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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cada a&#241;o nacen aproximadamente 15 millones de nacidos pret&#233;rmino &#40;NPT&#41;&#44; dato que sigue aumentando<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">1&#44;2</span></a>&#44; siendo uno de los problemas m&#225;s importantes en salud infantil&#44; tanto por su frecuencia y morbimortalidad como por el coste econ&#243;mico y social que provoca<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; Por ello&#44; es primordial conocer los posibles problemas asociados a la prematuridad para actuar lo antes posible&#44; ya que las evidencias confirman que nacer de forma prematura puede afectar al desarrollo del ni&#241;o a lo largo de toda su vida<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;5</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El grado de prematuridad puede marcar el desarrollo del ni&#241;o&#44; que depende de la edad gestacional &#40;EG&#41;&#44; siendo la clasificaci&#243;n m&#225;s utilizada la de prematuro extremo &#40;&#60;<span class="elsevierStyleHsp" style=""></span>28 semanas de EG&#41;&#44; muy prematuro &#40;28<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>32 de EG&#41; y prematuro moderado o tard&#237;o &#40;32<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>37 semanas de EG&#41;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">6&#44;7</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Dentro de los NPT&#44; el problema m&#225;s frecuente es el desfase en las habilidades cognitivas<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">8</span></a>&#46; La literatura recoge m&#225;s dificultades entre los 4 y los 6 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">9</span></a>&#44; encontr&#225;ndose relaci&#243;n entre el nivel de desarrollo y EG&#44; aumentando las dificultades cognitivas conforme disminuye la EG<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">10&#44;11</span></a>&#46; En estudios de neuroimagen&#44; se observan resultados similares<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">12</span></a> en nacidos antes de la semana 33&#44; con reducciones en el volumen cerebral en regiones espec&#237;ficas que&#44; a largo plazo&#44; se asocian con un peor resultado cognitivo<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">13</span></a>&#46; M&#225;s recientemente<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">14</span></a>&#44; con una muestra constituida por 54 ni&#241;os de entre 4 y 5 a&#241;os&#44; donde la mitad eran muy prematuros&#44; se concluye que existen d&#233;ficits neurocognitivos en los NPT en todos los dominios cognitivos estudiados&#46; A pesar de que no existe consenso sobre c&#243;mo evolucionan estas diferencias<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">15</span></a>&#44; hay datos que apuntan que conforme aumenta la EG&#44; hay menor disparidad en los resultados globales de desarrollo&#44; e incluso se normalizan<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">16&#44;17</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Respecto al desarrollo en &#225;reas concretas&#44; encontramos que las m&#225;s afectadas son la verbal y la motora<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">18&#8211;20</span></a>&#46; Referente al &#225;rea verbal&#44; Ment et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">21</span></a> evaluaron a 296 neonatos nacidos con un peso entre 600 y 1&#46;250<span class="elsevierStyleHsp" style=""></span>g&#44; a los 3&#44; 4 y medio&#44; 6 y 8 a&#241;os&#44; observando que la mayor&#237;a de los NPT presentaban mejor&#237;a en habilidades verbales al aumentar la edad&#46; Rodr&#237;guez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">22</span></a> observaron que esta &#225;rea era la m&#225;s comprometida entre los 3 y los 5 a&#241;os&#44; y Aarnoudse-Moens et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">23</span></a> detectaron que los ni&#241;os nacidos antes de la semana 30 presentaban m&#225;s dificultades en la fluidez verbal que los ni&#241;os nacidos a t&#233;rmino&#46; Por el contrario&#44; otros estudios se&#241;alan que los ni&#241;os NPT presentan un desarrollo verbal normal<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">24&#44;25</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En