Different Intervention Models of Premature Infants Based on the ICF Biopsychosocial Model

Premature birth is defined as one in which it occurs before 37 completed weeks of gestation. Prematurity is due to different circumstances, and premature babies can be classified according to gestational age as extremely premature, very premature, or moderately to late preterm. Prematurity is one of the main biological risk factors, and that it contributes to the appearance of changes in the neuropsychomotor development of babies, which may compromise their functional capacity. Thus, screening is essential so that families are guided and premature babies receive adequate early intervention through follow-up programs, mainly aimed at functionality. Given this, and to help standardize health approaches, since 2001 with the development of the biopsychosocial model of health, based on the International Classification of Functioning, Disability and Health (ICF), the use of the ICF is recommended in research and in clinical practice. However, although the use of the ICF in interventions is recommended worldwide, and the literature shows a growing increase in the use of the ICF in studies involving children and young people, there is a shortage of studies, especially in what culminates neuropsychomotor development and prematurity. Thus, the main objective of this study is to analyze the impact of different interventional models on the neuropsychomotor development of premature babies based on the biopsychosocial model of the ICF. This is a randomized, uncontrolled clinical trial, participants will be premature babies with corrected age between 4 and 24 months. Parents of babies who meet the proposed inclusion criteria will be invited to allow participation by signing the Free and Informed Consent term.

The study is composed of two large groups: Stimulation plus Orientations Group and Orientations Group. Participants in both groups will follow the same inclusion and exclusion criteria. Regardless of delay in neuropsychomotor development, during and at the end of each of the three assessments, parents or guardians from both groups received verbal guidance. In addition, in the first evaluation, a printed guide with guidelines for stimulating the baby at home will be given to all families, where the guidelines were divided by months, encompassing from 4 to 24 corrected months.

The guidance guide for families was produced by the researchers emphasizing appropriate stimuli for the corrected age. The guide aims to stimulate neuropsychomotor development, in order to give the baby the opportunity to experiment with new skills, through different postures and transfers, and through facilitation, motor, cognitive, auditory, visual and sensory stimuli. The guidelines prioritize rudimentary postures (prone, supine, lateral decubitus, sitting and standing), in addition to stimuli on cognitive, language, visual and auditory aspects. Parents or guardians will be asked to stimulate their children daily, at the time that is most appropriate for the family's routine, strengthening the bond with the baby. Control of the frequency of performing the stimuli at home will be carried out, the control will be carried out by the families themselves by filling in a column in the guide for information on frequency. The researchers will get in touch with the families in the guidance group once a month to guide and clarify possible doubts, while the families in the guidance plus stimulation group, as they will attend more often than once a month, will have the opportunity to clarify doubts directly with the researcher during the consultations. The researchers will also be available to all families in both groups throughout the entire survey over the phone.

Thinking that we can find families with unfavorable socioeconomic conditions and, also, with the intention of standardizing the stimuli, appropriate toys for each age group will be delivered to all families in the two groups, which will be made by the researchers.

All babies in both groups will participate in a follow-up program where assessments will take place in 4 moments with an interval of 4 months between them on the first year of life (tolerating a window of one month and a half), where: initial assessment, time 1 (t1): 4 corrected months; time 2 (t2): 8 corrected months; time 3 (t3) 12 months corrected; on the time 4 (t4) (will be tolerating a window of four months), 24 months corrected for extreme birth babies (< 28 weeks gestational age) and 24 months cronologic for babies ≥ 28 weeks gestational age. There will be four moments of evaluation that will consist of the analysis of:

• Neuropsychomotor development through the Bayley Infant and Toddler Development Scales, third edition (Bayley III);
• Montreal Cognitive Assessment (MoCA).
• Patient identification data through an evaluation questionnaire and initial anamnesis, information from the health booklet and data from the medical record.
• Affordances in the Home Environment through Affordances in the Home Environment for Motor Development - Children's Scale (AHEMD-IS);
• Quality of life through the Pediatric Inventory on Baby Quality of Life (PedsQL®);
• Socioeconomic data through the Socioeconomic Questionnaire of the Brazilian Research Association (ABEP).
• Parents' cognitive assessment through the Montreal Cognitive Assessment (MoCA).

Inclusion criteria

• 1. Gestational age less than 37 weeks, corrected age between 4 and 12 months (one and a half month window) and at 24 months (four months window)
• Babies from the High Risk Outpatient Clinic of the UCS Clinical Center, registered there;
• Authorization of those responsible for the minor consenting to participation in the study by signing the Free and Informed Consent Form (TCLE).

Exclusion criteria

• All those subjects who do not follow the items mentioned above;
• Presenting neurological diseases;
• Presence of acute diseases (eg pneumonia, bronchiolitis, trauma)
• Musculoskeletal alterations;
• Genetic syndromes;
• In genetic investigation;
• Heart diseases with indication for surgical intervention;
• Untreated congenital torticollis;
• Congenital clubfoot;
• Cerebral hemorrhage grade IV
• Those who do not undergo the first and/or last evaluation;
• Incomplete evaluation;
• Convulsive crisis during study period;
• Participants from other intervention programs.