Estrategias de intervención en la UCI neonatal: un enfoque fisioterapéutico / Intervention strategies in the neonatal ICU: a physiotherapeutic approach

Resumen El fisioterapeuta a lo largo de su profesión ha ampliado el espectro de intervenciones y escenarios de desempeño, siendo uno de los más recientes el abordaje en la unidad de cuidado intensivo neonatal. Recientemente se han reportado en la literatura diferentes estrategias de intervención con el objetivo de lograr un desarrollo adecuado del neonato, tales como masaje, estimulación kinestésica, educación en el programa madre canguro, y maniobras de tórax. El objetivo del artículo fue revisar la información actual proveniente de la evidencia científica disponible sobre estas diferentes estrategias de intervención aplicadas en la unidad de cuidado intensivo neonatal, por lo que se realizó una revisión bibliográfica de los artículos encontrados entre febrero y agosto del 2019 en las bases de datos PUBMED y SCOPUS. Se obtuvieron 40 artículos que cumplieron los criterios de selección y que se incluyeron en la revisión. Finalmente, se concluye que estas estrategias de intervención fisioterapéutica contribuyen al logro de un desarrollo integral adecuado en el neonato. MÉD.UIS.2021;34(1): 63-72

Abstract The physiotherapist throughout his profession has broadened the spectrum of interventions and performance scenarios, one of the most recent being the approach in the neonatal intensive care unit. Recently, different intervention strategies have been reported in the literature with the aim of achieving adequate development of the newborn, such as massage, kinesthetic stimulation, education in the kangaroo mother program, and chest maneuvers. This article aimed to review the current information from the scientific evidence available on these different intervention strategies in the neonatal intensive care unit, so a bibliographic review of the articles found between February and August 2019 in PUBMED and SCOPUS databases was carried out. 40 articles which met the eligibility criteria were obtained and included in the review. Finally, it is concluded that these physiotherapeutic intervention strategies contribute to the achievement of an adequate integral development in the neonate. MÉD.UIS.2021;34(1): 63-72

The impact of anemia and body mass index (BMI) on neuromotor development of preschool children

Summary Objective: According to data from the World Health Organization (WHO), anemia is a prevalent health problem that leads to increased morbidity and mortality, especially in preschool children. Anemia is recognized as a major health problem due to its negative effects on the mental and physical development during childhood. The aim of our study was to determine the levels of anemia of children in a kindergarten affiliated to the Directorate of National Education using a non-invasive method, and to investigate the effects of anemia on the physical, mental and neuromotor development of children. Method: The levels of anemia was evaluated by using a non-invasive measurement device. Data collection was performed by means of a questionnaire to evaluate the children's physical development and set Denver Developmental Screening Test II scores. Results: Our findings show that 21% of non-anemic and 15% of anemic children are in the suspected abnormal group according to their DDST II total score. Furthermore, it has been identified that mild anemia has a positive effect on neuromotor development, while overweight and obesity affect neuromotor development in a negative way. Conclusion: According to the results obtained from the study, mild anemia may have a positive effect on the children's neuromotor development, while malnutrition could have a negative impact.

Maternal voluntary physical activity attenuates delayed neurodevelopment in malnourished rats.

NEW FINDINGS: What is the central question of this study? In the present study, a reproducible model of maternal voluntary physical activity was developed to evaluate the adaptive response of physical activity by attenuating the effects of maternal undernutrition on physical features, reflex ontogeny and growth trajectory of offspring during development. What is the main finding and its importance? Maternal physical activity may induce neuronal maturation of sensorimotor connections impacting on the patterns of locomotor activity in malnourished offspring. Thus, physical activity should be considered as a therapeutic means of countering the effects of maternal undernutrition, by providing a useful strategy for enhancing the neuronal activity of children born to mothers who experience a restricted diet during pregnancy. This study evaluated the effects of maternal voluntary physical activity during pregnancy and lactation on somatic growth (SG), reflex ontogeny (RO) and locomotor activity (LA) of rats whose mothers were protein restricted. Virgin female Wistar rats were divided into the following six groups: control, normal protein (C-NP, n = 4); control, low protein (C-LP, n = 4); inactive, normal protein (I-NP, n = 8); inactive, low protein (I-LP, n = 7); very active, normal protein (VA-NP, n = 8); and very active, low protein (VA-LP, n = 6). Voluntary physical activity was recorded daily in dams. The LP groups were fed an 8% casein diet, whereas control groups were fed a 17% casein diet during pregnancy and lactation. Offspring were evaluated in terms of SG (body weight and length, latero-lateral skull axis and anteroposterior head axis) and RO (palmar grasp, righting, free-fall righting, negative geotaxis, cliff avoidance, auditory startle response and vibrissa placing). The LA was evaluated at 23, 45 and 60 days old in the open field. Voluntary physical activity was reduced during pregnancy and lactation independent of the maternal diet. Pups from LP dams showed delayed SG, reflex maturation and patterns of LA when compared with control pups. The C-LP and I-LP pups showed a delayed SG, RO and LA. Pups from VA-LP mothers showed no delay in SG and RO and presented a faster development of patterns of LA. Maternal voluntary physical activity attenuated the effects of LP diet on indicators of neurodevelopment and patterns of LA of offspring.

Desenvolvimento neuromotor e dentição de crianças atendidas em serviços públicos de saúde do Brasil, no primeiro ano de vida / Neuromotor development and teething of children assisted in public health services in Brazil, in the first year of life

Este artigo tem como objetivo identificar, através da percepção materna, o desenvolvimento de crianças atendidas no primeiro ano de vida em serviços públicos de saúde do Brasil. Em entrevista com as mães, foram levantados sinais de desenvolvimento: firmar a cabeça, sentar, engatinhar, andar com ajuda ou sozinha, falar e dentição de 5655 crianças. As respostas categóricas (sim/não) foram avaliadas segundo associação com: idade e escolaridade maternas, idade gestacional no parto, peso ao nascer, estado nutricional e anemia da criança, aleitamento materno e uso de chupeta. Os resultados revelaram que a maior proporção de crianças apresenta-se atrasada em relação aos padrões estabelecidos pelo Ministério da Saúde para o desenvolvimento neuromotor e dentição. A prematuridade foi o fator mais freqüentemente associado a sinais de desenvolvimento não atingidos e a dentição foi o sinal mais sensível às mesmas variáveis. Verificou-se que parte dos resultados negativos talvez sejam conseqüência da dificuldade materna em identificar os sinais subjetivos de desenvolvimento. Sugere-se que um levantamento dos sinais de desenvolvimento seja realizado por profissionais treinados permitindo verificar critérios e/ou intervenções adequadas para modificar a situação encontrada(AU)

This article aims to estimate, through maternal perception, the prevalence of development signs, and determine associated risk factors among infants receiving routine health care in public clinics. The cross-sectional study included 5655 infants in the first year of life. The information regarding the child was obtained from the mother/caregiver by means of an interview. The development signs studied were: sustaining the head, seating, crawling, walking with some help or by itself, speaking, and also teething. The categorical answers (yes/no) were evaluated according to: maternal age and schooling, gestational age at childbirth, birth weight, child's nutritional status and anemia, breast-feeding, and use of pacifier. Results showed that most of the children are delayed according to the standards of neuromotor development and teething established by the Ministry of Health. Prematurity was the factor most often associated with non-reached development signs, and teething was the sign most frequently associated with the selected variables. It was verified that part of the negative results may be a consequence of the maternal difficulty in identifying subjective development signs. It is suggested that a survey to identify development signs is conducted by trained professionals to check criteria and/or adequate interventions to change the observed results.(AU)