cuanto al desarrollo motor&#44; se se&#241;ala que las discapacidades neuromotoras pueden aumentar a menor EG<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">10</span></a>&#46; Fern&#225;ndez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">26</span></a> describieron secuelas en el desarrollo neurol&#243;gico de ni&#241;os con antecedentes de prematuridad y extremado bajo peso al nacer&#44; concluyendo que el retraso psicomotor era una de las complicaciones m&#225;s importantes a los 2 a&#241;os&#46; Millar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">27</span></a>&#44; cuya muestra estaba constituida por muy prematuros y prematuros extremos evaluados entre los 40 y los 86 meses&#44; determinaron que presentaban alteraciones neuromotrices leves&#46; En contraposici&#243;n a esto&#44; Shapira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">24</span></a> observaron que el 68&#37; de los ni&#241;os nacidos prematuros con un peso igual o inferior a 1&#46;500<span class="elsevierStyleHsp" style=""></span>g obtuvieron una puntuaci&#243;n normal a los 3 a&#241;os&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Respecto al desarrollo de la capacidad num&#233;rica del ni&#241;o NPT&#44; los trabajos revisados que se centran en la etapa preescolar no facilitan datos sobre el nivel de competencias en el &#225;rea num&#233;rica&#46; No obstante&#44; encontramos que entre los 5 y 10 a&#241;os pueden presentar dificultades relativas a las operaciones aritm&#233;ticas<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">28&#44;29</span></a> las cuales mejoran con el paso de los a&#241;os durante la etapa de Educaci&#243;n Primaria<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">28</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Por otro lado&#44; se ha comprobado que los ni&#241;os con antecedentes de prematuridad presentan d&#233;ficits en memoria y atenci&#243;n<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">30</span></a>&#44; lo que puede afectar a la memoria a largo plazo<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">En definitiva&#44; nacer de forma prematura parece tener un efecto importante en el neurodesarrollo del ni&#241;o<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">32</span></a>&#44; pero la literatura no aporta demasiadas evidencias sobre la evoluci&#243;n del desarrollo en este periodo&#44; siendo necesario un seguimiento para poder detectar e intervenir de forma precoz en aquellos d&#233;ficits que pueden manifestarse despu&#233;s de los 2 a&#241;os&#44; y suponer un riesgo significativo de desfase al inicio de la escolarizaci&#243;n obligatoria<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">33</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La mayor&#237;a de las investigaciones centran su atenci&#243;n hasta los 24 meses&#44; existiendo poca informaci&#243;n sobre c&#243;mo evolucionan los posibles desfases en la etapa preescolar e inicio de la Educaci&#243;n Primaria<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">34</span></a>&#44; generando incertidumbre por la falta de resultados concluyentes&#46; En este estudio se plantea evaluar el desarrollo psicomotor de un grupo de ni&#241;os y ni&#241;as con antecedentes de prematuridad &#40;GP&#41;&#44; a los 4&#44; 5 y 6 a&#241;os de edad&#44; y compararlos con un grupo de ni&#241;os no prematuros &#40;GNP&#41;&#44; as&#237; como atendiendo al grado de prematuridad &#40;GP1 y GP2&#41;&#46; Los resultados obtenidos nos ayudar&#225;n a conocer el perfil de desarrollo de este grupo de riesgo en el inicio de la etapa escolar&#44; lo cual resulta imprescindible para dise&#241;ar intervenciones preventivas&#44; que ayuden a mejorar el grado de capacitaci&#243;n con el que este grupo afronta la escolarizaci&#243;n obligatoria&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes y m&#233;todo</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se ha realizado un estudio prospectivo longitudinal de tipo anal&#237;tico observacional con un dise&#241;o de casos y controles&#44; que incluy&#243; un grupo de ni&#241;os con antecedentes de prematuridad sin secuelas graves a los 4 a&#241;os y un grupo no prematuro&#44; ambos homog&#233;neos en sexo y edad cronol&#243;gica&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La