VALOR PREDITIVO DA GENERAL MOVEMENTS ASSESSMENT NA AVALIAÇÃO NEUROLÓGICA DE RECÉM-NASCIDOS PRÉ-TERMO: UMA METANÁLISE

Pires, Camila da Silva; Marba, Sérgio Tadeu Martins; Caldas, Jamil Pedro de Siqueira; Stopiglia, Mônica de Carvalho Sanchez

Acessibilidade / Reportar erro

Brasil

Revista Paulista de Pediatria

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Brasil

Español English

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Sumário

ARTIGO DE REVISÃO • Rev. paul. pediatr. 38 • 2020 • https://doi.org/10.1590/1984-0462/2020/38/2018286 copiar

VALOR PREDITIVO DA GENERAL MOVEMENTS ASSESSMENT NA AVALIAÇÃO NEUROLÓGICA DE RECÉM-NASCIDOS PRÉ-TERMO: UMA METANÁLISE

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo:

Analisar o valor preditivo da General Movements Assessment para o diagnóstico de alterações do neurodesenvolvimento em recém-nascidos pré-termo.

Fonte de dados:

Foi realizada uma revisão sistemática da literatura utilizando as bases de dados: Scientific Electronic Library Online (SciELO), National Library of Medicine, National Institutes of Health (PubMed) e Excerpta Medica Database (EMBASE). Os artigos foram filtrados por idioma, ano de publicação, população de interesse, utilização do Método Prechtl de avaliação e presença das variáveis relacionadas ao valor preditivo da escala. O Quality Assessment of Diagnostic Accuracy Studies 2 foi utilizado para avaliar a metodologia dos artigos. Foi realizado o cálculo de sensibilidade, especificidade, Diagnostic Odds Ratio, razão de verossimilhanças positiva e negativa e parâmetro de acurácia.

Síntese dos dados:

Foram incluídos seis artigos dentre os 342 encontrados. A escala, quando realizada no período Writhing Movements, possui bom poder discriminativo para o desfecho paralisia cerebral, com valores elevados de sensibilidade e acurácia. Quando realizada no período Fidgety Movements, possui maior valor preditivo para paralisia cerebral, com valores elevados em todas as medidas de acurácia diagnóstica. O risco de viés foi considerado elevado na seleção de pacientes e no fluxo e momento da avaliação. Desse modo, a escala tem potencial para detectar indivíduos que evoluíram com alterações do neurodesenvolvimento, porém, os artigos apresentaram limitações quanto à seleção dos sujeitos e à forma de avaliação do desfecho neurológico.

Conclusões:

Apesar dos altos valores preditivos descritos para identificação de alterações neurológicas, novas pesquisas são necessárias, devido à heterogeneidade dos estudos e ao método de avaliação a longo prazo do neurodesenvolvimento.

Palavras-chave:
Exame neurológico; Recém-nascido prematuro; Prognóstico; Paralisia cerebral

Autor, ano	Desenho do estudo	Época da avaliação GMA	Avaliação final (meses)	Escala de avaliação	Desfecho
Olsen et al.²³23. Olsen JE, Allinson LG, Doyle LW, Brown NC, Lee KJ, Eeles AL, et al. Preterm and term-equivalent age general movements and 1-year neurodevelopmental outcomes for infants born before 30 weeks’ gestation. Dev Med Child Neurol. 2018;60:47-53. https://doi.org/10.1111/dmcn.13558 https://doi.org/https://doi.org/10.1111/...	Ensaio clínico descritivo longitudinal	WM	12	AIMS, NSMDA, TINE	Disfunção neurológica
Dimitrijević et al.²⁴24. Dimitrijević L, Bjelaković B, Čolović H, Mikov A, Živković V, Kocić M, et al. Assessment of general movements and heart rate variability in prediction of neurodevelopmental outcome in preterm infants. Early Hum Dev. 2016;99:7-12. https://doi.org/10.1016/j.earlhumdev.2016.05.014 https://doi.org/https://doi.org/10.1016/...	Ensaio clínico descritivo longitudinal	WM FM	24	TINE	PC
Spittle et al.²⁵25. Spittle AJ, Spencer-Smith MM, Cheong JL, Eeles AL, Lee KJ, Anderson PJ, et al. General movements in very preterm children and neurodevelopment at 2 and 4 years. Pediatrics. 2013;132:e 452-8. https://doi.org/10.1542/peds.2013-0177 https://doi.org/ttps://doi.org/10.1542/p...	Ensaio clínico descritivo longitudinal	WM FM	24, 48	BAYLEY MABC-2 DAS-II	PC
Sustersic et al.²⁶26. Sustersic B, Sustar K, Paro-Panjan D. General movements of preterm infants in relation to their motor competence between 5 and 6 years. Eur J Paediatr Neurol. 2012;16:724-9. https://doi.org/10.1016/j.ejpn.2012.05.008 https://doi.org/https://doi.org/10.1016/...	Ensaio clínico descritivo longitudinal	WM FM	60-72	M-ABC	Disfunção neurológica
Burger et al.²⁷27. Burger M, Frieg A, Louw QA. General movements as a predictive tool of the neurological outcome in very low and extremely low birth weight infants--a South African perspective. Early Hum Dev. 2011;87:303-8. https://doi.org/10.1016/j.earlhumdev.2011.01.034 https://doi.org/https://doi.org/10.1016/...	Ensaio clínico descritivo longitudinal	FM	12	PDMS-II AIMS	PC
Spittle et al.²⁸28. Spittle AJ, Boyd RN, Inder TE, Doyle LW. Predicting motor development in very preterm infants at 12 months’ corrected age: the role of qualitative magnetic resonance imaging and general movements assessments. Pediatrics. 2009;123:512-7. https://doi.org/10.1542/peds.2008-0590 https://doi.org/https://doi.org/10.1542/...	Ensaio clínico descritivo longitudinal	WM FM	12	AIMS, NSMDA	Disfunção neurológica PC

