Percepção de dor e habilidades funcionais em crianças de 4-6 anos de idade nascidas prematuras com experiência prévia de dor
Data
2018-04-13
Autores
Rodrigues, Adriana Cardoso 
Orientadores
Guinsburg, Ruth
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A exposição à dor repetitiva no período neonatal se associa a alterações da microestrutura cerebral e ao neurodesenvolvimento cognitivo, motor e comportamental mais pobre em prematuros. Objetivo: Analisar, em crianças com 4-6 anos de idade nascidas pré-termo, comparadas a nascidas a termo, se há associação entre o número de procedimentos dolorosos sofridos no período neonatal e a sensibilidade ao estímulo mecânico, a percepção subjetiva de dor e o desempenho funcional. Métodos: Coorte prospectiva de 28 prematuros nascidos de 28-32 semanas de idade gestacional sem malformações congênitas e sem hemorragia intracraniana grave, comparada a 28 crianças de termo saudáveis, todos entre 4-6 anos de idade. Os grupos foram comparados para os desfechos: teste de sensibilidade com o estesiômetro, percepção subjetiva de dor por meio de ilustrações relativas a dor física, dor relacionada a procedimentos médicos e dor decorrente de isolamento social, além de desempenho funcional com o Inventário de Avaliação Pediátrica de Incapacidade (PEDI). Utilizou-se a correlação linear entre os escores obtidos para cada desfecho e o número de procedimentos dolorosos no período neonatal e foi aplicada a análise de variância (ANOVA) para tais desfechos com dois fatores: classe socioeconômica (A/B ou C/D) e número de procedimentos dolorosos até 28 dias. Resultados: Não houve diferenças quanto à percepção de dor desencadeada por estímulo mecânico e à avaliação subjetiva da dor pela própria criança em situações hipotéticas de dor física, procedimentos médicos e situações psicossociais. Não foram encontradas correlações entre o número de procedimentos dolorosos no período neonatal e a avaliação de dor sentida pelas crianças entre 4-6 anos de idades em situações hipotéticas de dor física, dor decorrente de procedimentos médicos e dor psicossocial. Na análise multivariada, mais de 25 procedimentos dolorosos no período neonatal, em associação com o nível socioeconômico ampliou a percepção de dor desencadeada por situação de isolamento social. No que se refere ao desempenho funcional, o grupo pré-termo apresentou maior dificuldade para a execução dos itens relativos à mobilidade do que os nascidos a termo. Não foram encontradas correlações entre o número de procedimentos dolorosos e o escore do PEDI em todos os seus domínios. Na ANOVA, para os domínios autocuidados e mobilidade, houve pior desempenho das crianças de nível socioeconômico elevado (A/B) submetidas a mais de 25 procedimentos dolorosos no período neonatal, comparadas às que não receberam procedimentos dolorosos no período neonatal. Conclusão: A exposição a
procedimentos dolorosos repetitivos no período neonatal parece atuar em conjunto com fatores ambientais como um dos múltiplos moduladores do neurodesenvolvimento.
Introduction: Exposure to repetitive pain in the neonatal period is associated with changes in brain microstructure and poorer cognitive, motor and behavioral neurodevelopment in preterm infants. Objective: To study, in-4-6 years old children born preterm, compared to those born full-term, if there is an association between the number of painful procedures during the neonatal period and the sensitivity to mechanical stimulation, subjective pain perception and performance in activities of daily life. Methods: Prospective cohort study of 28 preterm infants with 28-32 weeks of gestational age without congenital malformations and without severe intracranial hemorrhage, compared to 28 healthy term infants, all aged 4-6 years old. The groups were compared for the following outcomes: sensitivity test for mechanical stimuli, subjective perception of pain in illustrations depicting physical pain illustrations, medical pain procedures and social isolation pain, as well as functional performance with the Pediatric Assessment Inventory of Disability (PEDI). Statistical analysis included linear correlation between the scores obtained for each outcome and the number of painful procedures in the neonatal period and analysis of variance (ANOVA) using as dependent variable each outcome and as independent factors the socioeconomic class (A/B or C/D) and number of painful procedures during the neonatal period. Results: There were no differences regarding pain perception triggered by mechanical stimuli and subjective pain evaluation by the children that scored the illustrations of physical pain, medical procedures and social isolation. No correlation was found between the number of painful procedures in the neonatal period and the assessment of pain by children for all hypothetical situations of pain. In the multivariate analysis, more than 25 painful procedures in the neonatal period, in association with the socioeconomic level, increased the perception of pain triggered by social isolation. Regarding functional performance, the preterm group presented greater difficulty in the execution of mobility-related items. No correlations were found between the number of painful procedures in the neonatal period and the PEDI score in all domains. In the multivariate analysis, for self-care and mobility domains, there was a worse performance of children of high socioeconomic level (A/B) who were exposed to more than 25 painful procedures in the neonatal period. Conclusion: Exposure to repetitive painful procedures in the neonatal period seems to act in conjunction with environmental factors as one of the multiple modulators of neurodevelopment of preterm infants.
Introduction: Exposure to repetitive pain in the neonatal period is associated with changes in brain microstructure and poorer cognitive, motor and behavioral neurodevelopment in preterm infants. Objective: To study, in-4-6 years old children born preterm, compared to those born full-term, if there is an association between the number of painful procedures during the neonatal period and the sensitivity to mechanical stimulation, subjective pain perception and performance in activities of daily life. Methods: Prospective cohort study of 28 preterm infants with 28-32 weeks of gestational age without congenital malformations and without severe intracranial hemorrhage, compared to 28 healthy term infants, all aged 4-6 years old. The groups were compared for the following outcomes: sensitivity test for mechanical stimuli, subjective perception of pain in illustrations depicting physical pain illustrations, medical pain procedures and social isolation pain, as well as functional performance with the Pediatric Assessment Inventory of Disability (PEDI). Statistical analysis included linear correlation between the scores obtained for each outcome and the number of painful procedures in the neonatal period and analysis of variance (ANOVA) using as dependent variable each outcome and as independent factors the socioeconomic class (A/B or C/D) and number of painful procedures during the neonatal period. Results: There were no differences regarding pain perception triggered by mechanical stimuli and subjective pain evaluation by the children that scored the illustrations of physical pain, medical procedures and social isolation. No correlation was found between the number of painful procedures in the neonatal period and the assessment of pain by children for all hypothetical situations of pain. In the multivariate analysis, more than 25 painful procedures in the neonatal period, in association with the socioeconomic level, increased the perception of pain triggered by social isolation. Regarding functional performance, the preterm group presented greater difficulty in the execution of mobility-related items. No correlations were found between the number of painful procedures in the neonatal period and the PEDI score in all domains. In the multivariate analysis, for self-care and mobility domains, there was a worse performance of children of high socioeconomic level (A/B) who were exposed to more than 25 painful procedures in the neonatal period. Conclusion: Exposure to repetitive painful procedures in the neonatal period seems to act in conjunction with environmental factors as one of the multiple modulators of neurodevelopment of preterm infants.
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Citação
RODRIGUES, Adriana Cardoso. Percepção de dor e habilidades funcionais em crianças de 4-6 anos de idade nascidas prematuras com experiência prévia de dor. 2018. 66 f. Tese (Doutorado em Pediatria) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2018.