muestra qued&#243; constituida por 98 participantes de una provincia del sur de Espa&#241;a&#44; distribuidos de forma uniforme en 2 grupos&#58; grupo prematuro GP &#40;nacidos antes de la semana 37&#41; y grupo no prematuro GNP &#40;nacidos a partir de la semana 37&#41;&#46; Ambos grupos fueron evaluados en 3 momentos diferentes &#40;4&#44; 5 y 6 a&#241;os de edad&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La poblaci&#243;n de reci&#233;n nacidos con menos de 37 semanas&#44; que ingresaron en UCIN de un hospital de tercer nivel&#44; procedentes de la misma provincia fue de 116&#44; de los cuales 14 presentaron secuelas graves&#46; La <span class="elsevierStyleItalic">N</span> fue de 102 casos&#44; de los cuales 25 familias no quisieron participar o no se les localiz&#243;&#44; y 5 no acudieron a la primera evaluaci&#243;n&#46; La muestra <span class="elsevierStyleItalic">&#40;n&#41;</span> de 72 casos resultante es representativa con un margen de error de 0&#44;05&#46; Los valores de referencia que se tomaron para la realizaci&#243;n del tama&#241;o de la muestra fueron&#58; <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#44; nivel de confianza del 95&#37; &#40;<span class="elsevierStyleItalic">z</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;96&#41; y <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;2&#46; Para calcular el valor <span class="elsevierStyleItalic">p</span>&#44; nos basamos en el trabajo de G&#243;mez et al&#46; &#40;2019&#41;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">35</span></a>&#44; donde el porcentaje de nacidos prematuros con secuelas transitorias era del 20&#37;&#46; A lo largo de los 3 a&#241;os del seguimiento&#44; se descartaron para este estudio 23 casos al no disponer de todas las medidas o encontrarse incompletas&#46; Finalmente&#44; la muestra definitiva del GP qued&#243; constituida por 20 ni&#241;os y 29 ni&#241;as&#44; con un peso medio al nacimiento de 1&#46;555&#44;05<span class="elsevierStyleHsp" style=""></span>g&#46; La edad media de la madre fue de 33 a&#241;os&#44; para un 73&#44;46&#37; era su primer embarazo y en un 71&#44;5&#37; el parto fue por ces&#225;rea &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">El GNP&#44; formado por 20 ni&#241;os y 29 ni&#241;as nacidos a t&#233;rmino y sin necesidades de salud o educativas&#44; fue seleccionado de los diferentes centros educativos donde se encontraban escolarizados los participantes del GP&#46; Fue un muestreo de conveniencia&#44; pareados por sexo y fecha de nacimiento del compa&#241;ero con antecedentes de prematuridad&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Para valorar el posible efecto del grado de prematuridad&#44; se ha tenido en cuenta la EG&#44; quedando el GP1 constituido por 12 ni&#241;os y 19 ni&#241;as &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#41; nacidos antes de la semana 32 de gestaci&#243;n &#40;muy prematuros y extremos&#41;&#44; y el GP2 constituido por 8 ni&#241;os y 10 ni&#241;as &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#41;&#44; nacidos entre las semanas 32 y 36&#44;6 de gestaci&#243;n &#40;prematuros moderados y tard&#237;os&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se evalu&#243; el desarrollo psicomotor a los 4&#44; 5 y 6 a&#241;os de edad&#44; aplic&#225;ndoles las escalas McCarthy de Aptitudes y Psicomotricidad para ni&#241;os<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">36</span></a>&#44; compuesta por 18 subtest independientes agrupados en 6 subescalas&#58; Verbal&#44; Perceptivo-Manipulativa&#44; Num&#233;rica&#44; Memoria&#44; Motricidad y un &#205;ndice General Cognitivo&#46; En todas&#44; el intervalo medio es de 50 y la desviaci&#243;n t&#237;pica de 10 &#40;40-60&#41;&#44; salvo en el &#205;ndice General Cognitivo&#44; cuyo intervalo medio es 100 y la desviaci&#243;n t&#237;pica 16 &#40;84-116&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Dicha prueba presenta un suficiente rigor psicom&#233;trico&#46; En el &#205;ndice General Cognitivo el coeficiente promedio de fiabilidad fue de 0&#44;93&#44; variando en las dem&#225;s entre 0&#44;79 y 0&#44;88&#46; Respecto a la estabilidad&#44; los coeficientes de fiabilidad oscilan entre 0&#44;75 y 0&#44;90&#46; Su validez est&#225; demostrada en distintos estudios&#44; existiendo