Intervenção "Tummy Time" no desenvolvimento motor e cognitivo de recém-nascidos - ensaio clínico randomizado

Abstract

Different interventions have been developed aiming to improve the neurological outcomes of preterm newborns (PTNB), thus offering early organized care and considering parental involvement seems to be an important alternative in this process. Among the alternatives, Tummy Time (TT) may provide the necessary stimuli to minimize the negative impacts on motor and cognitive development; moreover, its practice can be performed at home. The aim of this study was to evaluate the daily experience of TT on head elevation and the motor and cognitive development of preterm infants living in areas with difficult access to specialized outpatient physiotherapy services. This was a randomized, controlled, and blind clinical trial, consisting of 31 PTNB with a gestational age of 33±2 weeks and weighing less than 2500g, who were followed up after hospital discharge until 4 months of corrected age in the Follow-up outpatient clinic. Sixteen babies were included in the TT group, where parents were invited and guided, through an illustrative booklet, to practice TT for at least 30 minutes during their routine activities and playtime, and 15 babies in the conventional care (CC) group, which involved mothers as the main providers of their newborns' biological needs and followed the care routinely oriented in outpatient consultations. Motor and cognitive outcomes were assessed using the Bayley-III scale at 2 and 4 months of corrected age. Head elevation was evaluated through video using the angle between the earlobe and the baby's support surface at baseline, 2, 3, and 4 months of corrected age, using the Kinovea® software. The results were analyzed by an examiner blinded to the group allocation. The composite motor score of the Bayley was higher in the TT group than in the CC group at 2 months (TT 117.85+/-9.67, CC 85.91+/-13.81, p=<0.001) and 4 months (TT 126.62+/-16.15, CC 87.80+/-18.54, p=0.003) of corrected age. The composite cognitive scale was also higher in the TT group than in the CC group only at 2 (TT 98.57+/-7.44, CC 83.33+/-13.37, p=<0.001) and 4 (TT 105.00+/-14.88, CC 81.00+/-24.24, p=<0.001) months of corrected age. The head elevation angle increased over time but did not differ between the groups (p=0.66). Although head elevation was similar in both groups, TT practice seems to have expanded infants' perspective to explore their own body and environment, favoring the development of motor and cognitive patterns, assessed by the Bayley. One of the study limitations was the fact that 31% of participants were lost to follow-up in the second assessment. This demonstrates the challenge of offering and maintaining early intervention programs for PTNB in low-income contexts. Therefore, TT practice in preterm infants may improve motor and cognitive functions as a home-based approach immediately after discharge.