Detecção precoce de deficiências neuromotoras em lactentes prematuros e a termo nos primeiros quatro meses de idade: estudo coorte longitudinal

Abstract

Prematurity is a prevalent risk factor in Brazil and is associated with atypical neuromotor development in infants. Given this scenario, the importance of early detection becomes evident, particularly in facilitating timely referrals for effective interventions that can minimize the long-term effects on learning and motor coordination in preterm infants. In this context, early monitoring—particularly before four months of age—is crucial, as this is a period of heightened neural plasticity that precedes the manifestation of neuromotor impairments. The objective of this study was to identify neuromotor impairments in preterm and full-term infants at three and four months of age using the General Movement Assessment (GMA), Hammersmith Infant Neurological Examination (HINE), and Infant Motor Profile (IMP), and at six months using the HINE and IMP. This longitudinal observational study included 30 infants assessed at three and four months of age and reassessed at six months. Participants were divided into two groups: the Preterm Group (PG), comprising 15 infants born at less than 37 weeks of gestation, and the Control Group (CG), comprising 15 full-term infants born between 37 and 41 weeks of gestation. Four instruments were administered: the HINE, IMP, GMA, and the Affordances in the Home Environment for Motor Development–Infant Scale (AHEMD-IS). Descriptive and exploratory statistical analyses were conducted, including group comparisons and correlation tests, with a significance level set at 5%. Group comparison analyses revealed that the PG had significantly lower mean values for birth weight (p < 0.001), birth length (p < 0.001), and gestational age (p < 0.001) compared to the CG. A statistically significant difference was also observed in mean family income between groups (p = 0.031). The HINE identified significant differences between groups at three (p < 0.001), four (p < 0.001), and six months (p < 0.001), with lower mean scores in the PG at all time points. When combining the 'abnormal' and 'absent' categories of the GMA, 18% (n = 2) of the PG at three months and 14% (n = 1) at four months were classified as at risk. In the CG, 8.3% (n = 1) at three months and 14.3% (n = 1) at four months were also at risk. At six months, the PG had significantly lower mean IMP total scores compared to the CG (p < 0.001). Strong positive correlations were found between the AHEMD-IS stimulation variety subscale and several HINE subsections and IMP domains. Additionally, a moderate positive correlation was observed between the AHEMD-IS total score and both the HINE total score and overall IMP performance. In conclusion, the GMA, HINE, and IMP instruments effectively detected predictive markers of neuromotor developmental delays. Furthermore, the study demonstrated that the dimensions and total score of the AHEMD-IS are positively correlated with neuromotor development as assessed by the HINE and IMP. Among the 30 infants studied, six were identified with neuromotor impairments at six months of age based on assessments at three and four months. These infants were subsequently referred to follow-up programs and/or early intervention services.