correlaci&#243;n entre los resultados del MSCA y los del CI del WPPSI y Stanford-Binet<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">37&#44;38</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">El GP fue seleccionado en base al criterio de prematuridad de los nacidos en el citado hospital en 2 fases en un periodo de 2 a&#241;os&#46; Se contact&#243; con los padres para ofrecerles toda la informaci&#243;n relativa al estudio&#44; solicit&#225;ndoles su participaci&#243;n a trav&#233;s del modelo de consentimiento elaborado ad hoc&#46; Fueron citados para realizar la evaluaci&#243;n que se llev&#243; a cabo a los 4&#44; 5 y 6 a&#241;os de edad&#46; El presente estudio fue aprobado por el Comit&#233; Coordinador de &#201;tica de la Investigaci&#243;n Biom&#233;dica de la comunidad aut&#243;noma&#44; cumpli&#233;ndose en todo momento lo establecido en la Declaraci&#243;n de Helsinki respecto a principios &#233;ticos&#46; En el caso del GNP&#44; previo consentimiento de los padres del GP&#44; se contact&#243; con los centros educativos donde estaban escolarizados&#44; solicitando su colaboraci&#243;n&#46; Posteriormente&#44; los padres de los alumnos seleccionados&#44; atendiendo a la edad y el sexo&#44; fueron informados y firmaron el consentimiento informado&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La evaluaci&#243;n de ambos grupos fue pareada en edad y tiempo&#46; Se realizaron an&#225;lisis no param&#233;tricos &#40;<span class="elsevierStyleItalic">U</span> de Mann-Whitney para las comparaciones intergrupos&#44; Wilconxon para los estudios longitudinales intragrupo&#44; y Kruskal-Wallis para realizar el estudio de la comparativa de los 3 grupos estudiados una vez subdividido el GP&#41;&#44; al no cumplir los criterios de normalidad&#46; Para todo ello&#44; se us&#243; el programa estad&#237;stico SPSS v&#46; 24&#46;0 para Windows y se determin&#243; la significatividad en <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Para calcular el tama&#241;o del efecto&#44; se realizaron an&#225;lisis <span class="elsevierStyleItalic">r</span> de Rosenthal al tratarse de pruebas no param&#233;tricas&#44; para la diferencia entre 2 variables analizadas&#44; la cual puede ser peque&#241;a &#40;0&#44;10&#41;&#44; media &#40;0&#44;30&#41;&#44; grande &#40;0&#44;50&#41; o muy grande &#40;0&#44;70&#41;&#44; dependiendo del resultado obtenido<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">39</span></a>&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0095" class="elsevierStylePara elsevierViewall">La muestra estaba formada por 98 participantes &#40;50&#37; con antecedentes de prematuridad y 50&#37; nacidos a t&#233;rmino&#41;&#46; Para valorar la influencia de la EG se subdividi&#243; el GP en GP1 &#40;63&#37;&#41; y GP2 &#40;37&#37;&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Al analizar el nivel de desarrollo en prematuros y a t&#233;rmino se encuentran resultados dentro del intervalo medio en todas las &#225;reas y en los diferentes momentos &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Al comparar GP y GNP&#44; en los diferentes momentos&#44; encontramos puntuaciones m&#225;s bajas en el GP a los 4 a&#241;os en todas las &#225;reas evaluadas&#44; excepto en la Num&#233;rica&#44; no detect&#225;ndose diferencias a los 5 y 6 a&#241;os&#46; El tama&#241;o del efecto en las &#225;reas Perceptivo-Manipulativa&#44; &#205;ndice General de Cognitivo y Motora a los 4 a&#241;os es de tipo medio &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Al realizar los an&#225;lisis intragrupo longitudinales&#44; encontramos que en el GP los logros en el &#225;rea Verbal mejoran de los 4 a los 5 a&#241;os &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;008&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;377<span class="elsevierStyleItalic">&#41;</span>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Atendiendo al grado de prematuridad&#44; las puntuaciones en los GP1 y GP2 se sit&#250;an dentro del rango medio&#44; aunque en el GP2 las puntuaciones son m&#225;s elevadas en todas las &#225;reas y tiempos de medida &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Para conocer la influencia del grado de prematuridad en el desarrollo posterior del ni&#241;o&#44; se realizaron an&#225;lisis <span class="elsevierStyleItalic">U</span> de