Graziela Ferreira Biazus

Introducción. La hemorragia peri-intraventricular (HPIV) afecta a los bebés prematuros y es una de las principales causas de deficiencias neurológicas en esta población. Clasificada en cuatro grados, la forma leve (grados I y II) presenta resultados controvertidos en cuanto al impacto en el neurodesarrollo. Objetivo. Comparar el desempeño motor de prematuros con HPIV leve y prematuros sin PIVH nacidos en un hospital de referencia en Rio Grande do Sul. Método. Estudio retrospectivo comparativo compuesto por prematuros con HVIP leve y prematuros sin HVIP nacidos con edad gestacional (EG) menor de 36+6 semanas y que fueron internados en la UCI Neonatal del Hospital de Clínicas de Porto Alegre en los últimos 10 años. Se analizaron variables como grado PIVH, puntuación y clasificación del TIMP (Test of Infant Motor Performance) y características prenatales y neonatales como EG, peso al nacer y Apgar. Resultados. La muestra estuvo compuesta por 48 bebés, divididos equitativamente entre los dos grupos y emparejados por EG y sexo. No se encontraron diferencias estadísticamente significativas entre los grupos en relación al peso al nacer, peso en la evaluación, Apgar, EG en la evaluación, estado nutricional y rendimiento motor. Predominaron los individuos de sexo masculino con desarrollo motor atípico y los nacidos con EG menor de 32 semanas. La mitad de los prematuros del grupo sin HPIV presentaron un desempeño motor clasificado como atípico. Conclusión. No se encontraron diferencias significativas en relación al desempeño motor entre los grupos, lo que sugiere que la prematuridad, independientemente de la presencia de HPIV leve, puede ser decisiva para los cambios en el neurodesarrollo.

’Early intervention programs have continuously treated infants and their families during the lockdown caused by the COVID-19 pandemic via online platforms. Such remote treatment aimed to minimize the deleterious effects social isolation could bring to subjects in full development. Yet the results of this process ’were unknown, including toward a new approach to care. Thus, this study aimed to assess whether the positive effects of face-to-face early motor intervention on the motor development of at-risk infants mirror those in remote sessions. This comparative ex-post-facto study evaluated the motor development of at-risk infants by the Alberta Infant Motor Scale. All subscales showed significant differences from pre-to-post treatment in both groups, which were not different from each other. However, evaluating percentiles showed a statistically significant difference in the remote group. In the sample, 15 infants received face-to-face treatment and 15, remote care. This study aimed to investigate remote early physical therapy interventions due to the efficacy the home environment and the remote physical therapy guided by a professional.

RESUMO Sabe-se que os serviços de intervenção precoce (IP) trabalharam de forma contínua para atender remotamente bebês e suas famílias durante o confinamento causado pela pandemia de covid-19. O atendimento não presencial veio para minimizar os efeitos deletérios que essa limitação social pôde trazer aos sujeitos em pleno desenvolvimento, mas não se conhecia o resultado desse processo, nem mesmo para torná-lo uma nova abordagem de atendimento. Assim, o objetivo do estudo foi verificar se os efeitos positivos produzidos no desenvolvimento motor de bebês de risco pela intervenção motora precoce presencial foram os mesmos produzidos pela forma remota. Foi realizado um estudo ex-post-facto comparativo. Para avaliar o desenvolvimento motor dos bebês de risco, foi utilizada a Alberta infant motor scale (Aims). Pode-se observar em todas as subescalas que a diferença do pré para o pós foi significativa em ambos os grupos, que não diferiram entre si. No entanto, quando avaliado o percentil, a diferença é estatisticamente significativa no grupo remoto. Destes, 15 bebês faziam parte do grupo presencial e 15 bebês do grupo remoto. Os achados deste estudo propõem investigar os atendimentos de fisioterapia precoce no contexto remoto, uma vez que o ambiente domiciliar e a fisioterapia remota guiada por um profissional mostraram-se eficazes.

Background: Congenital syphilis (CS) is a transplacental infection that can lead to many long-term sequelae when not adequately treated; however, knowledge about the motor and neurological signs that newborns (NBs) with CS may present is scarce. Objective: The aim of this study was to describe the results of neurological assessment scales and general movements in NBs with CS in the first days of life. Methods: In this case-series, the Hammersmith Neonatal Neurological Examination (HNNE) and General Movements Assessment (GMA) scales were used to evaluate NBs under treatment for CS in a public Brazilian hospital in the first days of life. Results: The sample consisted of 11 NBs, with a mean birth weight of 3140.5 g, and an Apgar score at 5 min of 8.3. Among the 11 mothers, 4 (36.4%) had fewer than six prenatal visits and 5 (45.5%) did not receive any syphilis treatment. All NB (100%) were asymptomatic, with normal long bone X-rays and cerebrospinal fluid analysis. The mean score on the HNNE was 22 (suboptimal/abnormal). Eight NBs (72.7%) showed abnormalities on GMA scale (with six [54.5%] being mildly abnormal and two [18%] definitely abnormal). Only three NBs (27.3%) returned for outpatient follow-up. Conclusions: Neurological and motor evaluations were abnormal in most of the asymptomatic NBs under treatment for CS in the first days of life, when assessed through specific scales (HNNE and GMA). Most mothers did not receive adequate treatment for syphilis during pregnancy, and there were important deficiencies in post-discharge follow-up. Further studies are needed to confirm these findings and investigate whether the observed abnormalities are linked to biological or environmental factors during pregnancy.

