nowadays researchers are working on decision-making by collecting behavioral significant information, especially during human-interactions in sports activities. Thus, since more than forty years, researches such as in motor praxeology analysis the internal logic of sports practices through systemic and structural analyses. Consequently a classification of sports activities was raised and gave eight different domains of motor action. These domains are based on the nature of physical environment (certain or uncertain environment), the attendance of opponents and/or partners. The aim of this thesis is to propose a systemic and structural methodological approach by comparing through a meta-analysis the impact of a regular sports practice in three different domains of motor activities on motor-behavior and decision-making. Our approach is built on an experimental model previously established by modeling the paradoxal game called the ―four corners game‖. Thus a smart wireless system for modeling visual and auditory searching behavior was conceived for measuring simple and complex reaction time. B-percept® helps as well to make observations, self-efficacy survey, test score-predictions and personal self-physical profile. This research allowed us to find relevant results. However, we need to be cautious about their generalization. Indeed, we have found that practicing sport positively influences the simple and complex reaction times and significantly increases self-efficacy of sports practitioners. Moreover, they could have a better ability to predict their scores at B-percept® tests. Meta-analysis through sports specialties and habitus were proceeded to improve results‘ analyzes, however, we still needing several investigations through future researches to propose a generalization of the equation model of B-percept®. In the near future, this experimental new model will be available for researchers in physical education and sports, teachers and coaches. It could also be proposed to training centers for students with special needs (handicap). We are looking forward helping to improve scholar programs made from sports activities as to be classified through the domain of actions.

Introdução: A síndrome Spoan é uma forma de paraplegia espástica complicada de herança recessiva recentemente identificada em indivíduos originários do sudoeste do estado do Rio Grande do Norte. O quadro clínico é caracterizado por atrofia óptica congênita, paraplegia crural espástica de caráter progressivo e neuropatia axonal levando a perda da função motora em membros superiores. A caracterização fenotípica dessa doença não está completa, e não foram realizados estudos quantitativos e funcionais, que poderiam mensurar a intensidade e contribuir para a definição de uma estratégia de reabilitação. Objetivos: caracterizar o desempenho motor e as habilidades funcionais de indivíduos acometidos pela Spoan. Casuística e metodologia: participaram do estudo 61 indivíduos com diagnóstico clínico de Spoan com idade entre 5 e 72 anos. Avaliou-se a força de preensão palmar por meio do dinamômetro hidráulico de Jamar e a sensibilidade a pressão profunda e protetora dos pés e mãos por meio dos monofilamentos de náilon de Semmes-Weinstein. Definiu-se o grau de dependência dos indivíduos afetados por meio do Índice de Barthel modificado. Considerou-se para a descrição do desempenho motor: 1. quantificação da espasticidade, por meio da escala modificada de Ashworth; 2. grau de disfunção, de acordo com a escala ponderada de paraplegia espástica descrita por Schule e a escala funcional de paraplegia espástica hereditária descrita por Fink; 3. grau da capacidade de deambulação, por meio do índice de deambulação 4. grau da capacidade de sentar, por meio da escala de avaliação motora. Resultados: constatou-se fraqueza de preensão manual em todos os indivíduos e os valores obtidos indicam correlação inversa moderada entre a idade e a força manual. A sensibilidade mostrava-se anormal em 100% dos indivíduos avaliados em pelo menos seis pontos dos pés e mãos. O grau de dependência foi mínimo em 3,3%, médio em 23,3%, grave em 46,6% e total em 26,6% dos pacientes. Na escala de Schule, 60% dos indivíduos obtiveram entre 40/52 e 52/52 pontos e na escala de Fink detectou-se grau 5 (máximo) de disfunção em 71% dos pacientes. O grau de espasticidade teve uma distribuição bimodal, em média, de 30,5% com grau 1 e 37,7% grau 4. A capacidade de deambulação mostrou-se reduzida, com 83% dos indivíduos restritos a cadeira de rodas e 11% acamados. A habilidade de sentar-se estava preservada em todos os pacientes, sendo que 53% o faziam apenas com apoio. Conclusão: A síndrome Spoan é uma forma grave de paraplegia espástica hereditária, responsável por incapacidade progressiva e duradoura. / INTRODUCTION: Spoan syndrome is a complex form of spastic paraplegia of recessive inheritance recently identified in individuals from Southwest of Rio Grande do Norte state. Clinical features are characterized by congenital optic atrophy, progressive spastic paraplegia, and axonal neuropathy, resulting in severe handicap. Phenotypic description of this disease is nevertheless not complete; functional and quantitative studies, that would help planning a rehabilitation strategy, have not been undertaken. OBJECTIVES: To evaluate the motor performance and functional abilities of individual with Spoan syndrome. CASUISTIC AND METHODS: 61 individuals with confirmed diagnosis of Spoan, with ages ranging from 5 and 72 years were evaluated. Hand grip strength was measured with a Jamar hydraulic dynamometer and the sensitivity to deep pressure and protective hands and feet with Semmes-Weinstein nylon monofilaments. Functional abilities were verified by the Modified Barthel Index. For motor performance, the following procedures were performed: 1. Spasticity quantification, according to modified Ashworth scale; 2. Dysfunction level, according to the spastic paraplegia rating scale described by Schule and functional scale of hereditary spastic paraplegia described by Fink; 3. Gait ability, verified with deambulation index; 4.Sitting ability, using motor assessment scale. RESULTS: grip hand weakness was reduced in all patients, with a moderate inverse correlation between age and hand strength. Sensibility was abnormal in 100% of evaluated individuals in at least six points of hands and feet. Dependency level was minimum in 3.3%, moderate in 23.3%, severe in 46.6%, and total in 26.6% of individuals. According to Schule s scale , 60% of individuals scored between 40/52 and 52/52 points; in Fink s scale,71% achieved level 5 (maximum) of dysfunction. Spasticity level had a bimodal distribution, with 30,5% achieving level 1 and 37,7% level 4. Gait ability was reduced, with 83% of individuals being wheelchair bound and 11% bedridden. Sitting ability was preserved in all patients, but 53% were able to sit only with support. CONCLUSION: Spoan syndrome is a severe form of hereditary spastic paraplegia that is responsible for progressive and long lasting handicap.