Mann-Whitney por pares &#40;GP1 vs&#46; GNP&#59; GP1 vs&#46; GP2 y GP2 vs&#46; GNP&#41;&#46; Se encuentran resultados significativos entre los muy prematuros &#40;GP1&#41; y los moderados-tard&#237;os &#40;GP2&#41;&#44; detect&#225;ndose m&#225;s dificultades a menor EG&#44; y a mayor edad cronol&#243;gica &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Tambi&#233;n se encuentran puntuaciones significativamente m&#225;s bajas en GP1 frente al GNP en las &#225;reas Verbal&#44; Perceptivo-Manipulativa&#44; &#205;ndice General Cognitivo y Motor a los 4 y a los 6 a&#241;os &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; Por el contrario&#44; no se hallan datos estad&#237;sticamente significativos entre los GP2 y GNP&#46; El tama&#241;o del efecto es medio en todas las relaciones se&#241;aladas&#44; a excepci&#243;n del &#205;ndice General Cognitivo a los 5 a&#241;os entre GP1 y GP2&#44; que es peque&#241;o&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Por &#250;ltimo&#44; en el an&#225;lisis intragrupo&#44; comprobamos que en GP1 existen diferencias tanto en el &#225;rea Verbal &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;011&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;459&#41; como en la Perceptivo-Manipulativa &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;030&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;389&#41; entre los 4 y los 5 a&#241;os&#44; con un tama&#241;o del efecto medio en ambos casos&#46; En el caso de la Verbal&#44; los resultados mejoran a los 5 a&#241;os&#44; mientras que en Perceptivo-Manipulativa sucede lo contrario&#46; En el resto de &#225;reas y medidas no encontramos hallazgos rese&#241;ables&#44; salvo una tendencia al descenso en las puntuaciones del GP1 a la edad de 6 a&#241;os&#46; En el GP2 no se observan discrepancias intragrupo&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">Algunas investigaciones afirman que los ni&#241;os con antecedentes de prematuridad pueden presentar dificultades en el desarrollo<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">13&#44;15</span></a>&#46; Los resultados obtenidos en este estudio coinciden parcialmente&#44; ya que las puntuaciones alcanzadas por el grupo de prematuros se encuentran en el rango medio&#46; No obstante&#44; al compararlos con sus iguales se encuentran diferencias significativas&#44; que se hacen m&#225;s notables cuando se atiende al grado de prematuridad&#46; Es a los 4 a&#241;os cuando las diferencias con respeto a los no prematuros son m&#225;s evidentes&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">En lenguaje&#44; los resultados hallados apoyan los encontrados por Ment et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">21</span></a>&#44; donde las diferencias entre prematuros y no prematuros a los 4 a&#241;os no se mantuvieron en el tiempo&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En cuanto al &#225;rea Motora&#44; los datos se relacionan parcialmente con los obtenidos en otras investigaciones<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">20&#44;26&#44;29</span></a>&#44; detect&#225;ndose diferencias entre prematuros y no prematuros&#44; aunque solo a los 4 a&#241;os&#46; Es posible que las alteraciones neuromotrices leves<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">27</span></a> o de percepci&#243;n visual<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">29</span></a> encontradas a edades similares se relacionen con las diferencias obtenidas en el &#225;rea Perceptivo-Motriz&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Los resultados hallados en Memoria solo muestran diferencias a los 4 a&#241;os&#44; pero es a partir de los 6 cuando es b&#225;sica para aprendizajes de mayor nivel de exigencia&#46; Por ello&#44; es posible que se presenten m&#225;s dificultades a edades superiores<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">28&#44;30</span></a>&#46; Estos datos sugieren la necesidad de una evaluaci&#243;n con pruebas espec&#237;ficas de memoria&#44; despu&#233;s de los 6 a&#241;os&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Cuando el nacimiento es antes de la semana 32 el nivel de desarrollo es inferior respecto a los nacidos a t&#233;rmino&#44; mientras que no existen diferencias entre los prematuros moderados o tard&#237;os y los a