Joan E. Sarnat at Psychoanalytic institute of Northern California. Joan E. Sarnat . O’Dea and Sarnat The Supervisory Relationship. (, pp. Air Pollution and Acute Respiratory Response in a Panel of Asthmatic. Children along the U.S.–Mexico Border. Stefanie Ebelt Sarnat,. 1. of newborns, several neurological scores have been created for newborns, such as the currently available Sarnat and. Sarnat,9 Thompson,10 and Garcia-Alix

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Comparison of chronological and corrected ages in the gross motor assessment of low-risk preterm infants during the first year of life. To evaluate the need of chronological age correction according to the degree of prematurity, when assessing gross motor development in preterm infants, during the sarmat year of life.

Cohort, observational and prospective study. Alberta Infant Motor Scale AIMS was used to evaluate 43 preterm infants with low risk for motor neurological sequelae, during the first year of corrected age. Mean scores were analyzed according to chronological and corrected ages. Children with motor neurological sequelae were excluded during follow-up.

Gross motor mean scores in preterm infants tended to be higher when corrected age was used compared with those obtained when using chronological age, during the first twelve months.

At thirteen months of corrected age, an overlapping of confidence intervals between corrected and chronological ages was observed, suggesting that from that period onwards correction for the degree of prematurity is no sxrnat necessary.

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Corrected age should be used for gross motor assessment in preterm infants during the first year of life. Estudo coorte, observacional e prospectivo.

Several pre and perinatal complications seen in preterm infants are well known risk factors for the development of future neurological disabilities. Not only do stress and medical complications make the premature births qualitatively different from full-term births, but also the long period in the incubator and the early influence of gravidity have an impact on preterm postural development at and after term There is still controversy among the studies in the literature whether the neurodevelopment of preterm without major neurological sequelae are either delayed ; accelerated 10,11 ; or equivalent to term infant development Some authors 13,14,16 have found that prematurity may jeopardize gross and fine motor development domains, while others 17 concluded that the major impact was on the mental skills.

Most studies ,16, addressing the developmental outcome of preterm infants have taken into account both chronological and corrected ages. Studies using correction point out that such procedure can overestimate the developmental progress in preterm infants, because most of the infants would be considered to be in the normal or relatively high-average level of development ,17,20, On the other hand, the use of chronological age would underestimate the developmental progress and there would be a higher rate of preterm infants reported as suspect, or functioning at a very low-average level, when they are in fact normal, leading to undesirable parental anxiety and over-referral for stimulation programs 9,16,17, In order to avoid unnecessary worries and to counter-balance the disadvantages of under and overestimation, some authors have suggested using both ages for developmental assessment 19, The Alberta Infant Motor Scale AIMS is a developmental assessment tool which was devised to evaluate infant gross motor skills, from birth to independent walking.

AIMS provides an evaluative index scores and percentile rank which measures changes in motor performance over time, before and after intervention and compares them with the norm raw data measures 22, The purpose of the study was to assess the gross motor development of preterm infants, with low-risk for major motor neurological problems, during the first year of corrected age, using the AIMS in order to evaluate the need for correction of chronological age for the degree of prematurity, during this period.

Fifty preterm inborn infants, with low risk for neurological problems, were consecutively enrolled in a non-randomized way, and followed prospectively until independent walking, from June to November Data from the first visit after hospital discharge until 13 months of corrected age were used for statistical analysis.

Infants were selected based on the mother willingness to participate in the study during the first follow-up visit, after hospital discharge. The attending population comes predominantly from low social economic classes, with urban characteristics. The Hospital Ethics Committee approved the study and a signed informed consent was obtained from all parents. Infants with major intraventricular hemorrhages grades III or IV of Papile 24moderate or severe neonatal hypoxic-ischemic encephalopathy 25cerebral malformations, genetic syndromes, visual or hearing deficits, or neonatal seizures were excluded.

Infants who developed neurological abnormalities spasticity, reflex abnormalities, hypotonia, motor deficits or seizures, during the follow-up period, were referred to neurological evaluation and, if it was confirmed, he was excluded from the study and assigned elsewhere to multidisciplinary intervention treatment.