Hintergrund: In dieser Arbeit wurde untersucht, ob durch die Nutzung von Remifentanil eine Verbesserung der Narkoseführung und Beschleunigung der postoperativen Erholung bei kurzen, schmerzarmen, diagnostischen Eingriffen zu erzielen ist. In der vorliegenden Studie wird ein Narkosekonzept unter Verwendung von Remifentanil/Propofol/Isofluran einer häufig für kurze gynäkologische Operationen genutzten Kombination Ketamin/Propofol/Lachgas gegenübergestellt. Methode: Die Untersuchung fand im Zeitraum April 1997 bis März 1998 im Krankenhaus im Friedrichshain (Berlin) statt. Einer statistischen Zufallsliste entsprechend wurden 108 Patientinnen, die vorher festgelegte Einschlusskriterien erfüllten, einer der beiden Narkosemethoden im einfach-blind Modus zugeordnet. Zur Bearbeitung der Fragestellung wurden kurze gynäkologische Eingriffe (Kürettagen, Interruptiones) ausgewählt. Die Dokumentation der Erholung erfolgte unmittelbar postnarkotisch unter Anwendung psychomotorischer und kognitiver Leistungstests (Memo- Test, Zahlen nachsprechen, Zahlenverbindungstest, Test d2, Maddox wing, Finger-Tapping). Die Aussage dieser Untersuchungen wurde durch Analogskalen (Schmerz-Score, Befindlichkeitsskala) und standardisierte Fragen (intraoperatives Träumen, Zufriedenheit) ergänzt. Die Teilnehmerinnen wurden dreimal hintereinander der selben standardisierten Untersuchungs-, Test- und Befragungsfolge unterzogen. Ergebnisse: Die beiden Untersuchungsgruppen waren hinsichtlich der allgemeinen Ausgangsdaten Alter, Gewicht, Größe, Body-Maß-Index und Nebenerkrankungen vergleichbar. Hinsichtlich der am Vortag (t0) erhobenen Ausgangsdaten und der Verteilung von Persönlichkeitscharakteristika gab es zwischen den Gruppen keine Unterschiede. Die in den Untersuchungen erhobenen Daten zeigten deutliche Vorteile in der psychomotorischen Erholung für die Remifentanil-Gruppe. Schnellere postoperative Erholung konnte durch die psychomotorischen Leistungstests sowie in den Analogskalen belegt werden. Vorteil der Verwendung von Remifentanil ist das Erwachen am Ende der Operation mit sofortigem Wiedererlangen der Koordination. Die narkosebedingten Nachwirkungen Übelkeit und Erbrechen sind selten und die Patienten fühlen sich wohl. Ein entscheidender Nachteil der Kombination Propofol/Remifentanil ist jedoch der intraoperative Abfall von Blutdruck und Herzfrequenz. In der Ketamin-Gruppe ist die Häufigkeit intraoperativer Träume erstaunlich hoch. Schlussfolgerung: Der Einsatz von Remifentanil bei Eingriffen, die postoperativ mit geringen bis mäßigen Schmerzen verbunden sind, sichert eine komplikationsarme und im Vergleich zu Ketamin schnellere postoperative Erholung. Der Überwachungsaufwand und die Überwachungsdauer können somit erheblich reduziert werden. Der indikationsgerechte Einsatz von Remifentanil bei diesen Eingriffen kann dazu beitragen, die Patientensicherheit zu erhöhen und gleichzeitig Aufwand und Kosten für die postoperative Patientenbetreuung zu senken. / Background: Aim of this study was to figure out, if the use of remifentanyl can improve management of anaesthesia and cause faster recovery after minor gynaecological operative procedures. For that reason we compared the common anaesthetic procedure using ketamine/ propofol/ nitrous oxide with the combination remifentanil/ propofol/ isoflurane. Method: The investigation was performed during April 1997 until March 1998 in the hospital Krankenhaus im Friedrichshain (Berlin). 108 female patients, who met fixed inclusion criteria before, were assigned to a statistic coincidence list according to one of the two methods of anaesthesia in single-blind mode. Short gynaecological interventions as curettages or termination of pregnancy were selected for the study. The recovery documentation took place immediately post narcotic, using psychomotor and cognitive performance tests (word recall, number recall, Maddox wing, finger tapping, number-connection test, test d2). The results of these investigations were supplemented by the results of line analogue rating scales (pain score, feeling scale) and standardized questions (intraoperative dreaming, satisfaction). According to a standardized schedule, the participants underwent three times the same standardized investigations-, tests- and questioning sequences. Results: The two groups of investigations were comparable regarding the general data age, weight, size, and Body measure index and side diseases. Regarding the original data, obtained at the previous day (t0), and the distribution of personality characteristics, there were no differences between the groups. The data raised in the investigations showed clear advantages in the psychomotor recovery for the group of remifentanil. Faster post narcotic recovery can be proved by the psychomotor performance tests as well as in the rating scales. Most important advantage of the use of remifentanil is awaking at the end of the operation with the immediate regaining of the coordination. The anaesthesia related side effects as nausea and vomiting are rare and the patients feel well. A remarkable disadvantage of the combination propofol/remifentanil is, however, the intraoperative drop of blood pressure and heart frequency, especially in elderly patients. Frequency of intraoperative dreaming can be observed much more in the ketamine group. Conclusion: By the use of remifentanil in operative procedures, causing less, up to moderate postoperative pain, we secured rare complications and post surgical faster recovery compared with the ketamine group. The postoperative monitoring expenditure as well as the duration of monitoring can be substantially reduced. The indication-fair use of remifentanil in these surgical procedures surgery can contribute to increase patient security and to lower expenditure and costs of the post surgical patient care at the same time.

Le métier de psychomotricien appartient à la catégorie des métiers dits « de la relation ». La perspective dans laquelle s’inscrit ce travail, le cadre conceptuel dans lequel il s’ancre, diffèrent donc de ceux propres à une activité de production : son travail se caractérise par sa nature interactionnelle. Les pratiques des psychomotriciens sont à la croisée de la thérapie, de la rééducation et de l'éducation. Elles concernent les personnes de tous les âges, allant du sujet sain au sujet malade en passant par celui rencontrant des difficultés circonstancielles. L’étendue du champ de compétences et l’extension des domaines d’intervention nous amènent à poser la question de la spécificité de l’activité du psychomotricien en situation d’interaction avec ses patients ou avec ses partenaires de séance. Notre recherche porte sur l’analyse de cette activité professionnelle. Il ne s’agit pas d’étudier son travail ou de décrire son emploi. Son activité, telle qu’il la réalise en situation d’intervention et telle qu’il l’organise au cours de son développement spatial et temporel, est la dimension de son métier que nous cherchons à comprendre. Dans les processus de conceptualisation sous-jacents à la conduite de son activité en situation opèrent des formes d’organisation invariante de son activité et des concepts organisateurs de cette activité. Le cadre théorique dans lequel s’ancre notre démarche est celui de la didactique professionnelle. Notre analyse se fonde sur une approche interactionnelle et multimodale de l’activité professionnelle, une approche de l’activité par le sensible. Il apparaît dans cette activité une forme de développement spécifique que nous appelons "stratégie chorégraphique". Elle se décline dans une dynamique organisationnelle sous-tendue par la mise en œuvre d’un schème spécifique, celui que nous nommons « le sens de l’équilibre ». Composition, mesure et souplesse le caractérisent.Notre recherche recèle des enjeux relatifs à la formation professionnelle. Elle comporte également des perspectives de développement professionnel. / Psychomotor therapists belong to the category of the professions of the relation. The perspective of this profession and its conceptual field in which it is anchored differ from those related with an activity of production; This professional activity is entirely characterized by its interactional nature. The approaches of psychomotor therapists are at the intersection of therapy, rehabilitation and/or education. Originally addressed to children with a compromised development, those practices are now relevant to people of all ages, from the healthy to sick subjects as well as to subjects having circumstantial difficulties. The scope of the field of competence and the extension of the fields of intervention leads us to question the specificity of the activity of the psychomotor therapist while he intervenes with his patients or his partners of working session. Our research focuses on the analysis of this professional activity. The matter is not to study the work or to describe the job. The way of he realizes his activity in situation of intervention and the way he organize its spatial and temporal development are what we attempt to understand. In the processes of conceptualization that underlie the conduct of one's activity in a situation, there are forms of invariant organization of one's activity, concepts that organize it.Our research takes place in the theoretical framework of adult learning, i.e. professional didactics. Our analysis is based on an interactional and multimodal approach of the professional activity, an approach through the sensible. In this activity appears a specific structure of development that we call "choregraphical strategy". It comes in an organizational dynamic underlied by the implementation of a specific pattern, that we call “sens of balance pattern”. Composition, moderation and flexibility characterize it. Our research contains issues related to professional training. It also includes opportunities for professional development.