Background: Congenital syphilis (CS) is a transplacental infection that an lead to many long-term sequelae when not adequately treated; however, knowledge about the motor and neurological signs that newborns (NB) with CS may present is scarce. Objective: To describe the results of neurological assessment scales and general movements in NB with CS in the first days of life. Methods: Cross-sectional study. The Hammersmith Neonatal Neurological Examination (HNNE) and General Movements Assessment (GMA) scales were used to evaluate NB under treatment for CS in a public Brazilian hospital in the first days of life. Results: Sample consisted of 11 NB, with a mean birth weight of 3140.5g, and Apgar score at 5 minutes of 8.3. Among the 11 mothers, 4 (36.4%) had fewer than 6 prenatal visits and 5 (45.5%) did not receive any syphilis treatment. All NB (100%) were asymptomatic, with normal long bone X-rays and cerebrospinal fluid analysis. The mean score on the HNNE was 22 (suboptimal/abnormal). Eight NB (72.7%) showed abnormalities on GMA scale (6 [54.5%] being mildly abnormal and 2 [18%] definitely abnormal. Only 3 NB (27.3%) returned for outpatient follow-up. Conclusions: A high prevalence of abnormalities in neurological and GMA scales was observed in NB with asymptomatic CS in the first days of life. Most mothers did not receive adequate treatment for syphilis during pregnancy, and there were important deficiencies in post-discharge follow-up. Further studies are needed to confirm these findings and investigate whether the observed abnormalities are linked to biological or environmental factors during pregnancy.

Objective The aim of this study was to evaluate the incidence of nasal injury in preterm newborns (NB) using the Neonatal Skin Condition Score within 7 days of noninvasive ventilation (NIV) and to compare the incidence of injury in NB weighing ≥1,000 g and those weighing <1,000 g at the time of initiation of NIV support. Methods This is a prospective, observational study carried out in a neonatal intensive care unit of a public hospital in Rio Grande do Sul from July 2016 to January 2021. Patients were stratified into two groups at the time of NIV initiation: group 1 (weight ≥1,000 g) and group 2 (weight <1,000 g). To assess the condition of nasal injury, a rating scale called the Neonatal Skin Condition Score was applied during the first seven consecutive days on NIV. Kaplan-Meier, log-rank test, and Cox proportional hazards regression were used to estimate the hazard ratio (HR) and 95% confidence interval (CI). Results In total, 184 NB were evaluated. Nasal injury was reported in 55 (30%) NB. The risk of nasal injury was 74% higher in group 2 (19/45) than in group 1 (36/139) (HR: 1.74; 95%CI 0.99–3.03, p=0.048). Conclusion The incidence of nasal injury in infants submitted to NIV by nasal mask was high, and the risk of this injury was greater in preterm infants weighing <1,000 g.

O Marco de Ação da Educação 2030 e boom tecnológico são de grande relevância na Educação Inclusiva (EI). Objetivo: realizar uma revisão sistemática sobre Tecnologia Assistiva (TA) na EI de escolares no processo de alfabetização. Fontes dos dados: revisão sistemática de artigos publicados nos últimos oito anos e disponíveis nas seguintes bases de dados: Pubmed, SciELO, Lilacs e Medline. A estratégia de busca incluiu a combinação das seguintes palavras-chave: inclusão educacional, equipamentos de autoajuda, dispositivos de auto ajuda, educação especial. Também incluiu os unitermos na língua inglesa: maintreaming child, education special, self-help devices child. A união dessas palavras foi feita sempre com o termo AND. Síntese dos dados: A estratégia de pesquisa resultou em 610 títulos listados e 124 selecionados para a revisão. Pela leitura do título e do resumo, 17 artigos foram selecionados e incluídos com a combinação TA na EI. A revisão possibilitou a análise de pesquisas no âmbito nacional e internacional. Participaram da análise 2881 alunos com necessidades educacionais especiais (NEEs), 391 pais e professores e 29 colaboradores da equipe de TA. Os principais resultados encontrados na revisão foram que a EI depende de diversas abordados tais como questões acadêmicas, comportamental, mobilidade / acessibilidade, social e transporte e deve haver maior compreensão sobre aplicação da TA na EI. Conclui-se que a EI deve ser parte integrante de um sistema educacional, permitir flexibilidade e adaptação curriculares para alunos com NEEs e a TA tem como benefício facilitar a inserção desses alunos no ambiente escolar.

Introduction: In neonatal therapy units, physical therapy is directed toward integral baby care. Objective: To describe the profile of newborns (NBs) hospitalized in a Neonatal Intensive Care Unit (NICU). Methods: Retrospective documentary study with data collection from medical records from July 2011 to July 2013. The sample consisted of NBs who performed motor and respiratory therapy. Data were grouped into five categories according to birth weight (≤ 1000g, 1001-1500g, 1501-2000g, 2001-2500g, ≥ 2501g). Results: total of 1,884 newborns were admitted to the NICU within the stipulated period, 168 (13.9%) underwent physical therapy. Of the 168 NBs who underwent physical therapy, 137 were born in the hospital (81.5%) and 31 were transferred there (18.5%); 17 of these babies died during the neonatal hospital stay (10.1%). All newborns of the extremely low birth weight group (≤ 1000g) required mechanical ventilation, 72.7% non-invasive ventilation and 16.6% high-frequency oscillatory ventilation. The occurrence of pneumothorax in the extremely low birth weight group was 13.8% and 16% in the group with birth weight 1001-1500g. Conclusion: Infants with low birth weight (<2500g) constituted the profile of NBs who underwent physical therapy, which was directly related to higher incidence of death and pneumothorax, as well as increased use of mechanical and non-invasive ventilation.