Erdoğan KAVLAK, Fatih TEKİN, Mustafa BURAK

Investigation of Factors Affecting Neuromotor Behavior in Premature Neonates

Amaç: Prematüre infantlarda nörolojik muayeneler ve gelişimsel testlerle tespit edilen anormallikler, bebeğin yaşamını etkileyecek kadar ciddi veya geçici olabilir. Bu çalışmanın amacı prematüre yenidoğanlarda nöromotor davranışı etkileyen çeşitli faktörleri araştırmaktır. Gereç ve Yöntem: Çalışmaya prematürite tanısı ile tedavi gören 13 yenidoğan (E=6, K=7) dahil edildi. Olgulara ağrı değerlendirmesi, ağrı ve strese dayalı konfor değerlendirmesi ve nöromotor beceri değerlendirmesi yapıldı. Bulgular: Bebeğin doğumundan önceki 1 yıllık dönemde maternal psikolojik stresin varlığının ve bebeğin erkek cinsiyette olmasının, nöromotor davranışların gelişiminde gecikmelere neden olduğu görülmüştür (p<0,05). Solunum cihazına bağlı olarak respirasyon yapabilen infantlar, nöromotor davranış bakımından en kötü durumdadır (p<0,05). Prematüre yenidoğanın nöromotor davranış becerileri ile hamilelik süresi ve doğum ağırlığı arasında pozitif; ağrı ve konfor durumu ile ise negatif bir korelasyon mevcuttur (p<0,05). Nöromotor davranış becerileri ile Apgar Skoru arasında ise herhangi bir ilişki bulunamamıştır (p<0,05). Sonuç: Maternal psikolojik stresin varlığı, erkek cinsiyet, solunum cihazına bağlı solunum, ağrı varlığı ve daha kötü konfor durumu nöromotor becerileri olumsuz yönde etkiler. Buna karşılık emzirme yoluyla beslenme, daha uzun gebelik süresi ve daha yüksek doğum ağırlığı nöromotor becerileri olumlu yönde etkiler. Nöromotor beceriler ile Apgar Skoru ve doğum yöntemi arasında ise ilişki yoktur.

Anahtar Kelimeler:

Nöromotor Davranış, Prematürite, Ağrı, Konfor, Apgar Skoru

Investigation of Factors Affecting Neuromotor Behavior in Premature Neonates

Purpose: Abnormalities detected by neurological examinations and developmental tests performed in premature infants can be severe or transient, which may be severe enough to affect survival of baby. The aim of this study was to investigate various factors affecting neuromotor behavior in premature neonates. Materials and Methods: 13 neonates (M=6, F:7) who were treating for prematurity diagnosis included in the study. A pain assessment, comfort evaluation for pain and stress, and neuromotor skills assessment were performed to neonates. Results: Presence of maternal psychological stress during one-year period before birth of baby and male gender caused retardation in terms of neuromotor behavior (p<0.05). Infants whose respiration is depending on inhaler are the worst in neuromotor behavior (p<0.05). There was a positive correlation between neuromotor behavior skills of premature neonate and duration of pregnancy and birth weight, and negative correlation with pain and comfort status (p<0.05). There was no correlation between Apgar Score and neuromotor behavior (p<0.05). Conclusion: Presence of maternal psychological stress, male gender, respiration dependent on respiratory device, pain and worse comfort status adversely affect neuromotor skills. Conversely, breastfeeding, longer duration of pregnancy period, and higher birth weight positevely affect neuromotor skills. There is no relationship between neuromotor skills and Apgar Score; neuromotor skills and delivery method.

Keywords:

