Investigation of Factors Affecting Neuromotor Behavior in Premature Neonates

Year 2019, Volume: 7 Issue: 3, 179 - 186, 05.09.2019

Erdoğan Kavlak , Fatih Tekin , Mustafa Burak

https://doi.org/10.30720/ered.526931

Abstract

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.

Keywords

Nöromotor Davranış, Prematürite, Ağrı, Konfor, Apgar Skoru

Investigation of Factors Affecting Neuromotor Behavior in Premature Neonates

Abstract

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

References

• 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.