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Doctoral Thesis
DOI
https://doi.org/10.11606/T.61.2014.tde-09042015-092443
Document
Author
Full name
Tatiane Romanini Rodrigues Alencar
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Bauru, 2014
Supervisor
Committee
Marques, Ilza Lazarini (President)
Alonso, Nivaldo
Borgo, Hilton Coimbra
Moraes, Marcia Cristina Almendros Fernandes
Padula, Niura Aparecida de Moura Ribeiro
Title in Portuguese
O desenvolvimento neuropsicomotor de pacientes com Sequência de Robin isolada
Keywords in Portuguese
desempenho psicomotor
desenvolvimento infantil
Exame neurológico
síndrome de Pierre Robin.
Abstract in Portuguese
Objetivos: Avaliar o desenvolvimento neuropsicomotor de crianças com Sequência de Robin isolada (SRI), submetidas ao tratamento de obstrução das vias aéreas conforme protocolo do Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC/USP), com intubação nasofaríngea (INF) ou tratamento postural. Verificar se o desenvolvimento neuropsicomotor do grupo INF difere do grupo postural, e avaliar a eficácia da INF em evitar sequelas de hipóxia. Materiais e Métodos: Estudo prospectivo realizado no HRAC/USP, com crianças com SRI, de 2 a 6 anos, divididas em dois grupos de acordo com o tipo de tratamento realizado: INF (Grupo 1), e postural (Grupo 2). Dados do tempo de uso da INF e sonda nasogástrica (SNG), cirurgia de miringotomia, classificação socioeconômica, grau de escolaridade dos pais, entre outros, foram coletados. Os participantes foram avaliados por meio do Teste de Screnning de desenvolvimento de Denver II (Teste de Denver II) e Exame Neurológico Evolutivo Adaptado (ENEA). Resultados: Total de 62 crianças foram avaliadas, sendo 38 do Grupo 1 e 24 do Grupo 2. Os resultados do Teste de Denver II demonstraram que 73,7% das crianças do Grupo 1 e 79,2% do Grupo 2 apresentaram desenvolvimento normal. Os resultados do ENEA apresentaram-se normais para 89,5% das crianças do Grupo 1 e 87,5% do Grupo 2. Não houve diferença significativa entre os dois grupos no Teste de Denver (p=0,854) e no ENEA (p=0,789). Realizaram a miringotomia 47,3% das crianças do Grupo 1 e 58,3% do Grupo 2. Nos resultados dos dois testes, a área do desenvolvimento mais prejudicada foi a linguagem, o que pode ser reflexo das oscilações de audição e da disfunção velofaríngea. Houve concordância moderada (k=0,563) entre os resultados dos dois testes aplicados no Grupo 1, e concordância substancial (k=0,704) no Grupo 2. O tempo médio de uso da INF foi de 60 ± 28 dias. Na análise socioeconômica do Grupo 1, 42,1% se encaixavam na classificação baixa superior, e 28,9% na média inferior; no Grupo 2, 20,8% se encaixavam na baixa inferior, e 58,3% na baixa superior, sem diferença entre os grupos (p=0,211). Não houve associação significativa entre a classificação socioeconômica e os resultados dos testes de desenvolvimento aplicados. O nível de escolaridade mais encontrado entre os pais dos participantes foram: 3º grau completo (Grupo 1) e 2º grau completo (Grupo 2), sem diferença estatística entre os grupos. Conclusões: A maioria das crianças com SRI tratadas com INF apresentaram desenvolvimento neuropsicomotor normal, semelhante aos casos menos graves do grupo postural. As crianças tratadas com INF não apresentaram sinais clínicos evidentes de sequelas neurológicas da hipóxia.
Title in English
The neurological development of patients with isolated Robin Sequence.
Keywords in English
Child development
neurologic examination
Pierre Robin syndrome
psychomotor performance.
Abstract in English
Objectives: To assess the neurological and psychomotor development of children with Isolated Robin Sequence (IRS), submitted to the treatment of airway obstruction according to the protocol of the Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo (HRAC/USP), with nasopharyngeal intubation (NPI) or postural treatment. Verify if the neurodevelopment of the NPI group differs from postural group, and evaluate the effectiveness of NPI to prevent sequels of hypoxia. Materials and Methods: Prospective study conducted at HRAC/USP, with children SRI, with 2 to 6 years old, divided into two groups according to the type of treatment performed: NPI (Group 1) and postural (Group 2). Time data of use NPI, nasogastric tube (NGT), myringotomy surgery, socioeconomic status, education level of parents, among others, were collected. Participants were assessed through the development of Screnning Denver II Test (Denver II) and Neurologic Evolutionary Examination Adapted (NEEA). Results: The total of 62 children was evaluated, being 38 in the Group 1 and 24 in the Group 2. The results of the Denver Developmental Screening Test II showed that 73.7% of Group 1 and 79.2% of Group 2 presented with normal development. The results of NEEA had presented normal for 89.5% of children in the Group 1 and 87.5% in the Group 2. There was no significantly difference between the two groups at Denver Test (p=0.854) and in the NEEA Test (p=0.789). The myringotomy was performed by 47.3% of children in the Group 1 and 58.3% of children in the Group 2. The results showed language as the most impaired area, which may reflect fluctuations of hearing and velopharyngeal dysfunction. There was moderate agreement (k=0.563) between the results of the two tests applied in the Group 1, and substantial agreement (k=0.704) in the Group 2. The average time of use of the NPI was 60 ± 28 days. In the socioeconomic analysis of Group 1, 42.1% fit the low ranking higher, and 28.9% in the average lower. In the analyses of Group 2, 20.8% were in the low ranking lower, and 58.3% were in the low ranking the top. There was no different statistic between groups (p=0.211). There was no significant association between socioeconomic status and results of development tests performed. The levels of education most found between the participants parents were: completed graduation (Group 1), and secondary school (Group 2) with no statistical difference between groups. Conclusions: Most of children with IRS treated with NPI showed normal neurological and psychomotor development, similar of minor cases of postural group. The children treated with NPI didn't show evident clinical signs of neurological sequels of hypoxia.
 
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Publishing Date
2015-04-09
 
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