Neuromotor Behavior, Prematurity, Pain, Comfort, Apgar Score,

PDF

___

Ambuel, B., Hamlett, K.W., Marx, C.M., Blimer, J.L. (1992). Assessing distress in pediatric intensive care environments: The COMFORT Scale. Journal of Pediatric Psychology, 17, 95-109.
Can, G. & İnce, Z. (2002). Preterm doğanlar, intrauterin büyüme geriliği, makrozomi, çoğul gebelik. Neyzi O, Ertuğrul T (Editors). Pediatri 1. Nobel Tıp Kitapevi; 326-342, İstanbul.
Carmichael, K., Burns, Y., Gray, P., O'Callaghan, M. (1997). Neuromotor behavioural assessment of preterm infants at risk for impaired development. Aust J Physiother, 43(2), 101-107.
Dağoğlu, T., Yurdakök, M., Erdem, G. (Editors) (2004). Neonatoloji’de Prematürite, 123-129, Güneş Tıp Kitapevi, Ankara.
Francis, D,. Diorio, J., LaPlante, P., Weaver, S., Seckl, J.R., Meaney, M.J. (1996). The role of early environmental events in regulating neuroendocrine development. Moms, pups, stress, and glucocorticoid receptors. Ann N Y Acad Sci, 794, 136–152.
Graignic-Philippea, R., Dayan, J., Chokronb, S., Jacquetb, A.Y., Tordjmana, S. (2014). Effects of prenatal stress on fetal and child development: A critical literature review. Neuroscience and Biobehavioral Reviews, 43, 137–162.
Gunnar, M.R. (1998). Quality of early care and buffering of neuroendocrine stress reactions: potential effects on the developing human brain. Prev Med, 27(2), 208–211.
Hack, M., Wilson-Costello, D., Friedman, H., Taylor, G.H., Schluchter, M., Fanaroff, A.A. (2000). Neurodevelopment and predictors of outcomes of children with birth weights of less than 1000 g. Arch Pediatr Adolesc Med, 154, 725-731.
Hindmarsh, G.J., O’Callaghan, M.J., Mohay, H.A., Rogers, Y.M. (2000). Gender differences in cognitive abilities at 2 year in ELBW infants. Early Hum Dev, 60, 115-122.
Hoekstra, R.E., Ferrara, B., Couser, R.J., Payne, N.R., Connett, J.E. (2004). Survival and long-term neurodevelopmental outcome of extremely premature infants born at 2326 weeks’ gestational age at a tertiary center. Pediatrics, 113, e1-6.
Lawrence, J., Alcock, D., McGrath, P., Kay, J., MacMurray, S.B., Dulberg, C. (1993). The development of a tool to assess neonatal pain. Neonatal Network 12(6), 59–66.
Monique, A.A., Caljouw-Marguerite, A.C., Kloos-Madeleine, Y., Olivier-Ida, W., Heemskerk-Winke, C.R., Pison-Gerben, D., et al. (2007). Verhoef measurement of pain in premature infants with a gestational age between 28 to 37 weeks: Validation of the adapted COMFORT Scale. Journal of Neonatal Nursing, 13, 13-18.
Msall, M.E., Buck, G.M., Rogers, B.T., Duffy, L.C., Mallen, S.R., Catanzaro, N.L. (1993). Predictors of mortality, morbidity, and disability in a cohort of infants < or = 28 weeks' gestation. Clin Pediatr, 32, 521-527.
Nelson, K.B. & Ellenberg, J.H. (1981). Apgar scores as predictors of chronic neurologic disability. Pediatrics, 68, 36–44.
Noble, Y. & Boyd, R. (2012). Neonatal assessments for the preterm infant up to 4 months corrected age: a systematic review. Dev Med Child Neurol, 54(2), 129-139.
Schneider, M.L. (1992). Delayed object permanence development in prenatally stressed rhesus monkey infants (Macaca mulatta). Occup Ther J Res, 12, 96–110.
Schneider, M.L. & Coe, C.L. (1993). Repeated social stress during pregnancy impairs neuromotor development of the primate infant. J Dev Behav Pediatr, 14(2), 81–87.
The Apgar Score (2015). Committee Opinion No 644. American College of Obstetricians and Gynecologists. Obstet and Gynecol; 126(4), 52-55.
Van den Bergh, B.R., Mulder, E.J., Mennes, M., Glover, V. (2005). Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: links and possible mechanisms. A review. Neuroscience and Biobehavioral Reviews, 29, 237–258.
Vohr, B.R., Wright, L.L., Dusick, A.M., Mele, L., Verter, J., Steichen, J.J., et al. (2004). Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Developmental Neonatal Research Network, 1993-1994. Pediatrics, 105, 1216-1226.
Wood, N.S., Costeloe, K., Gibson, A.T., Hennessy, E.M., Marlow, N., Wilkinson, A.R. (2005). The EPICure study: associations and antecedents of neurological and developmental disability at 30 months of age following extremely preterm birth. Arch Dis Child Fetal Neonatal Ed, 90, F134-140.
Wood, N.S., Marlow, N., Costeloe, K., Gibson, A.T., Wilkinson, A.R., for the EPICure Study Group. (2000). Neurologic and developmental disability after extremely preterm birth. EPICure Study Group. N Eng J Med, 343, 378-384.
Woodward, L.J., Anderson, P.J., Austin, N.C., Howard, K., Inder, T.E. (2006). Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. New England Journal of Medicine, 355(7), 685-694.