INTRODUÇÃO: O Método Canguru é um tipo de assistência neonatal que consiste no contato precoce pele a pele entre a mãe e o recém-nascido de baixo peso, de forma crescente e pelo tempo que ambos entenderem ser prazeroso e suficiente, permitindo dessa forma, uma maior participação dos pais no cuidado a seu recém-nascido, acompanhado de suporte assistencial, por uma equipe de saúde treinada adequadamente. Tem como premissa a interação dinâmica e continua entre fatores biomédicos e ambientais. OBJETIVO: Descrever a evolução do desenvolvimento motor e cognitivo de pré-escolares de muito baixo peso egressos do Método Canguru, que receberam leite humano durante o período de internação. MÉTODOS: Foram estudadas 54 crianças prematuras, no período de Janeiro de 2004 a Janeiro de 2011 que participaram do Método Canguru e acompanhadas no Ambulatório de Seguimento, até a idade pré-escolar. Essas crianças foram submetidas ao teste Denver II, com um ano e novamente na idade préescolar quando foi aplicada a Escala de Maturidade Mental Colúmbia. METODOLOGIA ESTATÍSTICA: As variáveis contínuas serão descritas através de suas médias e desvios-padrão. Aquelas com comportamento não paramétrico, serão descritas através da mediana e do intervalo inter-quartil. As variáveis categóricas serão descritas através de suas proporções e intervalos de confiança de 95%. Para descartar a hipótese de nulidade será utilizado o nível de corte de 5%. RESULTADOS: Na amostra houve predominância do sexo feminino de 65%, e cerca de 30% dos RNPT foram PIG. As medianas do peso de nascimento e idade gestacional foram 1316g e 32 semanas, respectivamente. A mediana da idade materna foi de 28 anos, ensino fundamental completo com nove anos de estudo e a renda per capita de R$150,00. Entre as 54 crianças do estudo, 15% tiveram Hemorragia Perintraventricular grau I, 19% desenvolveram displasia broncopulmonar e nenhuma apresentou retinopatia da prematuridade. No teste Denver II de 54 crianças na idade de um ano corrigida, constatamos um risco no desempenho do desenvolvimento motor grosso de 31%, na linguagem 7%, psicossocial 6% e motor adaptativo 2%. Na idade pré-escolar observamos uma diminuição significativa do risco no desempenho do desenvolvimento para 4% em linguagem, 3% em motor grosso e 0% em psicossocial e motor adaptativo. Na idade pré-escolar o desempenho cognitivo se assemelhou a normalidade, quando comparado com a população brasileira, de acordo com a padronização da Escala Colúmbia. Os fatores de risco para o desempenho no desenvolvimento neuropsicomotor das crianças com um ano de idade corrigida estão associados ao tempo de internação e inicio da posição Canguru e foram estatisticamente significantes (p=0,009), (p=0,013), mesmo depois de ajustar à análise para as variáveis da idade gestacional, peso de nascimento, idade materna e sexo. Embora não tenha havido significância estatística, as crianças que foram amamentadas por mais tempo (meses) tiveram percentualmente menor risco para o desempenho neuropsicomotor. Nesta amostra constatamos em relação ao aleitamento materno total a mediana de sete meses e para o aleitamento exclusivo a mediana de três meses. CONCLUSÃO: A análise da evolução do desenvolvimento motor e cognitivo de pré-escolares nascidos pré-termo de muito baixo peso e egressos do Método Canguru, mostrou que, as crianças com um ano de idade corrigida, apresentaram 38% de risco no desempenho neuropsicomotor e ao atingirem a idade pré-escolar, apenas 5% demonstraram este risco. No que diz respeito ao desenvolvimento cognitivo, os valores obtidos foram percentualmente acima da média da população brasileira. Estes achados sugerem que as crianças que foram RNPT MBP alimentadas com leite humano durante sua internação e egressas do Método Canguru podem apresentar um desempenho no desenvolvimento tanto motor como cognitivo semelhante ao padrão de normalidade / INTRODUCTION: The Kangaroo Method is a perinatal care concerning skin contact between the mother and the low birth weight (LBW) newborn as long as both consider it pleasant and necessary. It allows greater parental participation in the care of their low birth weight newborn closely followed by properly trained healthcare professionals. The dynamic and continuous interaction between biomedical and environmental factors is its premise. OBJECTIVE: To describe the cognitive and motor development of children at preschool age that were born with very low birth weight (VLBW), former patients of the Kangaroo Method that were breastfed during hospital stay. METHOD: Fifty four preterm infants were studied between January 2004 and January 2011. The infants participated in the Kangaroo Method and they were followed up to preschool age by trained professionals in a followup ambulatory. These children were submitted to Denver II test by the time they were one year old and again at preschool age. Columbia Mental Maturity scale was applied to the children at preschool age. STATISTICAL ANALYSIS: The continual variables will be described by their averages and standard deviations. The nonparametric variables will be described by the medians and the interquartile interval. The categorical variables will be described by their proportions and the confidence interval of 95%. A 5% cutoff point will be applied to discard the null hypothesis. RESULTS: In the sample 65% were female, approximately 30% of the preterm newborn were small for the gestational age. Birth weight and gestational age medians were respectively 1316g and 32 weeks. Maternal age median was 28 years old. The mothers completed elementary school in nine years and their per capita income was R$ 150,00. The fifty four children involved in the study 15% had peri-intraventricular hemorrhage level 1, 19% had bronchopulmonary dysplasia and none had retinopathy of prematurity. The fifty four children were assessed at one year old, corrected age, to Denver II test and the following development risks were detected, 31% gross motor, 7% language, 6% psychosocial and 2% adaptive motor. At preschool age there was a considerable decrease in those parameters, 4% for language and 3% for gross motor 0% for psychosocial and adaptive motor. According to the Columbia scale standardization cognitive performance at preschool age resembled normality when compared with Brazilian population. Our study identified that the children involved had a higher performance than the population of reference (Brazilian population). Hospitalization period and the beginning of the Kangaroo position determined the risks factors for psychomotor development at one year old, corrected age, even after the adjustments in the analysis for gestational age, birth weight, mother\'s age and gender (p=0,009), (p=0,013) had been made. Although there was no statistical significance children breastfed for longer period had a lower psychomotor development risk. For the sample enrolled the median for total breastfeeding was 7 months and the exclusive breastfeeding 3 months. CONCLUSION: The Kangaroo Method had an impact on motor and cognitive developmental performance of the preschool age children born preterm with very low birth weight. At one year old, corrected age, the children concerned presented a 38% risk in psychomotor performance, however at preschool age the percentage dropped to 5%. The measured values for cognitive development were above the average for the Brazilian population. These findings suggest that very low birth weight preterm newborn that were breastfed during hospital stay and submitted to Kangaroo Method may present motor as well as cognitive developmental performances similar to normal standard

INTRODUÇÃO: O Método Canguru é um tipo de assistência neonatal que consiste no contato precoce pele a pele entre a mãe e o recém-nascido de baixo peso, de forma crescente e pelo tempo que ambos entenderem ser prazeroso e suficiente, permitindo dessa forma, uma maior participação dos pais no cuidado a seu recém-nascido, acompanhado de suporte assistencial, por uma equipe de saúde treinada adequadamente. Tem como premissa a interação dinâmica e continua entre fatores biomédicos e ambientais. OBJETIVO: Descrever a evolução do desenvolvimento motor e cognitivo de pré-escolares de muito baixo peso egressos do Método Canguru, que receberam leite humano durante o período de internação. MÉTODOS: Foram estudadas 54 crianças prematuras, no período de Janeiro de 2004 a Janeiro de 2011 que participaram do Método Canguru e acompanhadas no Ambulatório de Seguimento, até a idade pré-escolar. Essas crianças foram submetidas ao teste Denver II, com um ano e novamente na idade préescolar quando foi aplicada a Escala de Maturidade Mental Colúmbia. METODOLOGIA ESTATÍSTICA: As variáveis contínuas serão descritas através de suas médias e desvios-padrão. Aquelas com comportamento não paramétrico, serão descritas através da mediana e do intervalo inter-quartil. As variáveis categóricas serão descritas através de suas proporções e intervalos de confiança de 95%. Para descartar a hipótese de nulidade será utilizado o nível de corte de 5%. RESULTADOS: Na amostra houve predominância do sexo feminino de 65%, e cerca de 30% dos RNPT foram PIG. As medianas do peso de nascimento e idade gestacional foram 1316g e 32 semanas, respectivamente. A mediana da idade materna foi de 28 anos, ensino fundamental completo com nove anos de estudo e a renda per capita de R$150,00. Entre as 54 crianças do estudo, 15% tiveram Hemorragia Perintraventricular grau I, 19% desenvolveram displasia broncopulmonar e nenhuma apresentou retinopatia da prematuridade. No teste Denver II de 54 crianças na idade de um ano corrigida, constatamos um risco no desempenho do desenvolvimento motor grosso de 31%, na linguagem 7%, psicossocial 6% e motor adaptativo 2%. Na idade pré-escolar observamos uma diminuição significativa do risco no desempenho do desenvolvimento para 4% em linguagem, 3% em motor grosso e 0% em psicossocial e motor