All infants had neurological evaluations performed by one of the authors Classificacion at the end of the follow-up period, to assure that none had a major neurological abnormality motor delay, reflex abnormality, muscle tone abnormality, focal neurological signs. AIMS consists u 58 items organized into 4 postures: During the assessment, the infants were laid undressed either on the examining table or on a firm clasicicacion.


Younger infants, who did not assume or execute the positions independently, had to be placed. However xe facilitation, nor handling was allowed. In order to encourage and motivate the infants to move and explore the environment, verbal cues and toys were used.

Each assessment lasted 30 to 50 minutes in order to the infant have enough time to show his motor performance in the four positions. Gestational age GA was calculated based on the best obstetric estimate, in the following increasing order: Corrected age is calculated by subtracting the infant gestational age from 40 weeks and then subtracting this difference from the infant chronological age at the time of testing.

The first three assessment interval periods according to chronological age clasoficacion irregular days; days; daysbut from the fourth assessment onwards, the interval periods were 30 days apart. The negative interval periods used for corrected age assessments represents those that took place before term, while the subsequent assessments kept the chronological age interval pattern. Mean scores were calculated monthly, considering both chronological and corrected ages.

An additional line is provided in the Figures representing an estimate of mean scores. For this purpose, a nonlinear model was adjusted to the observed mean score values. The fitting was considered adequate if the coefficient of determination r 2 was higher than 0.

The program SPSS, version Forty-three preterm infants without major neurological abnormality completed the study and all were able to walk unaided before 18 months of corrected age. Seven infants were excluded during the follow-up: Table 1 shows the general data of the study group. The observed, estimated and confidence interval mean scores according to chronological and corrected ages for each of the interval periods are shown respectively, in Tables 2 and 3.

Gross motor development scores were higher after age correction compared with those obtained when chronological ages were used, as shown in Fig 1 by the lack of overlapping between the two curves during the first twelve months. At thirteen months of age, we observed an overlapping of the confidence intervals suggesting that from that period onwards age correction for the degree of prematurity is no longer necessary see also Tables 2 and 3.

Also, scores obtained when using chronological ages were lower in comparison with AIMS normative data, as shown in Fig 2 see also Tables 2 and 4. Furthermore, after age correction for the degree of prematurity our scores shifted upward and overlapped with AIMS normative ones as can be seen in Fig 3. There is much debate over the use of either corrected or chronological age scores to evaluate infant developmental level, most of them dealing with problems of reducing measurement errors.

Our results showed that, when using chronological age, motor development of preterm infants with low-risk for neurological disorders is underestimated during the first year of life, according to AIMS, leading to false-negative diagnostic of motor delay. The preterm infant gross motor development seems to maturate according to conceptional rather than chronological age. Therefore our data suggest, in accordance with other studies 7,8,20,27that correction of chronological age for the degree of prematurity is the best way to effectively evaluate preterm infants, as far as gross motor development is concerned.

Although some developmental assessment tools favor chronological age correction 28,29there are still controversies regarding the best correction method full or partial and its implications for intervention eligibility. Some 28 leave to the examiner the decision to administer the item based on either corrected or chronological age and to compare the normative sample to derive the standard scores.

Historia de la neonatología

Therefore, the same child may have different score outcome depending on the examiner approach, ranging sarnaf significant delay to normal We observed that our infants had chronological age mean scores lower than corrected age scores during the first year. Although the assessment tools used in other studies included only a few fine motor items as part of the developmental assessment and used flasificacion different measures of development, they agree with our results 13,14,16,17, Others 13,14 reported that when chronological age was used, preterm infant chronological and corrected mean scores were significantly lower than full-term.

We found that full age correction should be used to assess preterm motor development throughout the first year of corrected age. Siegel 21 used full correction only in the early months, whereas Lems et al. When assessing preterm motor development by Peabody Developmental Motor Scale, age correction should be used at least up to 18 months of age 13but in an earlier study, the same author 14 reported the need for correcting up to one year.