Desfecho	Artigo	n	Idade (Média)	Peso (Média)	SENS (IC95%)	ESP (IC95%)	DOR (IC95%)	LR+ (IC95%)	LR- (IC95%)
PC	Dimitrijević et al.²⁴24. Dimitrijević L, Bjelaković B, Čolović H, Mikov A, Živković V, Kocić M, et al. Assessment of general movements and heart rate variability in prediction of neurodevelopmental outcome in preterm infants. Early Hum Dev. 2016;99:7-12. https://doi.org/10.1016/j.earlhumdev.2016.05.014 https://doi.org/https://doi.org/10.1016/...	79	NF	NF	0,958 (0,699-0,996)	0,717 (0,602-0,810)	58,385 (3,28-1039,6)	3,391 (2,287-5,029)	0,058 (0,004-0,879)
	Spittle et al.²⁵25. Spittle AJ, Spencer-Smith MM, Cheong JL, Eeles AL, Lee KJ, Anderson PJ, et al. General movements in very preterm children and neurodevelopment at 2 and 4 years. Pediatrics. 2013;132:e 452-8. https://doi.org/10.1542/peds.2013-0177 https://doi.org/ttps://doi.org/10.1542/p...	99	27,3 ± 1,5	1008 ± 265	0,969 (0,759-0,997)	0,465 (0,363-0,570)	26,912 (1,56-464,43)	1,810 (1,457-2,248)	0,067 (0,004-1,039)
	Spittle et al.²⁸28. Spittle AJ, Boyd RN, Inder TE, Doyle LW. Predicting motor development in very preterm infants at 12 months’ corrected age: the role of qualitative magnetic resonance imaging and general movements assessments. Pediatrics. 2009;123:512-7. https://doi.org/10.1542/peds.2008-0590 https://doi.org/https://doi.org/10.1542/...	86	27,3 ± 1,5	1014 ± 265	0,917 (0,517-0,991)	0,421 (0,320-0,529)	7,989 (0,43-149,34)	1,582 (1,168-2,144)	0,198 (0,014-2,848)
Disfunções neurológicas menores	Olsen et al.²³23. Olsen JE, Allinson LG, Doyle LW, Brown NC, Lee KJ, Eeles AL, et al. Preterm and term-equivalent age general movements and 1-year neurodevelopmental outcomes for infants born before 30 weeks’ gestation. Dev Med Child Neurol. 2018;60:47-53. https://doi.org/10.1111/dmcn.13558 https://doi.org/https://doi.org/10.1111/...	137	27,8±1,5	1031 ± 262	0,764 (0,655-0,846)	0,362 (0,256-0,483)	1,828- (0,875-3,821)	1,196 (0,957-1,494)	0,654 (0,388-1,102)
	Spittle et al.²⁵25. Spittle AJ, Spencer-Smith MM, Cheong JL, Eeles AL, Lee KJ, Anderson PJ, et al. General movements in very preterm children and neurodevelopment at 2 and 4 years. Pediatrics. 2013;132:e 452-8. https://doi.org/10.1542/peds.2013-0177 https://doi.org/ttps://doi.org/10.1542/p...	99	27,3 ± 1,5	1008 ± 265	0,969 (0,759-0,997)	0,465 (0,363-0,570)	26,912 (1,56-464,43)	1,810 (1,457-2,248)	0,067 (0,004-1,039)
	Sustersic et al.²⁶26. Sustersic B, Sustar K, Paro-Panjan D. General movements of preterm infants in relation to their motor competence between 5 and 6 years. Eur J Paediatr Neurol. 2012;16:724-9. https://doi.org/10.1016/j.ejpn.2012.05.008 https://doi.org/https://doi.org/10.1016/...	45	31,6 ± 3,3	1788 ± 718	0,833 (0,584-0,947)	0,359 (0,217-0,532)	2,805 (0,60-13,06)	1,301 (0,922-1,836)	0,464 (0,137-1,575)
	Spittle et al.²⁸28. Spittle AJ, Boyd RN, Inder TE, Doyle LW. Predicting motor development in very preterm infants at 12 months’ corrected age: the role of qualitative magnetic resonance imaging and general movements assessments. Pediatrics. 2009;123:512-7. https://doi.org/10.1542/peds.2008-0590 https://doi.org/https://doi.org/10.1542/...	86	27,3 ± 1,5	1014 ± 265	0,790 (0,619-0,897)	0,482 (0,358-0,609)	3,514 (1,281-9,636)	1,527 (1,121-2,081)	0,435 (0,209-0,906)