adaptativo. Na idade pré-escolar o desempenho cognitivo se assemelhou a normalidade, quando comparado com a população brasileira, de acordo com a padronização da Escala Colúmbia. Os fatores de risco para o desempenho no desenvolvimento neuropsicomotor das crianças com um ano de idade corrigida estão associados ao tempo de internação e inicio da posição Canguru e foram estatisticamente significantes (p=0,009), (p=0,013), mesmo depois de ajustar à análise para as variáveis da idade gestacional, peso de nascimento, idade materna e sexo. Embora não tenha havido significância estatística, as crianças que foram amamentadas por mais tempo (meses) tiveram percentualmente menor risco para o desempenho neuropsicomotor. Nesta amostra constatamos em relação ao aleitamento materno total a mediana de sete meses e para o aleitamento exclusivo a mediana de três meses. CONCLUSÃO: A análise da evolução do desenvolvimento motor e cognitivo de pré-escolares nascidos pré-termo de muito baixo peso e egressos do Método Canguru, mostrou que, as crianças com um ano de idade corrigida, apresentaram 38% de risco no desempenho neuropsicomotor e ao atingirem a idade pré-escolar, apenas 5% demonstraram este risco. No que diz respeito ao desenvolvimento cognitivo, os valores obtidos foram percentualmente acima da média da população brasileira. Estes achados sugerem que as crianças que foram RNPT MBP alimentadas com leite humano durante sua internação e egressas do Método Canguru podem apresentar um desempenho no desenvolvimento tanto motor como cognitivo semelhante ao padrão de normalidade / INTRODUCTION: The Kangaroo Method is a perinatal care concerning skin contact between the mother and the low birth weight (LBW) newborn as long as both consider it pleasant and necessary. It allows greater parental participation in the care of their low birth weight newborn closely followed by properly trained healthcare professionals. The dynamic and continuous interaction between biomedical and environmental factors is its premise. OBJECTIVE: To describe the cognitive and motor development of children at preschool age that were born with very low birth weight (VLBW), former patients of the Kangaroo Method that were breastfed during hospital stay. METHOD: Fifty four preterm infants were studied between January 2004 and January 2011. The infants participated in the Kangaroo Method and they were followed up to preschool age by trained professionals in a followup ambulatory. These children were submitted to Denver II test by the time they were one year old and again at preschool age. Columbia Mental Maturity scale was applied to the children at preschool age. STATISTICAL ANALYSIS: The continual variables will be described by their averages and standard deviations. The nonparametric variables will be described by the medians and the interquartile interval. The categorical variables will be described by their proportions and the confidence interval of 95%. A 5% cutoff point will be applied to discard the null hypothesis. RESULTS: In the sample 65% were female, approximately 30% of the preterm newborn were small for the gestational age. Birth weight and gestational age medians were respectively 1316g and 32 weeks. Maternal age median was 28 years old. The mothers completed elementary school in nine years and their per capita income was R$ 150,00. The fifty four children involved in the study 15% had peri-intraventricular hemorrhage level 1, 19% had bronchopulmonary dysplasia and none had retinopathy of prematurity. The fifty four children were assessed at one year old, corrected age, to Denver II test and the following development risks were detected, 31% gross motor, 7% language, 6% psychosocial and 2% adaptive motor. At preschool age there was a considerable decrease in those parameters, 4% for language and 3% for gross motor 0% for psychosocial and adaptive motor. According to the Columbia scale standardization cognitive performance at preschool age resembled normality when compared with Brazilian population. Our study identified that the children involved had a higher performance than the population of reference (Brazilian population). Hospitalization period and the beginning of the Kangaroo position determined the risks factors for psychomotor development at one year old, corrected age, even after the adjustments in the analysis for gestational age, birth weight, mother\'s age and gender (p=0,009), (p=0,013) had been made. Although there was no statistical significance children breastfed for longer period had a lower psychomotor development risk. For the sample enrolled the median for total breastfeeding was 7 months and the exclusive breastfeeding 3 months. CONCLUSION: The Kangaroo Method had an impact on motor and cognitive developmental performance of the preschool age children born preterm with very low birth weight. At one year old, corrected age, the children concerned presented a 38% risk in psychomotor performance, however at preschool age the percentage dropped to 5%. The measured values for cognitive development were above the average for the Brazilian population. These findings suggest that very low birth weight preterm newborn that were breastfed during hospital stay and submitted to Kangaroo Method may present motor as well as cognitive developmental performances similar to normal standard

Made available in DSpace on 2016-08-19T18:16:08Z (GMT). No. of bitstreams: 1 Roxana Desterro.pdf: 688994 bytes, checksum: ceb8107f09c4ea13f75ca8e4a721da06 (MD5) Previous issue date: 2007-12-13 / The scientific and technologic advances that occurred in the neonatal ITU over the last decades increased the survival rate of babies over and over more premature. Due to the occurency of possible sequelae inherent to this condition, it has been a bigger interest for de development of egress babies from these unites of treatment. The present study is retrospective, longitudinal, analytical of a control case, nested to a cohort. It proposes to evaluate the motor and cognitive development of premature babies who had brain ultrasound alterations at the neonatal period and the possible risk factors for its delay. It has been selected 99 premature children weighting 1800 grams or less in the birth and pregnancy age inferior to 37 weeks, submitted to a transfontanelar ultrasound in the neonatal period during their neonatal ITU (Intensive Therapy Unity) internment. The socio-economic, cultural, environmental, perinatal clinic events and mother characteristics were analysed. To evaluation of the neural, psychomotor development, the Denver II test was used. A sample made, in the majority, of corrected 12 months old children. The birth weight average was 1032 grams and the pregnancy average was 31,3 weeks. The ultrasonic alterations were present in 49, 4% of the children. In them, the periventricular leucomalacy was more frequent corrected one year old babies with alterations in the Denver II test. 34, 3% of the realized tests had unsatisfactory results. As risk factors for the development alteration, Ultrasonic alterations and low family incomes were significant for the study. . The positive predictive value of transfontanelar ultrasonic exams for the neural psychomotor development was 51,02% and the negative predictive value was 82% When the family incomes variable is added to the transfontanelar ultrasonic alterations, the positive predictive value increased to 90% and the negative predictive value decreased to 71,91%. It is believed that the variable family incomes added to the analysis is a good alternative to increase the prediction capacity development alterations of premature children with transfontanelar ultrasonic alterations. / Os avanços científicos e tecnológicos que ocorreram nas UTI neonatais nas últimas décadas, aumentaram a sobrevida de bebês cada vez mais prematuros. Devido ocorrência de possíveis seqüelas inerentes a essa condição, houve um interesse maior pelo desenvolvimento dos bebês egressos dessas unidades de tratamento. O presente estudo é retrospectivo, longitudinal, analítico do tipo caso controle, aninhado a uma coorte. Foi avaliado o desenvolvimento motor e cognitivo de prematuros que tiveram alterações ultra-sonográficas cerebrais no período neonatal e os possíveis fatores de risco para o seu atraso. Selecionou-se 99 crianças prematuras com peso de nascimento menor ou igual a 1800 gramas e idade gestacional abaixo de 37 semanas e que fizeram ultra-sonografia transfontanelar no período neonatal durante sua internação em UTI neonatal. Analisaram-se variáveis sócio-econômicas, culturais, ambientais, eventos clínicos perinatais e características maternas. Para avaliação do desenvolvimento neuropsicomotor utilizou-se o Teste de Denver II. A população foi composta de crianças com 12 meses de idade corrigida. A média de peso de nascimento foi de 1032 gramas e a média de idade gestacional foi de 31,3 semanas. As alterações ultra-sonográficas estiveram presentes em 49,4% das crianças. Destas, a leucomalácia periventricular foi a mais presente nos bebês com alteração no Teste de Denver II na idade corrigida de 1 ano. Dentre os testes realizados, 34,3% tiveram resultados desfavoráveis. Dos fatores de risco para alteração de desenvolvimento, alterações ultra-sonográficas cerebrais e renda familiar mostram-se estatisticamente significantes para o estudo. O valor preditivo positivo dos exames ultra-sonográficos transfontanelares para alterações de desenvolvimento neuropsicomotor, foi de 51,02% e valor preditivo negativo de 82%. Ao se acrescentar a variável renda familiar às alterações ultra-sonográficas transfontanelares, o valor preditivo positivo aumentou para 90% e o valor preditivo negativo reduziu-se para 71,91%. Acredita-se que o acréscimo à análise da variável renda familiar baixa é boa alternativa para aumentar a capacidade de predição de alterações do desenvolvimento de prematuros com alterações ultra-sonográficas transfontanelares.