t&#233;rmino&#46; Estos resultados apoyan estudios en la misma etapa evolutiva<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">9&#44;14</span></a> donde se evidencian dificultades cognitivas y en el desarrollo neurol&#243;gico cuanto mayor es el grado de prematuridad<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">11&#44;12</span></a>&#46; Es decir&#44; nacer muy prematuro se relaciona con peores competencias cognitivas y motoras durante la etapa preescolar&#44; no siendo tan evidente en los moderados o tard&#237;os<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">16&#44;17</span></a>&#46; Estos datos hacen previsible que los muy prematuros necesiten mayores apoyos al inicio de Educaci&#243;n Primaria&#44; puesto que muestran logros significativamente m&#225;s bajos a esta edad en la mayor&#237;a de las &#225;reas evaluadas&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Por &#225;reas&#44; los resultados en Lenguaje apoyan lo planteado por Rodr&#237;guez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">22</span></a> y S&#225;nchez-Joya et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">14</span></a> donde los muy prematuros ten&#237;an peores resultados&#44; o tambi&#233;n los de Aarnoudse-Moens et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">23</span></a> que observaban una peor fluidez verbal en comparaci&#243;n con los no prematuros&#46; Situaci&#243;n similar a la anterior encontramos en el &#225;rea Motora<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">10&#44;27</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Es destacable la escasez de estudios de preescolares nacidos muy prematuros que eval&#250;en las &#225;reas de Memoria y Num&#233;rica&#46; Por lo que habr&#237;a que considerar las diferencias halladas&#44; muy significativas en Memoria&#44; tanto a los 4 como a los 6 a&#241;os&#44; ya que pueden condicionar los logros posteriores&#46; Respecto a las habilidades matem&#225;ticas&#44; se han se&#241;alado diferencias entre los muy prematuros y los a t&#233;rmino<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">29</span></a>&#44; donde la percepci&#243;n visual podr&#237;a tener un papel mediador en la etapa escolar<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">28</span></a>&#46; En este caso&#44; tambi&#233;n se evidencian dificultades num&#233;ricas atendiendo a la EG&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Los datos obtenidos en el an&#225;lisis intragrupo no arrojan hallazgos concluyentes&#46; Aunque s&#237; se observa que en el grupo de muy prematuros las puntuaciones descienden a medida que aumenta la edad y el nivel de exigencia&#46; Por el contrario&#44; en el grupo de prematuros moderados y tard&#237;os las puntuaciones van mejorando y tienden a situarse al nivel de los nacidos a t&#233;rmino&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Al inicio de la presente investigaci&#243;n nos planteamos valorar la influencia de la prematuridad a lo largo de la etapa preescolar&#44; lo que supone una fortaleza&#44; que enriquece el trabajo realizado&#44; dadas las escasas oportunidades para evaluar todo este periodo&#46; Podemos concluir que el desarrollo psicomotriz de los prematuros queda condicionado por la EG al nacimiento&#46; Por lo que aquellos estudios que no toman en consideraci&#243;n esta variable pueden darnos una idea no realista del funcionamiento del grupo en esta etapa&#46; Analizando los logros seg&#250;n el grado de prematuridad&#44; podemos obtener informaci&#243;n m&#225;s ajustada sobre su perfil de desarrollo psicomotor&#46; As&#237;&#44; a los 6 a&#241;os los muy prematuros o extremos s&#237; presentan un rendimiento m&#225;s bajo no solo respecto a los nacidos a t&#233;rmino&#44; sino tambi&#233;n respecto a los prematuros moderados o tard&#237;os&#46; Estos datos pueden afectar en el inicio de la Educaci&#243;n Primaria&#44; donde el nivel de exigencia aumenta&#44; y el grupo de mayor prematuridad puede encontrar m&#225;s dificultades&#46; Por todo ello&#44; se considera necesario que la atenci&#243;n a esta poblaci&#243;n desde el contexto sanitario contin&#250;e m&#225;s all&#225; de los 6 a&#241;os&#44; etapa clave en la adquisici&#243;n de habilidades y aprendizajes que pueden condicionar su rendimiento escolar