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Title:
The influence on selected factors on the functional development of premature children
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Subject:
premature baby ; functional development ; Munich Functional Developmental Diagnostics
Abstract:
Introduction Prematurity remains a significant problem for both, less developed and highly developed countries. Annually, about 15 million babies are born under the 37th week of pregnancy. Technological improvements in Neonatal Intensive Care Units and the development of evidence-based medicine have become the main factors that have increased the survival rate of premature babies in the last 2-3 decades. Scientific reports inform us about the risk of premature birth, from severe neurological complications to minor disorders of psychomotor development. There are relatively few studies devoted exclusively to assessing the development of preterm babies without serious pulmonary and neurological complications. Objective of the work The main aim of the study was to evaluate the functional development of 2-year-old children born without serious preterm birth complications and who were hospitalized at a level III reference center after birth. Material and methods The study group consisted of 109 children aged 2 to 2,5 years old and their guardians. The group of premature babies comprised a total of 76 subjects, while the control group of babies born at full term comprised 32 subjects. Premature babies were divided into 3 groups according to the week of pregnancy end: very premature babies (n=29), moderately premature babies (n=32) and late premature babies (n=16). The research ; was carried out between July 2018 and January 2020 at the Outpatient Centre at the Neonatology Clinic of the University Hospital in Kraków, the Local Government Nursery No.33 in Krakow and the private physiotherapy practice Grzegorz Suder Physiotherapy in Liszki. The following methods were used for data collection: documentation analysis, diagnostic survey and evaluation of functional development based on the Munich Functional Developmental Diagnostics for the 2nd and 3rd year of life. The chi-square test was used to compare the value groups of the qualitative variables and the Kruskal Wallis test for the quantitative variables. The statistical analysis adopted non-parametric tests in all the functional development ranges studied based on the Shapiro-Wilk test. The results of the MFDR were analyzed between two groups using the Mann-Whitney U test and between three or more groups using the Kruskal-Wallis ANOVA ranking test. After detecting statistically significant differences, a post-hoc Wilcoxson analysis with Bonferroni correction was performed. The analysis of the strength of the correlation between the variables was performed using the Spearman's rho correlation. Finally, a multifactorial linear regression was performed in order to verify whether the studied relationships will remain statistically significant after taking into account factors whose distribution differs be ; tween the three defined groups of premature babies and which may also affect functional development. A statistical significance of α = 0,05 was assumed. The result of the analysis was therefore considered to be statistically significant if the p value determined on the basis of the test statistic is less than 0,05 (p ≤ 0,05). Results Full-term children achieved walking skills significantly earlier than very and moderate preterms. Full-term children obtained statistically significantly better results in the domain of manual dexterity than moderately premature children. In terms of perception development, full-term children obtained significantly better result than very, moderate and late preterms. On the other hand, in terms of the development of receptive and expressive speech, full-term children achieved significantly higher result in relation to moderately premature and late premature children. In the sphere of social development, full-term children obtained significantly better result than very, moderate, and late preterms. On the other hand, in the area of independence, full-term children acquired independence abilities significantly earlier than very and moderate preterms. In the author's own research, in all subgroups of children from I-IV, the analysis of the relationship between the expressive and receptive language development and manual dexterity showed a significa ; nt positive correlation (p <0,05, r> 0). The better the children performed in terms of speech development and comprehension, the greater the manual dexterity skills they demonstrated. Moreover, in each group of children examined, the analysis of the results showed a significantly positive (p <0,01, r> 0) correlation between speech comprehension and large motor development. Among the children studied, better speech comprehension scores were accompanied by higher walking age scores. The analysis indicated a significantly lower score of speech development, speech comprehension and the level of social age in boys compared to girls. It was also found that the place of residence did not affect the functional development of the preterm infants under study. The research demonstrated that premature children of mothers with higher education achieved significantly better results in terms of walking, perception, speech, social development and the level of independence compared to children born to mothers with secondary or primary education. On the other hand, children of fathers with higher education also performed significantly better, but only in terms of walking, social development and the level of independence compared to children of fathers with secondary or primary education. The analysis proved that the occupational dimension does not affect the development of manual skills, percep ; tion, speech, speech comprehension, social skills and the level of independence. Preterm infants who underwent infections during hospitalization obtained a lower result in terms of social development compared to those who were hospitalized without infection. In addition, there were no statistically significant differences between the functional development in 7 areas and premature babies from single, twin or triple pregnancies. Manual dexterity, speech development and comprehension as well as social level were statistically significantly lower among nursery children compared to children being in care at home. The statistical analysis also revealed that there are no differences in individual spheres of functional development depending on the number of siblings. The values of anthropometric measurements of the examined children were directly proportional to the level of development of walking age, manual skills, perception, speech comprehension, social skills and independence. The more the children in the study scored on the Apgar scale immediately after birth, the faster they developed in terms of walking, perception, speech comprehension, social development and independence. The duration of use of non-invasive nCPAP respiratory support also demonstrated a significant positive correlation (p <0,001, r> 0), but only in the development of walking, perception, social skills and i ; ndependence. The analysis of the relationship between the week of birth (hbd) of the examined children and the development in terms of walking age, perception, speech comprehension, social comprehension and independence showed a significant negative correlation (p <0,001, r <0). The later the child under the study was born, the higher his or her development was in the ranges given. Conclusions Preterm babies without serious complications are also at risk of delaying their functional development in various areas compared to their term-born peers. There was no significant delay observed in any area of functional development in very, moderate, late preterms.
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Rada Dyscypliny Nauki o zdrowiu
Promoter:
Gniadek, Agnieszka ; Kulesa-Mrowiecka, Małgorzata