<p>Uvod: Infertilitet se defini&scaron;e kao bezuspe&scaron;na koncepcija nakon jedne godine seksualnih odnosa bez upotrebe kontracepcije u fertilnoj fazi menstrualnog ciklusa. Metode asistirane reprodukcije predstavljaju efektivan način lečenja infertiliteta. Ispitivanje i identifikacija kratkoročnih i dugoročnih efekata arteficijalnih reproduktivnih tehnologija je veoma izazovan zadatak. Prvenstveni razlog tome je velika heterogenost u načinu sakupljanja, obrade, klasifikacije i tumačenja, sada već, obilja informacija koje su prikupljene u različitim istraživanjima. Individualni pristup lečenju neplodnosti, brz napredak i stalne promene u metodologiji arteficijalnih reproduktivnih tehnologija, uz ranije navedene pote&scaron;koće u vezi sa prikupljanjem i analizom podataka, značajno otežavaju precizno sagledavanje svih mogućih rizika i posledica arteficijanog začeća. Uprkos brojnim istraživanjima, naučnim publikacijama i akumuliranim dokazima, ostale su mnoge dileme u vezi odgovora na pitanja - da li su arteficijalno začete trudnoće u većoj meri praćene rizicima za neadekvatan razvoj ploda, lo&scaron;ijim perinatalnim ishodom i kakve su dugoročne posledice po decu, kao i da li su ovi rizici podjednako zastupljeni u jednoplodnim i vi&scaron;eplodnim trudnoćama.<br />Cilj rada: Ciljevi rada su bili da se utvrdi struktura morbiditeta kod prevremeno rođene dece začete vantelesnom oplodnjom (iz jednoplodnih i vi&scaron;eplodnih trudnoća) u prve dve godine života, te da se identifikuju perinatalni faktori koji su povezani sa pojavom akutnih i hroničnih komplikacija i oboljenja kod prevremeno rođene dece začete vantelesnom oplodnjom. Takođe, cilj rada je bio da se utvrde karakteristike psihomotornog razvoja kod prevremeno rođene dece začete vantelesnom oplodnjom na kraju dvanestog, osamnaestog i dvadesetčetvrtog meseca života, kao i da se identifikuju specifični faktori rizika za nepovoljan telesni, neurolo&scaron;ki i psiholo&scaron;ki ishod lečenja kod prevremeno rođene dece začete vantelesnom oplodnjom.<br />Materijal i metode: U studiju su uključena prevremeno rođena deca koja su bila hospitalizovana u Službi za neonatologiju i intenzivnu i poluintenzivnu negu i terapiju, i koja su nakon toga, tokom prve dve godine života redovno praćena u neonatolo&scaron;koj ambulanti Instituta za zdravstvenu za&scaron;titu dece i omladine Vojvodine u Novom Sadu. Retrospektivnim delom studije su obuhvaćena deca koja su lečena u Službi i praćena u neonatolo&scaron;koj ambulanti, a koja su rođena počev od 01. 01. 2011. do 31.12.2012. godine i praćena do navr&scaron;ena puna 24 meseca života. Podaci o pacijentima koji su uključeni u retrospektivni deo istraživanja prikupljani su pregledom medicinske dokumentacije. U prospektivni deo studije su uključena deca koja su lečena u Službi i koja su praćena u neonatolo&scaron;koj ambulanti, a koja su rođena između 01.01. 2013.godine i 31.12.2014. godine i potom praćena do navr&scaron;enih 24 meseca života. Iz navedene kohorte, formirane se dve grupe: Ispitivana grupa (Grupa 1) je obuhavatila svu prevremeno rođenu decu začetu vantelesnom oplodnjom koja su bila hospitalizovana i praćena na Institutu u navedenom periodu. Kontrolna grupa (Grupa 2) obuhvatila je prevremeno rođenu decu začetu prirodnim putem. Deca iz kontrolne grupe izabrana su iz kohorte tako da njihov broj bude jednak broju dece iz ispitivane grupe. Ispitanici iz ove grupe su ujednačeni (&#39;&#39;mečovani&#39;&#39;) sa decom iz ispitivane grupe prema gestacijskoj starosti i datumu rođenja. Gestacijska starost ispitanika iz kontrolne grupe se ne razlikuje za vi&scaron;e od &plusmn; 4 dana u odnosu na decu iz ispitivane grupe. Datum rođenja ispitanika koji su uključeni u kontrolnu grupu se ne razlikuje za vi&scaron;e od &plusmn; 3 meseca u odnosu na decu iz ispitivane grupe.<br />U momentu uključivanja u studiju uzimani su sledeći anamezni podaci:<br />Podaci u vezi sa majkom, trudnoći i porođaju: starost majke u momentu koncepcije, broj prethodnih poku&scaron;aja asistirane koncepcije, stručna sprema, mesto stanovanja, hronične bolesti dijagnostikovane pre trudnoće, akutne i hronične bolesti dijagnostikovane tokom trudoće (hipertenzija, pre-eklampsija, eklampsija, o&scaron;tećenje jetre), prevremena ruptura plodovih ovojaka, primena lekova tokom trudnoće, jednoplodna ili vi&scaron;eplodna trudnoća. Podaci o poremećajima posteljice i ovojaka: ablacija, placenta previja, horioamnionitis. Podaci u vezi sa detetom: intrauterina infekcija, intrauterina restrikcija rasta, način porođaja, Apgar skor. Antropometrijski parametri (telesna masa, telesna dužina, obim glave) na rođenju i tokom perioda ambulantnog praćenja deteta. Dužina inicijalne hospitalizacije deteta. Dužina invazivne i/ili neinvazivne respiratorne potpore i oksigenoterapije. Dijagnoze na otpustu iz bolnice: prisustvo te&scaron;kih posledica prematuriteta, &scaron;to podrazumeva: intrakranijalnu hemoragiju 3. i 4. stepena (definisanu u međunarodnoj klasifikaciji bolesti &ndash; deseta revizija (MKB10) pod &scaron;ifrom P52.2), cističnu periventrikularnu leukomalaciju, retinopatiju prematuriteta, bronhopulmonalnu displaziju, nekrotizirajući enterokolitis, sepsu i/ili meningitis (mikrobiolo&scaron;ki ili klinički dijagnostikovanu). Prisustvo urođenih anomalija ili genetskih sindroma i bolesti (definisanih u MKB10 pod &scaron;iframa Q00 do Q99), kao i prisustvo urođenih bolesti metabolizma (definisanih u MKB10 pod &scaron;iframa E00 do E90).<br />U retrospektivnom delu studije, pregledani su specijalistički izve&scaron;taji iz neonatolo&scaron;ke ambulante pri posetama deteta u uzrastu deteta od 12, 18 i 24 meseca, i beleženi su sledeći podaci: sve prethodno postavljene dijagnoze koje su navedene na specijalističkim izve&scaron;tajima iz neonatolo&scaron;ke ambulante, antropometrijski prametri u momentu pregleda (telesna dužina, telesna masa i obim glave), neurolo&scaron;ki nalaz (tonus, trofika, kožni i tetivni refleksi, prisustvo lateralizacije u neurolo&scaron;kom nalazu), nalaz oftalmologa (uredan nalaz/patalo&scaron;ki nalaz), procena fine i grube motorike, govora, kognitivne funkcije i socijalnog kontakta i zbirna procena psihomotornog razvoja. U prospektivnom delu studije, pri kontrolnim pregledima u neonatolo&scaron;koj ambulanti, u uzrastu deteta od 12, 18 i 24 meseca, određivano je i beleženo sledeće: ranije postavljene dijagnoze koje su navedene u medicinskoj dokumentaciji, antropometrijski prametri u momentu pregleda (telesna dužina, telesna masa i obim glave), neurolo&scaron;ki nalaz (tonus, trofika, kožni i tetivni refleksi, prisustvo lateralizacije u neurolo&scaron;kom nalazu), nalaz oftalmologa (uredan nalaz/patalo&scaron;ki nalaz), procena fine i grube motorike, govora, kognitivne funkcije i socijalnog kontakta i zbirna procena psihomotornog razvoja.<br />Rezultati: Prosečna vednost TM ispitanika iz Grupe 1, u uzrastu od 12 meseci, bila je statistički značajno manja u odnosu na ispitanike iz Grupe 2 (Studentov t test). Prosečne vednosti TD ispitanika iz obe grupe, u uzrastu od 12 meseci, nisu se statistički značajno razlikovale (Studentov t test). Prosečne vednosti OGL ispitanika iz obe grupe, u uzrastu od 12 meseci, nisu se statistički značajno razlikovale (Studentov t test). Udeo ispitanika sa patolo&scaron;kim oftalmolo&scaron;kim nalazom nije se statistički značajno razlikovao između Grupe 1 i Grupe 2 (Fi&scaron;erov test tačne verovatnoće). Udeo ispitanika sa patolo&scaron;kim neurolo&scaron;kim nalazom nije se statistički značajno razlikovao između Grupe 1 i Grupe 2 (Hi kvadrat test). Prosečne vrednosti globalnog koeficijenta razvoja (RQ), kao i prosečne vrednosti skora za pojedine elemente za procenu razvoja (motorika, koordinacija, govor i dru&scaron;tvenost) po Brunet -L&eacute;zine skali, nisu se statistički značajno razlikovale između grupa (Studentov t test). U Grupi 1 bilo je 92 (59,740%) deteta čiji je nekorigovani RQ bio ispod 90, dok je u Grupi 2 bilo 61 (39,610%) dete čiji je nekorigovani RQ bio ispod 90. Ova razlika u broju dece sa RQ koji je ispod proseka za kalendarski uzrast je statistički značajna (Hi kvadrat test, p=0,0004). Relativni rizik za ispodprosečno postignuće na testu za procenu psihomotornog razvoja (RQ&lt;90), za decu iz Grupe 1 bio je vi&scaron;i, u odnosu na decu iz Grupe 2 (RR = 1,495; 95% CI 1,181 &ndash; 1,892). U Grupi 1, bilo je 87 (56,494%) dece koja su postigla ispodprosečne korigovane vrednosti skora na testu za procenu psihomotornog razvoja (korigovani RQ&lt;90). U Grupi 2 bilo je 69 (44,805%) dece koja su postigla ispodprosečne korigovane vrednosti skora na testu za procenu psihomotornog razvoja (korigovani RQ&lt;90). Ova razlika je statistički značajna (Hi kvadrat test, p =0,040). Relativni rizik za ispodprosečno postignuće na testu za procenu psihomotornog razvoja (korigovani RQ&lt;90), za decu iz Grupe 1 bio je vi&scaron;i, u odnosu na decu iz Grupe 2 (RR = 1,261; 95%CI 1,008 &ndash; 1,577). U kategoriji dece, koja su i pored korekcije u odnosu na GS imala ispodprosečno postignuće na testu za procenu psihomotornog razvoja, u Grupi 1 čak 81/87 (93,310%) dece je imalo vrednost korigovanog RQ &ge; 85, a u Grupi 2 ovu vrednost korigovanog RQ imalo je 60/69 (86,956%) dece.