Ultra-sonografia cerebral neonatal normal no prematuro - é possível tranqüilizar os pais?

Abstract

Objective To evaluate the predictive value of neonatal cerebral ultrasonography for motor and cognitive development of very low birth weight preterm babies after twelve months corrected age. Methods

We studied a cohort of preterm babies with birth weight less than 1500g admitted to the Neonatal Intensive Care Unit of Instituto Fernandes Figueira, and followed up to 12-30 months corrected age for prematurity. A cerebral ultrasonography was performed before discharge. The results were classified as normal and abnormal (parenchymal hemorrhage, porencephaly, periventricular leucomalacia, ventricular dilatation). The babies were followed up at the Outpatient Follow-up Clinic and, between 12-30 months corrected age, underwent neurological assessment, observation of the acquisition of motor milestones, and assessment according to the Bayley Scales of Development. Results: We studied 83 babies. Cerebral ultrasonography was normal in 68 babies (81.9%) and abnormal in 15 (18.8%). At a mean age of 21 months, 63 children (75.9%) had normal motor development and 20 (24.0%) had motor abnormalities. The cognitive development was normal in 68 children (81.9%). The negative predictive value of the cerebral ultrasonography for motor development was 85.3%, and for cognitive development, 86.8%. The positive predictive value of the cerebral ultrasonography for motor development was 66.7%, and for cognitive development, 42.9%. Conclusions: The negative predictive values were greater than the positive predictive values in both areas of development. The probability that children with normal neonatal ultrasonography have normal motor and cognitive development is greater than 85%.

To evaluate the predictive value of neonatal cerebral ultrasonography for motor and cognitive development of very low birth weight preterm babies after twelve months corrected age. Methods

We studied a cohort of preterm babies with birth weight less than 1500g admitted to the Neonatal Intensive Care Unit of Instituto Fernandes Figueira, and followed up to 12-30 months corrected age for prematurity. A cerebral ultrasonography was performed before discharge. The results were classified as normal and abnormal (parenchymal hemorrhage, porencephaly, periventricular leucomalacia, ventricular dilatation). The babies were followed up at the Outpatient Follow-up Clinic and, between 12-30 months corrected age, underwent neurological assessment, observation of the acquisition of motor milestones, and assessment according to the Bayley Scales of Development. Results: We studied 83 babies. Cerebral ultrasonography was normal in 68 babies (81.9%) and abnormal in 15 (18.8%). At a mean age of 21 months, 63 children (75.9%) had normal motor development and 20 (24.0%) had motor abnormalities. The cognitive development was normal in 68 children (81.9%). The negative predictive value of the cerebral ultrasonography for motor development was 85.3%, and for cognitive development, 86.8%. The positive predictive value of the cerebral ultrasonography for motor development was 66.7%, and for cognitive development, 42.9%. Conclusions: The negative predictive values were greater than the positive predictive values in both areas of development. The probability that children with normal neonatal ultrasonography have normal motor and cognitive development is greater than 85%.

Methods

We studied a cohort of preterm babies with birth weight less than 1500g admitted to the Neonatal Intensive Care Unit of Instituto Fernandes Figueira, and followed up to 12-30 months corrected age for prematurity. A cerebral ultrasonography was performed before discharge. The results were classified as normal and abnormal (parenchymal hemorrhage, porencephaly, periventricular leucomalacia, ventricular dilatation). The babies were followed up at the Outpatient Follow-up Clinic and, between 12-30 months corrected age, underwent neurological assessment, observation of the acquisition of motor milestones, and assessment according to the Bayley Scales of Development. Results: We studied 83 babies. Cerebral ultrasonography was normal in 68 babies (81.9%) and abnormal in 15 (18.8%). At a mean age of 21 months, 63 children (75.9%) had normal motor development and 20 (24.0%) had motor abnormalities. The cognitive development was normal in 68 children (81.9%). The negative predictive value of the cerebral ultrasonography for motor development was 85.3%, and for cognitive development, 86.8%. The positive predictive value of the cerebral ultrasonography for motor development was 66.7%, and for cognitive development, 42.9%. Conclusions: The negative predictive values were greater than the positive predictive values in both areas of development. The probability that children with normal neonatal ultrasonography have normal motor and cognitive development is greater than 85%.

Results

We studied 83 babies. Cerebral ultrasonography was normal in 68 babies (81.9%) and abnormal in 15 (18.8%). At a mean age of 21 months, 63 children (75.9%) had normal motor development and 20 (24.0%) had motor abnormalities. The cognitive development was normal in 68 children (81.9%). The negative predictive value of the cerebral ultrasonography for motor development was 85.3%, and for cognitive development, 86.8%. The positive predictive value of the cerebral ultrasonography for motor development was 66.7%, and for cognitive development, 42.9%. Conclusions: The negative predictive values were greater than the positive predictive values in both areas of development. The probability that children with normal neonatal ultrasonography have normal motor and cognitive development is greater than 85%.

Conclusions

The negative predictive values were greater than the positive predictive values in both areas of development. The probability that children with normal neonatal ultrasonography have normal motor and cognitive development is greater than 85%.

Resumen

Objetivo

Verificar os valores preditivos da ultra-sonografia cerebral neonatal em relação ao desenvolvimento motor e cognitivo de prematuros de muito baixo peso após os 12 meses de idade corrigida.

Métodos

A população foi constituída de uma coorte de prematuros com peso de nascimento inferior a 1.500g, oriundos da UTI Neonatal do Instituto Fernandes Figueira, acompanhados até completarem 12 a 30 meses de idade corrigida para a prematuridade. Próximo à alta hospitalar, realizou-se a ultra-sonografia cerebral. Os resultados foram classificados em normal e anormal (hemorragia parenquimatosa, porencefalia, leucomalácia, dilatação ventricular). Os bebês foram acompanhados no Ambulatório de Seguimento e, entre 12 e 30 meses de idade corrigida, foram submetidos à avaliação neurológica, observação da aquisição dos marcos motores do desenvolvimento e aplicação da Escala de Bayley de desenvolvimento.

Resultados

A população em estudo foi constituída de 83 crianças. Os exames ultra-sonográficos foram normais em 68 bebês (81,9%) e anormais em 15 (18,0%). Com idade média de 21 meses, 63 crianças (75,9%) apresentaram desenvolvimento motor normal e 20 (24,0%), alterações motoras. O desenvolvimento cognitivo foi normal em 68 crianças (81,9%). O valor preditivo negativo da ultra-sonografia em relação ao desenvolvimento motor foi de 85,3% e em relação ao desenvolvimento cognitivo, 86,8%. O valor preditivo positivo da ultra-sonografia cerebral em relação ao desenvolvimento motor foi de 66,7% e ao cognitivo,42,9%.

Conclusões

Os valores preditivos negativos foram superiores aos positivos nas duas áreas do desenvolvimento. Diante de um resultado ultra-sonográfico normal, a probabilidade de a criança ter desenvolvimento motor e cognitivo normais é superior a 85%.