posterior&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Finalmente&#44; consideramos relevante indicar algunas limitaciones del estudio&#44; como el reducido n&#250;mero de casos al distribuir el grupo de prematuros atendiendo a la EG al nacimiento&#46; Para futuras investigaciones ser&#237;a interesante ampliar la muestra inicial para&#44; tras la mortalidad experimental&#44; mantener una potencia adecuada&#46; Adem&#225;s&#44; se deber&#237;a tomar en consideraci&#243;n la influencia de otras variables m&#233;dicas y&#47;o sociodemogr&#225;ficas&#59; analizar de forma pormenorizada las diferentes subescalas de las Escalas McCarthy y completar la evaluaci&#243;n psicom&#233;trica con pruebas m&#225;s espec&#237;ficas para cada &#225;rea de desarrollo&#44; especialmente lenguaje&#44; memoria&#44; funciones ejecutivas&#44; y utilizar pruebas de neuroimagen&#44; lo que podr&#237;a revelar conclusiones m&#225;s concretas sobre las funciones cerebrales m&#225;s afectadas&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Financiaci&#243;n</span><p id="par0175" class="elsevierStylePara elsevierViewall">Consejer&#237;a de Salud&#46; Junta de Andaluc&#237;a&#46; C&#243;digo&#58; PI-0397&#47;2007&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Junta de Andaluc&#237;a&#46; C&#243;digo&#58; 1999&#47;07&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicto de intereses</span><p id="par0185" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">En las &#250;ltimas d&#233;cadas&#44; el nacimiento de ni&#241;os prematuros se ha incrementado notablemente&#44; siendo importante conocer sus efectos&#46; El objetivo del estudio es determinar el perfil de desarrollo psicomotor de ni&#241;os con antecedentes de prematuridad&#44; a los 4&#44; 5 y 6 a&#241;os&#44; y compararlos con un grupo de ni&#241;os nacidos a t&#233;rmino para detectar posibles desajustes&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La muestra estaba constituida por 98 participantes&#44; distribuidos uniformemente en 2 grupos&#44; prematuros y a t&#233;rmino&#46; Se realiz&#243; un estudio de cohorte prospectivo longitudinal anal&#237;tico observacional con un dise&#241;o de casos y controles&#46; Se ha considerado la divisi&#243;n del grupo prematuro en muy prematuros y prematuros moderados y tard&#237;os&#46; Las evaluaciones se realizaron con las Escalas McCarthy de Aptitudes y Psicomotricidad para ni&#241;os&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Los datos muestran logros dentro de los intervalos medios&#46; No obstante&#44; se evidencian m&#225;s dificultades en el desarrollo a los 4 a&#241;os en el grupo de prematuros&#46; Atendiendo a la edad gestacional&#44; los muy prematuros &#40;edad gestacional menor de 32 semanas&#41; muestran puntuaciones significativamente m&#225;s bajas con respecto a los prematuros moderados y tard&#237;os&#44; fundamentalmente a los 6 a&#241;os&#44; y con los nacidos a t&#233;rmino&#44; a los 4 y 6 a&#241;os&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A menor edad gestacional&#44; son mayores las dificultades&#44; pudiendo afectar en la etapa de Educaci&#243;n Primaria&#46; Se considera la necesidad de efectuar un seguimiento a todos los prematuros en la etapa preescolar&#44; as&#237; como evaluar habilidades m&#225;s espec&#237;ficas y continuar con la atenci&#243;n desde equipos especializados&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The rate of premature births has significantly increased&#44; and it is important to determine its effects&#46; The objective of this study is to determine the psychomotor development profile of a group of children born prematurely&#44; at the age of 4&#44; 5 and 6&#44; and to compare them with a group of full-term birth children&#44; in order to detect any differences&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The sample consisted of 98 participants&#44; evenly distributed into two groups&#44; premature and full-term born children&#46; A prospective longitudinal observational analytical study&#44; with a design of cases and controls&#44; was carried out&#46; For some analyses&#44; the separation into early pre-term&#44; moderate pre-term&#44; and late pre-term was considered&#46; The evaluations were performed using the McCarthy Scale of Aptitudes and Psychomotor skills for children&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The