<br />Prosečne vednosti TM ispitanika iz obe grupe, u uzrastu od 18 meseci, nisu se statistički značajno razlikovale (Studentov t test). Prosečne vednosti TD ispitanika iz obe grupe, u uzrastu od 18 meseci, nisu se statistički načajno razlikovale (Studentov t test). Prosečne vednosti OGL ispitanika iz obe grupe, u uzrastu od 18 meseci, nisu se statistički značajno razlikovale (Studentov t test). Udeo ispitanika sa patolo&scaron;kim oftalmolo&scaron;kim nalazom nije se statistički značajno razlikovao između Grupe 1 i Grupe 2 (Hi kvadrat test). Udeo ispitanika sa patolo&scaron;kim neurolo&scaron;kim nalazom nije se statistički značajno razlikovao između Grupe 1 i Grupe 2 (Hi kvadrat test). Prosečne vrednosti RQ, kao i prosečne vrednosti skora za pojedine elemente za procenu razvoja (motorika, koordinacija, govor i dru&scaron;tvenost) po Brunet -L&eacute;zine skali su se statistički značajno razlikovale između grupa u uzrastu od 18 meseci (Studentov t test). U Grupi 1 bilo je 57 (37,013%) dece čiji je nekorigovani RQ bio ispod 90, dok je u Grupi 2 bilo 31 (20,130%) dete čiji je nekorigovani RQ bio ispod 90. Udeo dece sa RQ koji je ispod proseka za kalendarski uzrast je statistički značajno različit između grupa (Hi kvadrat test, p = 0,010). Relativni rizik za ispodprosečno postignuće na testu za procenu psihomotornog razvoja (nekorigovani RQ&lt;90), za decu iz Grupe 1 bio je vi&scaron;i, u odnosu na decu iz Grupe 2 (RR = 1,288; 95%CI 1,181 &ndash; 2,730). Statistički značajna razlika postojala je i kada je upoređen broj dece sa vrednostima korigovanog RQ ispod 90 u Grupi 1 i Grupi 2 (36 naspram 19 po redosledu navođenja; Hi kvardat test, p = 0,011). Relativni rizik za ispodprosečno postignuće na testu za procenu psihomotornog razvoja (korigovani RQ&lt;90), za decu iz Grupe 1 bio je vi&scaron;i, u odnosu na decu iz Grupe 2 (RR = 1,895; 95%CI 1,139 &ndash; 3,152).<br />Prosečne vednosti TM ispitanika iz obe grupe, u uzrastu od 24 meseca, nisu se statistički značajno razlikovale (Studentov t test). Prosečne vednosti TD ispitanika iz obe grupe, u uzrastu od 24 meseca, nisu se statistički značajno razlikovale (Studentov t test). Prosečne vednosti OGL ispitanika iz obe grupe, u uzrastu od 24 meseca, nisu se statistički značajno razlikovale (Studentov t test). Udeo ispitanika sa patolo&scaron;kim oftalmolo&scaron;kim nalazom nije se statistički značajno razlikovao između Grupe 1 i Grupe 2 (Hi kvadrat test). Udeo ispitanika sa patolo&scaron;kim neurolo&scaron;kim nalazom nije se statistički značajno razlikovao između Grupe 1 i Grupe 2 (Hi kvadrat test). Prosečne vrednosti RQ, kao i prosečne vrednosti skora za pojedine elemente za procenu razvoja (motorika, koordinacija, govor i dru&scaron;tvenost) po Brunet -L&eacute;zine skali, nisu se statistički značajno razlikovale između grupa, u uzrastu od 24 meseca (Studentov t test). U Grupi 1 bilo je 21 dete (13,636%) čiji je nekorigovani RQ bio ispod 90, dok je u Grupi 2 bilo 17 (11,049%) dece čiji je nekorigovani RQ bio ispod 90. Razlika u broju dece sa RQ koji je ispod proseka za kalendarski uzrast nije statistički značajna (Hi kvadrat test, p= 0,488). Statistički značajna razlika nije postojala ni kada je upoređen broj dece sa vrednostima korigovanog RQ ispod 90 u Grupi 1 i Grupi 2 (12 naspram 9 po redosledu navođenja; Hi kvardat test, p = 0,497).<br />Logističkom regresionom analizom pokazano je da su ve&scaron;tačko začeće, vi&scaron;eplodnost trudnoće i IUGR nezavisni faktori rizika za manju TM u kalendarskom uzrastu od 12 meseci. Logističkom regresionom analizom dobijena je statistički značajna korelacija između vrednosti RQ u uzrastu od 18 meseci i sledećih nezavisnih varijabli: arteficijalno začeta trudnoća i vi&scaron;eplodna trudnoća. Isptanici iz Grupe 1 i Grupe 2 nisu se statistički značajno razlikovali ni po jednom od posmatranih pokazatelja telesnog i psihomotornog razvoja u uzrastu od 24 meseca.<br />Struktura morbiditeta kod dece, tokom dvogodi&scaron;njeg perioda praćenja, nije se značajno razlikovala između grupa. Jedina razlika između grupa, konstatovana je u uzrastu od 12 i 18 meseci, bila je u učestalosti akutnih respiratornih infekcija, čija je pojava, pak, bila direktno povezana sa vi&scaron;eplodnim trudnoćama, odnosno brojem siblinga u domaćinstvu.<br />Zaključak: Prosečna starost majki dece koja su začeta IVF-om je veća od prosečne starosti majki dece koja su spontano začeta. Struktura morbiditeta majki dece koja su začeta IVF-om i majki dece koja su začeta spontanom koncepcijom je ista, ali je stopa morbiditeta veća kod majki dece koja su začeta IVF-om. Vi&scaron;eplodne trudnoće su veoma zastupljene kod začeća IVF-om. Trudnoće začete IVF-om se dominantno i skoro ekskluzivno okončavaju carskim rezom. Prevremena ruptura ovojaka ploda je česta komplikacija trudnoća koje su začete IVF-om. Stopa morbiditeta prevremeno rođene dece začete vantelesnom oplodnjom nije veća u odnosu na prevremeno rođenu decu začetu prirodnim putem. U strukturi morbiditeta kod dece koja su začeta vantelesnom opodnjom, zastupljena su ista oboljenja i komplikacije kao kod prevremeno rođene dece začete prirodnim putem. Incidencija pojedinih oboljenja je ista, sa izuzetkom bronhopulmonalne displazije koja se javlja če&scaron;če kod dece začete vantelesnom oplodnjom i retinopatije prematuriteta koja se javlja če&scaron;če kod dece začete prirodnim putem. Porođajna telesna masa, intrauterina restrikcija rasta, starost majke, stručna sprema majke, prethodna hronična oboljenja majke, bolesti majke dijagnostikovane tokom trudnoće, jednoplodna i vi&scaron;eplodna trudnoća, način porođaja i PROM su potencijalni faktori rizika za lo&scaron;iji postnatalni ishod kod dece iz arteficijalno začetih trudnoća. U uzrastu od 12 meseci, prevremeno rođena deca začeta tehnikama in vitro fetrilizacije, sem po dostignutoj telesnoj masi, ne razlikuju se značajno po drugim telesnim karakteristikama, od prevremeno rođene dece koja su začeta prirodnim putem. Faktori rizika za manju telesnu masu kod prevremeno rođene dece, u uzrastu od 12 meseci su: arteficijalno začeće, vi&scaron;eplodne trudnoće i intrauterina restrikcija rasta. U uzrastu od 12 meseci, prevremeno rođena deca začeta in vitro fertilizacijom, imaju blago lo&scaron;ije (ali ne i značajno niže) postignuće na testovima za procenu psihomotornog razvoja, odnosno imaju vi&scaron;i rizik da postignu ispodprosečne vrednosti skora na testu za procenu psihomotornog razvoja. U uzrastu od 18 meseci, nema razlike u pokazateljima telesnog razvoja između prevremeno rođene dece koja su arteficijalno začeta i dece koja su rođena iz spontano začetih trudnoća. U uzrastu od 18 meseci, prevremeno rođena deca iz arteficijalno začetih trudnoća imaju niže postignuće na testovima za procenu psihomotornog razvoja u odnosu na prevremeno rođenu decu iz spontano začetih trudnoća. Faktori rizika koji su povezani sa lo&scaron;ijim postignućem na testu za procenu psihomotornog razvoja kod prevremeno rođene dece su arteficijalno začeće trudnoće i vi&scaron;eplodnost trudnoće. U uzrastu od 24 meseca nema razlike u telesnim parametrima između prevremeno rođene dece koja su arteficijalno začeta i prevremeno rođene dece koja su začeta prirodnim putem. U uzrastu od 24 meseca nema razlike u postignuću na testu za procenu psihomotornog razvoja kod prevremeno rođene dece su arteficijalno začeće trudnoće i vi&scaron;eplodnost trudnoće. U uzrastu od 24 meseca, prevremeno rođena deca, i iz arteficijalno, i iz spontano začetih trudnoća, na testu za procenu psihomotornog razvoja postižu rezultate koji su u skladu sa njihovim kalendarskim uzrastom.