ABSTRACT
Diseño: Cohorte histórica. Escenario: Programa de seguimiento de recién nacidos de riesgo en un hospital de nivel 1 de complejidad, con una población de estrato socioeconómico bajo de Cali entre 1989 y 1997. Población: Se incluyeron 287 lactantes que completaron un año de seguimiento en el programa. Intervenciones: No aplica. Desenlaces principales: Frecuencia de compromiso neuromotor estimado mediante la prueba de Infanib. Resultados: Al año se evaluaron 80% de los niños que eran parte del programa. En 39 (13.6%) hubo un Apgar anormal a los 5 minutos. En 36 (12.5%) presentaron convulsiones neonatales, asociadas principalmente con asfixia perinatal severa e hipoglicemia. La prueba de Infanib fue anormal en 47 niños para una incidencia acumulada de 16.4% y una densidad de incidencia de 1.3 casos nuevos por 100 lactantes-año. La presencia de convulsiones se asoció con un Infanib anormal (RR crudo = 2.39 IC 95% 1.37-4.16). No hay modificación de efecto entre Apgar bajo y convulsiones. De los potenciales modificadores de efecto sólo el antecedente de meningitis bacteriana confundió el estimativo de la asociación entre convulsiones y un Infanib anormal. Conclusiones: Tanto las convulsiones neonatales como la meningitis bacteriana se asociaron independientemente con un Infanib anormal al año. Las convulsiones son un factor de riesgo importante (RR ajustado = 2.51 IC 95% 1.10-5.72) y fácil de reconocer que permite al clínico identificar pacientes con alto riesgo de compromiso neuromotor durante el primer año de vida.
Objective: To assess the putative association between 5 minutes Apgar score, neonatal seizures and neurodevelopmental delay (Infanib test) performed at 1 year of corrected age. Design: Historic cohort. Setting: A first level hospital in Cali, Colombia (1989 to 1997); Subjects came from a low socioeconomic stratum population. Study subjects: A total of 287 infants who completed the 1 year follow up program were included. Interventions: not applicable Main outcome measures: Incidence (cumulative and density) of neuromotor abnormalities (abnormal Infanib test) at 1 year of age. Results: Compliance with program visits was 80%. Thirty nine (13.6%) infants presented low 5 minutes Apgar score. Thirty six (12.5%) infants presented neonatal seizures, associated mainly with neonatal asphyxia and hypoglicemia. Forty seven infants had an abnormal Infanib test (cumulative incidence 16.4% and incidence density 1.3 new cases per 100 infants-year). A significant association between neonatal seizures and an abnormal Infanib was found (RR crude 2.39 IC 95% 1.37-4.16). Low 5 minutes Apgar score is not an effect modifier neither a confounder of the association between neonatal seizures and an abnormal Infanib. Exploring the presence or absence of effect modification only bacterial meningitis, demonstrated a role as confounder for the association between seizures and Infanib results. Conclusions: Both neonatal seizures and bacterial meningitis were independently associated with abnormal Infanib results. Neonatal seizures are not only an important risk factor (adjusted RR = 2.51 IC 95% 1.10-5.72), but an easily identifiable one that can help the physician taking the medical history to identify patients at high risk for neuromotor abnormalities during the first year of life.
Subject(s)
Infant, Newborn , Apgar Score , Infant, Newborn , Motor Activity , SeizuresABSTRACT
Recent advances in the technology of neonatal intensive care have greatly improved the survival rate of high-risk infants who would otherwise have died. However, the surviving infants still have higher risks of long-term neuro-developmental disabilities such as cerebral palsy. As a result, early intervention programs are advocated for the detection and remediation of neuromotor abnormalities in risk infants. A number of assessment scales and screening tools have been developed for the evaluation of infant neuromotor functions in western countries. Infant Neurological International Battery(INFANIB) was established by Ellison and Browning in 1985. INFANIB consists of assessment of posture, extremity and axial tone, primitive reflexes and postural reactions. This is relatively simple and easier for examiner and less burdensome to examinee. So we have used INFANIB as assessment tool for the detection of neurodevelopmental abnormal infants since 1993 and studied correlation between INFANIB results and neuromotor outcome for 2 years in 70 risk infants. All the infants of the abnormal results group (29 cases) on the initial INFANIB examination grew into either cerebral palsy (26 cases) or minor neural dysfunction group (3 cases) on the follow-up examinations. All the infants of the normal results group (12 cases) appeared to be in normal developmental outcomes on the follow up. However, the transient results group (29 cases) showed variable outcomes, which were 9 cases of cerebral palsy, 6 cases of minor neural dysfunctions, and 11 cases of normal development. INFANIB test results of the infants were highly sensitive and specific with the follow up examinations. Normal INFANIB results can be used to reassure parents of risk infants and an early intervention programs can be started to abnormal INFANIB infants. It can be used as a reliable screening tool for suspicious neurologically deviant neonates and infants. However the transient groups showed diverse neuromotor outcomes, they should be carefully monitored during infancy and childhood.