Length of stay in ICU may have impact on preterm babies’ behavior

Nov 30 2017

A study carried out at the Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), supported by FAPESP , indicates that the length of hospital stay in the neonatal ICU is the factor that best explains some of the behavioral problems related to the regulation axis emotional status of infants - regardless of the level of prematurity and the presence of pulmonary dysplasia and retinopathy of prematurity.

According to the research, whose results were published in the journal Early Human Development , stressful experiences related to neonatal pain can cause damage to the child's development both in early life and in later stages.

"In addition, the neonatal ICU environment has other factors that may impair child development, such as high noise, high brightness, repetitive tactile stimuli, and maternal separation," the researchers wrote.

The study examined effects of neonatal and sociodemographic characteristics on temperament and behavior in childhood in 100 preterm infants from 18 to 36 months of age with different levels of prematurity. All the infants participated in the program of care of the Neonatal ICU of the Hospital das Clínicas of Ribeirão Preto of FMRP-USP, where they were applied the temperament scale, which evaluates the temperament profile of these children, and a scale of indicators and behavior problems .

Predictors of behavioral patterns in adulthood

The study of 100 preterm infants found that those who needed to stay longer in the ICUs showed indicators of behavioral problems.

Maria Beatriz Martins Linhares, an associate professor at the FMRP-USP and study supervisor, explains that the initial phase is a kind of window of opportunity for development throughout the individual's life.

"Initial and emotional physiological regulation is a precursor to the series of behavioral regulation processes, so it is important to remember that from behavioral problems at this age it is possible to identify risk indicators of behavioral problems in adulthood. the six-year-old has a potential to prevent these problems, "he said.

The self-regulation process is completed at the age of five. However, at about 18 months, emotional regulation is improved, with subsequent behavioral regulation.

"Self-control emerges around three or four years of age with the development of the attention system, which is relevant to voluntary control, increasing the potential for regulating behavior," the authors write.

Already the temperament of the child usually changes throughout its development. "So with the typical development of the child, early reactive systems become increasingly regulated as fear-based and attention-directed control systems of inhibition mature," they said.

Linhares stresses that cognitive development involves not only physical growth and skills - in the areas of language, locomotion, motor - but also the affective, social and behavioral aspects. "So, just as motor development needs to be matched, behavioral indicators and temperament traits should also be."

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According to the World Health Organization, Brazil is the 10th country with the highest preterm birth rate.

As exhausting as the neonatal ICU is to the baby - including some painful procedures for it to gain weight and to be properly oxygenated (premature infants do not have fully formed lungs) - it is only in this environment and with the support of the multiprofessional team specializing in newborns -Mind that he can survive.

For the researchers, the finding confirms the need for developmental care programs in the structure of neonatal ICUs, both to reduce stressful and painful experiences and to improve protection strategies during the baby's initial development.

Methodology

The mothers of the babies who met the criteria for inclusion in the study - understanding how the instruments used for temperament assessment work - participated with interviews and responding to questionnaires.

Children with malformation, grade three of intracranial hemorrhage and with apparent cognitive problem did not participate in the study. Thirty-six participating children presented bronchopulmonary dysplasia and 63, severe retinopathy of prematurity, the most common diseases among premature infants.

"Previous studies have compared preterm and full-term infants, since preterm infants are more likely to have behavioral problems." In our study, we advanced the understanding of the development of preterm infants. we can develop strategies for protection, prevention and intervention to improve the development of these children, "said Rafaela Guilherme Monte Cassiano, a psychologist, doctoral student at the Department of Neurosciences and Behavioral Sciences at FMRP-USP and one of the authors of the study.