</p> / <p>Introduction: Infertility is defined as an unsuccessful conception after one year of sexual intercourse without the use of contraception in the fertilizing phase of the menstrual cycle. Assisted reproduction methods represent an effective way of treating infertility. Examination and identification of short-term and long-term effects of artificial reproductive technologies is a very challenging task. The primary reason for this is the great heterogeneity in the way of collecting, processing, classifying and interpreting, now, the abundance of information that has been gathered in various studies. Individual approach to the treatment of infertility, rapid progress and constant changes in the methodology of the artificial reproductive technologies, in addition to the aforementioned difficulties associated with the collection and analysis of data, significantly hamper accurate assessment of all possible risks and consequences artificial conception. Despite numerous studies, scientific publications and the accumulated evidence, many doubts about the question whether artificially conceived pregnancies are accompanied by the higher risks or inadequate fetal development, poor perinatal and long-term outcomes still remained.<br />The Aim: The objectives of this work were to determine the structure of morbidity in prematurely born children conceived by artificial reproductive technologies (from single and multiple pregnancies) in the first two years of life, and to identify perinatal factors that are associated with the occurrence of acute and chronic complications and diseases in prematurely born children from this pregnancies. In addition, the aim of the study was to determine the characteristics of psychomotor development in prematurely born children conceived by artificial reproductive technologies at the end of the twelfth, eighteenth and twenty-fourth month of life, as well as to identify specific risk factors for the unfavorable physical, neurological and psychological outcome of those children.<br />Materials and Methods: The study included premature born newborns who were hospitalized in the Department for neonatology and intensive and semi-intensive care unit, and are thereafter, during the first two years of life. The retrospective part of the study included children who were hospitalized at the Institute, and who were born from January 1st 2011. to December 31st 2012. and were followed up to 2 years of life. Data on patients included in the retrospective part of the survey were collected through a review of medical records. The prospective part of the study included children who were treated and followed up at the Institute, and who were born between January 1st 2013 and December 31st 2014. and then followed up to 2 years of life. From this cohort two groups were formed: The tested group (Group 1) included all preterm infants who were conceived by ART. The control group (Group 2) included naturally conceived prematurely born children. The children in the control group were selected from the cohort so that their number was equal to the number of children in the study group. The gestational age of the examinees from the control group does not differ for more than &plusmn; 4 days from the children from the study group. The date of birth of subjects included in the control group does not differ for more than &plusmn; 3 months from the children in the study group.<br />At the moment of inclusion in the study, the following individual data were taken:<br />Maternal data, pregnancy and childbirth: the age of the mother at the moment of conception, the number of previous attempts at assisted conception, professional care, place of residence, chronic diseases diagnosed before pregnancy, acute and chronic diseases diagnosed during pregnancy (hypertension, pre-eclampsia, eclampsia, liver damage), premature rupture of the fetuses, the use of medication during pregnancy, single or multiple pregnancy. Data on placental disorders and abnormalities: ablation, placenta overdose, horioamnionitis. Child-related data: intrauterine infection, intrauterine growth restriction, delivery method, Apgar score. Anthropometric parameters (body weight, body length, head circumference) at birth and during the period of outpatient monitoring of the child. Length of initial hospitalization of the child. Length of invasive and / or non-invasive respiratory support and oxygen therapy. Diagnosis on discharge from the hospital: the presence of severe consequences of prematurity, which implies intracranial hemorrhage of 3rd and 4th degree (defined in International Classification of Disease - Tenth Revision (MKB10) under code P52.2), cystic periventricular leukomalacia, retinopathy of prematurity, bronchopulmonary dysplasia , necrotizing enterocolitis, sepsis and / or meningitis (microbiologically or clinically diagnosed). Presence of congenital anomalies or genetic syndromes and diseases (defined in MKB10 under codes Q00 to Q99), as well as the presence of congenital metabolic diseases (defined in MKB10 under codes E00 to E90).<br />In the retrospective part of the study, specialist reports from a neonatological clinic were examined for child visits at the age of 12, 18 and 24 months, and the following data were ecorded: all pre-diagnosis reported on specialist reports from a neonatological clinic, anthropometric arms at the moment examination (body length, body weight and head circumference), neurological findings (tone, trophic, skin and tendon reflexes, presence of lateralization in neurological findings), ophthalmologist findings (neat / patial findings), assessment of fine and coarse motoring, speech, cognitive functions and social contact and a collective assessment of psychomotor development. In the prospective part of the study, during control examinations in a neonatological clinic, at the age of 12, 18 and 24 months, the following were determined and recorded: previously set out in the current medical documentation, anthropometric parameters at the moment of examination (body length, body weight and the volume of the head), neurological findings (tone, trophic, skin and tendon reflexes, presence of lateralization in neurological findings), ophthalmologist findings, assessment of fine and grose motor functions, speech, cognitive functions, social contact and psychomotor development.<br />Results: The average BW of subjects in Group 1 at the age of 12 months, was statistically significantly lower in relation to respondents from Group 2 (Student&#39;s T test). The average length of subjects from both groups at the age of 12 months did not statistically differ (Student&#39;s T test). The average head circumference between children from both groups, at the age of 12 months, did not statistically differ (Student&#39;s T test). The proportion of subjects with pathological ophthalmological findings did not statistically significantly differ between Group 1 and Group 2 (Fischer&#39;s exact probability test). The proportion of subjects with pathological neurological findings did not statistically significantly differ between Group 1 and Group 2 (Hi square test). The average values of the global development coefficient (RQ), as well as the average score values for individual elements of development evaluation test - Brunet-L&eacute;zine scale (motor function, coordination, speech and sociability) did not differ significantly between groups (Student t test). In Group 1 there were 92 (59.740%) of children whose uncorrected RQ was under 90, while in Group 2 there were 61 (39.610%) children whose uncorrected RQ was below 90. This difference in the number of children with RQ below the average for calendar age is statistically significant (Hi square test, p = 0.0004). The relative risk of under-achievement in the psychomotor evaluation test (RQ &lt;90) for children from Group 1 was higher than in children from Group 2 (RR = 1.495; 95% CI 1.181 - 1.922). In Group 1, there were 87 (56.494%) children who achieved sub-optimal corrected score values for the assessment of psychomotor development (corrected RQ &lt;90). In Group 2, there were 69 (44.805%) children who achieved sub-optimal corrected score values for the assessment of psychomotor development (corrected RQ &lt;90). This difference is statistically significant (Hi square test, p = 0.040). The relative risk for the suboptimal achievement in the psychomotor evaluation test (corrected RQ &lt;90) for children from Group 1 was higher than in Group 2 (RR = 1.261; 95% CI 1.008 - 1.577). In Group 1, as many as 81/87 (93.310%) of children had a corrected RQ value of &ge; 85, while in Group 2 this value of the corrected RQ there were 60/69 (86.956%) children.