Çok düşük doğum ağırlıklı prematüre bebeklerin okul çağında gelişimlerinin değerlendirilmesi
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Date
2007
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Publisher
Sağlık Bilimleri Enstitüsü
Abstract
This study aims to: 1) determine the developmental status at school age of children who received care in the Newborn Intensive Care Unit (NICU) at Ankara University Department of Pediatrics due to very low birth weight (VLBW) and 2) to develop an assessment method which can facilitate the developmental follow up of these children during health care encounters. The design of the study is cross sectional and non experimental. Of the 46 children children born with VLBW and cared for in the NICU in the year 1999, 8 died and 13 were living outside of Ankara. If the 25 living in Ankara, 21 could be contacted at age 7 and comprised the study sample (88%). The pediatrician?s evaluation included an interview with the parents and a thorough physical examination including neurological examination and vision screening. The pediatric assessment package referred to as the Guide for Monitoring Child Development in the School Age (GMCD-SA) was developed by adapting and compiling different screening tests such as Parent?s Evaluation of Developmental Status (PEDS), the Pediatric Symptom Checklist (PSC), problem behavior items from Vineland Adaptive Behavior Scales (VABS), School Performance Screening Test, Functional Independence Measure For Children (Weefım) and Draw-A-Person Test. The child psychiatrist?s evaluation was conducted one week within the pediatric assessment. This included results of the WISC-R administered by a psychologist, and a diagnostic assessment with the Schedule For Affective Disorders And Schizophrenia For School Age Children Present And Life Time Version (KSADS- PL). The pediatrician and child psychiatrist were blinded to each other?s results throughout the study until completion of all data collection. Most children were singleton (67%), boys (57%) and with birth weights between 1000-1500 grams (median 1200 g). Median age at assessment was 7,1 years (6,5 ? 7,9). The morbidity rates in 21 children were as follows: 10 children were diagnosed with behavior problems (47,6%), 7 with attention deficit hyperactivity disorder (33,3%), 5 (23,8%) with borderline IQ, 1 with learning disability (4,7%), and 1 child was diagnosed with major neurologic sequel involving spastic cerebral palsy. The overall sensitivity and specificity of the pediatrician?s screen using the GMCDSA to detect at least one problem that would lead to difficulties in functioning in school when compared to the gold standard assessment by the child psychiatrist was 80% (CI:0,54 ? 0,92) and 66,7% (CI:0,66 ? 0,90), respectively. The GMCD-SA added 20 minutes to the standard pediatric visit. Of the 16 children detected with at least one diagnosis only 5 had been detected before this evaluation and had received services. This study of the school age outcome of VLBW children from Turkey -a low to middle income country- has shown that although rates of mortality and major morbidity are low, minor morbidity including, behavioral problems, attention deficit hyperactivity disorder, cognitive problems, and learning disability is high and remains undetected at age seven. The GMCD-SA developed for the purposes of early detection during health visits has the potential to be used in countries such as Turkey to guide health providers and caregivers to determine the child?s need for additional support and services.
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Keywords
doğum, prematüre, bebek, prematüre bebeklerin okul çağı