Desfecho	Artigo	n	Idade (Média)	Peso (Média)	SENS (IC95%)	ESP (IC95%)	DOR (IC95%)	LR+ (IC95%)	LR- (IC95%)
PC	Dimitrijević et al.²⁴24. Dimitrijević L, Bjelaković B, Čolović H, Mikov A, Živković V, Kocić M, et al. Assessment of general movements and heart rate variability in prediction of neurodevelopmental outcome in preterm infants. Early Hum Dev. 2016;99:7-12. https://doi.org/10.1016/j.earlhumdev.2016.05.014 https://doi.org/https://doi.org/10.1016/...	79	NF	NF	0,958 (0,699-0,996)	0,848 (0,745-0,914)	128,143 (7,004-2344,4)	6,298 (3,564-11,128)	0,049 (0,003-0,743)
	Spittle et al.²⁵25. Spittle AJ, Spencer-Smith MM, Cheong JL, Eeles AL, Lee KJ, Anderson PJ, et al. General movements in very preterm children and neurodevelopment at 2 and 4 years. Pediatrics. 2013;132:e 452-8. https://doi.org/10.1542/peds.2013-0177 https://doi.org/ttps://doi.org/10.1542/p...	99	27,3 ± 1,5	1008 ± 265	0,969 (0,759-0,997)	0,912 (0,832-0,956)	320,333 (17,36-5905,0)	10,979 (5,512-21,868)	0,034 (0,002-0,525)
	Burger et al.²⁷27. Burger M, Frieg A, Louw QA. General movements as a predictive tool of the neurological outcome in very low and extremely low birth weight infants--a South African perspective. Early Hum Dev. 2011;87:303-8. https://doi.org/10.1016/j.earlhumdev.2011.01.034 https://doi.org/https://doi.org/10.1016/...	115	30 ± 2,1	1039,30 ± 160,6	0,850 (0,541-0,965)	0,977 (0,928-0,993)	236,867 (27,83-2016,4)	36,380 (10,4-127,3)	0,154 (0,035-0,672)
	Spittle et al.²⁸28. Spittle AJ, Boyd RN, Inder TE, Doyle LW. Predicting motor development in very preterm infants at 12 months’ corrected age: the role of qualitative magnetic resonance imaging and general movements assessments. Pediatrics. 2009;123:512-7. https://doi.org/10.1542/peds.2008-0590 https://doi.org/https://doi.org/10.1542/...	86	27,3 ± 1,5	1014 ± 265	0,917 (0,517-0,991)	0,811 (0,713-0,881)	47,194 (2,477-899,3)	4,849 (2,915-8,069)	0,103 (0,007-1,463)
Disfunções neurológicas menores	Spittle et al.²⁵25. Spittle AJ, Spencer-Smith MM, Cheong JL, Eeles AL, Lee KJ, Anderson PJ, et al. General movements in very preterm children and neurodevelopment at 2 and 4 years. Pediatrics. 2013;132:e 452-8. https://doi.org/10.1542/peds.2013-0177 https://doi.org/ttps://doi.org/10.1542/p...	99	27,3 ± 1,5	1008 ± 265	0,676 (0,440-0,847)	0,865 (0,776-0,922)	13,364 (4,061-43,977)	5,000 (2,663-9,388)	0,374 (0,187-0,748)
	Sustersic et al.²⁶26. Sustersic B, Sustar K, Paro-Panjan D. General movements of preterm infants in relation to their motor competence between 5 and 6 years. Eur J Paediatr Neurol. 2012;16:724-9. https://doi.org/10.1016/j.ejpn.2012.05.008 https://doi.org/https://doi.org/10.1016/...	45	31,6 ± 3,3	1788 ± 718	0,967 (0,747-0,997)	0,766 (0,596-0,879)	94,733 (5,031-1783,9)	4,124 (2,190-7,769)	0,044 (0,003-0,669)
	Spittle et al.²⁸28. Spittle AJ, Boyd RN, Inder TE, Doyle LW. Predicting motor development in very preterm infants at 12 months’ corrected age: the role of qualitative magnetic resonance imaging and general movements assessments. Pediatrics. 2009;123:512-7. https://doi.org/10.1542/peds.2008-0590 https://doi.org/https://doi.org/10.1542/...	86	27,3 ± 1,5	1014 ± 265	0,274 (0,149-0,449)	0,798 (0,677-0,882)	1,495 (0,539-4,147)	1,359 (0,629-2,939)	0,909 (0,706-1,171)

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[1] *Autor correspondente. E-mail: camipires@uol.com.br (C.S. Pires).