All these studies have justified the correction procedure due to the fact that it could increase the specificity of the assessment tool for identifying preterm infants with real motor delay 13,14,17, Although we were not able to verify whether partial age correction would clasificacin more appropriate to assess motor development during the first year of corrected age, we observed a tendency of the chronological age curve to reach aarnat corrected age curve during the last months of the first year of life, a fact that would suggest that partial correction would be possible during this age period.

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However, further studies should be done in order to investigate when and how partial correction should be applied, and if this procedure depends only on the degree of prematurity. The use of full correction, partial, or no correction is based on two theoretical points of view on sarnar maturation.

The biological perspective states that development is determined by the maturation of central nervous system, independently of environmental influences Correction for the degree of prematurity was devised to decrease the transient delay in preterm infant development until they catch up with their full-term peers.

The environmental perspective favors using chronological age, as it places higher importance on the role of external factors in the development of preterm infants 30,32 while partial correction intends to counter-balance the full correction and no correction approaches.

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Regardless of the theoretical framework it is unclear to what extent medical factors have negative effects beyond gestational age or to what extent environmental factors accelerate or inhibit the developmental functioning of preterm infants. Not only have the studies 12, differed as to when overestimation has occurred, but they have also reached conflicting conclusions regarding the clasifiaccion of whether or not to use both ages.

Whereas some studies 12,20 suggested using only corrected age, as it sarnta be a more sensitive index of developmental delay, others 19,21 supported using both ages during the first year. The decrease in the sensitivity in the assessment tool sarnaf using corrected age, and the advantages of increasing sensitivity to correctly identify the neurological abnormal preterm infants were the most often cited arguments. The main clinical implication of correction of chronological age for the degree of prematurity is that this could postpone the diagnosis of a developmental delay, as it may lead to overestimation of the infant development, whereas when no correction is used this could underestimate it, particularly, in extremely preterm infants.

On the other hand, overdiagnosis of a developmental delay leads to unnecessary referrals to sarbat interventions, which in turn, creates unwarranted anxiety for the parents 19, We observed that there was an overlap of chronological and corrected age mean scores confidence intervals at thirteen month of age Fig 1showing that, from this age onwards, correction for the degree of prematurity is no longer necessary.

We do not know whether this pattern is maintained further on, because we did not study the motor developmental behavior beyond this age. All infants had been assessed by a pediatric neurologist after walk attainment to exclude infants with major neurological signs of cerebral palsy. However, further investigations should be done to investigate whether the infants that have performed different from the average, may be predictive to minor neurological signs.

A neurodevelopmental assessment tool should be able to discriminate correctively infants with neuromotor delay from those with normal development. Our results suggest that, when using AIMS, scores should be corrected for the degree of prematurity to more accurately identify infants with real delay, which is in agreement with AIMS criteria Several infants missed one or more assessments during the study period for different reasons.

Monthly assessments, at the outpatient clinic, were jeopardized due to the fact that our children came from low social economic background, lived in the periphery of the city, and were difficult to get in touch by phone.

Historia de la neonatología | Blog de Angelita

Additionally, they were infants without major neurological abnormalities, a fact against a natural motivation for a periodic neurodevelopmental assessment. However, we believe that our results were not likely clasificacin be affected as the assessments were frequent throughout the study period.

Most of cohort studies that deal with preterm follow-up assessments in the first two years of age do not analyze data monthly , Children with cerebral palsy were excluded during follow-up, because the objective of the study was to study the motor development of preterm with low-risk for neurological disorders. The inclusion clzsificacion these infants would have lowered the observed mean scores and underestimated motor development of the whole clasificacionn.

Besides, AIMS is a scale that was not devised to monitor motor development of clasjficacion with neurological abnormalities We conclude that full correction of chronological age for the degree of prematurity should be used when assessing preterm infants gross motor development during the first year of corrected age. Hack M, Fanaroff AA. Early Hum Dev ; Risk factors of cerebral palsy in preterm infants. Am J Phys Med Rehabil ; Change in cognitive function over time in very low-birth- weight infants.

Sweeney KJ, Gutierrez T.