<br />At the age of 18 months, the average BW of subjects from both groups did not differ significantly (Student&#39;s T test). The average length of subjects from both groups, at the age of 18 months, did not statistically differ (Student&#39;s T test). The average head circumference of children from both groups, at the age of 18 months, did not statistically differ (Student&#39;s T test). The proportion of subjects with pathological ophthalmological findings did not statistically significantly differ between Group 1 and Group 2 (Hi square test). The proportion of subjects with pathological neurological findings did not statistically differ between Group 1 and Group 2 (Hi square test). The average RQ values, as well as the average scores for individual elements of psychomotor development (motor function, coordination, speech and sociability) according to the Brunet-L&eacute;zine scale, have been statistically significantly different between groups, at the age of 18 months (Student&#39;s T test). In Group 1 there were 57 (37.013%) children whose uncorrected RQ was below 90, while in Group 2 there were 31 (20,130%) children whose uncorrected RQ was below 90. The share of children with RQ below the average value for the calendar age is statistically significantly different between groups (Hi square test, p = 0.010). The relative risk for the suboptimal achievement in the Psychomotor Development Assessment (uncorrected RQ &lt;90) for Group 1 children was higher than in Group 2 (RR = 1.288; 95% CI 1.181 - 2.730). A statistically significant difference between Group 1 and Group 2 existed when the number of children with corrected RQ below 90 was compared (36 naspram 19 respectively, Hi quadrate test, p = 0.011). The relative risk for the suboptimal achievement on the Psychomotor Evaluation Test (corrected RQ &lt;90) for the children from Group 1 was higher when compared to children in Group 2 (RR = 1.895; 95% CI 1.139 &ndash; 3.152).<br />At the age of 24 months the average BW, body length and head circumference of subjects in both groups were not significantly different (Student&#39;s T test). The proportion of subjects with pathological ophthalmological findings did not statistically significantly differ between Group 1 and Group 2 (Hi square test). The proportion of subjects with pathological neurological findings did not statistically significantly differ between Group 1 and Group 2 (Hi square test). The average RQ values, as well as the average score values for individual elements for development evaluation (motor function, coordination, speech and sociability) according Brunet-L&eacute;zine scale, did not significantly differ between groups at the age of 24 months (Student&#39;s T test). In Group 1, there were 21 children (13.636%) whose uncorrected RQ was under 90, while in Group 2 there were 17 (11.049%) of children whose uncorrected RQ was below 90. The difference in the number of children with RQ below the average for the calendar age was not statistically significant (Hi square test, p = 0.488). A statistically significant difference did not exist even when the number of children with values of the corrected RQ below 90 in Group 1 and Group 2 (12 naspram 9 respectively, Hi quadrate test, p = 0.497) was compared.<br />Logistic regression analysis has shown that artificial conception, multiple pregnancy and IUGR are independent risk factors for lesser BW in a calendar age of 12 months. By logistic regression analysis, a statistically significant correlation between RQ values at 18 months of age and the following independent variables was obtained: artificially started pregnancy and multiple pregnancy. Group 1 and Group 2 patients did not significantly differ by any of the indicators of physical and psychomotor development at the age of 24 months.<br />The structure of morbidity in children, during the two-year follow-up period, did not differ significantly between groups. The only difference between the groups was found in the rates of acute respiratory infections at the age of 12 and 18 months (rate of infections was higher in Group 1), whose occurrence, however, was directly related to multiple pregnancies, or the number of sibling in the household.<br />Conclusion: The average age of mothers of children conceived by the IVF is higher than the average age of mothers of children who were conceived spontaneously. The structure of the morbidity of mothers of children who were artificially conceived and mothers of children born after spontaneous conception is the same, but the morbidity rate is higher in the mothers of children who were conceived by IVF. Pregnancies concieved by IVF almost exclusively ended by cesarean section. Premature rupture of the membranes is a common complication of IVF pregnancies. The rate of morbidity of prematurely born children conceived by ART is not higher than that of prematurely born children conceived naturally. The structure of morbidity in children from ART pregnancies was the same as in naturally conceived prematurely born children. The incidence of specific illnesses is the same, with the exception of bronchopulmonary dysplasia that occurs more frequently in children born from ART pregnancies, and retinopathy of prematurity that occurs more frequently in spontaneously conceived children. Maternal birth weight, intrauterine growth restriction, mother&#39;s age, maternal care, previous mother&#39;s chronic illness, mother&#39;s disease diagnosed during pregnancy, single and multiple pregnancies and PROM are potential risk factors for worse postnatal outcome in children from artificially initiated pregnancies. Risk factors for lower body weight in premature babies, at the age of 12 months, are: artificial conception, multiple pregnancy and intrauterine growth restriction. At the age of 12 months, prematurely born children from IVF pregnancies, have slightly worse (but not significantly lower) psychomotor achievements. At the age of 18 months, there is no difference in the indicators of physical development between prematurely born children who are artificially conceived and children born from spontaneous pregnancies. At the age of 18 months, prematurely born children from ART pregnancies have lower achievement on tests for assessing psychomotor development compared to prematurely born children from spontaneously initiated pregnancies. Risk factors associated with a poor performance on the psychomotor development assessment tests, in preterm infants, are an artificial conception of pregnancy and a multi fertile pregnancy. At the age of 24 months, there is no difference in the physical parameters between prematurely born children from ART and naturally conceived pregnancies. At the age of 24 months, there is no difference in the achievement on the test for the assessment of psychomotor development between children from ART and spontaneous pregnancies. At the age of 24 months, on the psychomotor development assessment, prematurely born children achieve the results consistent with their calendar age.</p>