data shows achievements within the middle intervals&#46; However&#44; there are more difficulties in development at 4 years in the group of premature children&#44; according to gestational age&#46; Early pre-term &#40;gestational age less than 32 weeks&#41; showed significantly lower scores compared to moderate and late pre-term&#44; mainly at 6 years&#44; and with those born at term&#44; at 4 and 6 years&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Development difficulties are greater at a lower gestational age&#44; and may affect the Primary Education stage&#46; The need to monitor all premature children in the preschool stage is suggested&#44; as well as to evaluate more specific skills and continue with the care from specialist teams&#46;</p></span>"
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                  \t\t\t\t">2-123&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">35 &#40;71&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;73&#44;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Uno&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;20&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;6&#44;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">GP&#58; grupo prematuro&#59; GNP&#58; grupo no prematuro&#59; IGC&#58; &#205;ndice General Cognitivo&#59; M&#58; Motriz&#59; Md&#58; mediana&#59; ME&#58; Memoria&#59; N&#58; Num&#233;rica&#59; PM&#58; Perceptivo-Manipulativa&#59; R&#58; rango&#59; V&#58; Verbal&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Se resalta en negrita los resultados significativos&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Edad&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 a&#241;os</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">R&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">U</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleItalic">&#40;p&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">r</span><a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 a&#241;os</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;306&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;393&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;327&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;111&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">103&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">115&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;000</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;418&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">55&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;056&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">5 a&#241;os</td><td class="td" title="\n
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                  \t\t\t\t">56&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;376&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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Original
Evolución del desarrollo psicomotor en preescolares con antecedentes de prematuridad
Evolution of psychomotor development in pre-school children born prematurely
Alejandra Victoria Pereira-Cerroa, María Dolores Lanzarote-Fernándezb,c,
Autor para correspondencia
lanzarote@us.es

Autor para correspondencia.
, María Merced Barbancho-Morantc,d, Eva María Padilla-Muñozb,c
a CEU Cardenal Spínola, Fundación San Pablo Andalucía CEU, Bormujos, Sevilla, España
b Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, Facultad de Psicología, Universidad de Sevilla, Sevilla, España
c Grupo de Investigación Pediatría Integral y Psicología Pediátrica CTS-152
d Hospital Universitario Virgen del Rocío, Sevilla, España
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6 y 8 a&#241;os&#44; observando que la mayor&#237;a de los NPT presentaban mejor&#237;a en habilidades verbales al aumentar la edad&#46; Rodr&#237;guez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">22</span></a> observaron que esta &#225;rea era la m&#225;s comprometida entre los 3 y los 5 a&#241;os&#44; y Aarnoudse-Moens et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">23</span></a> detectaron que los ni&#241;os nacidos antes de la semana 30 presentaban m&#225;s dificultades en la fluidez verbal que los ni&#241;os nacidos a t&#233;rmino&#46; Por el contrario&#44; otros estudios se&#241;alan que los ni&#241;os NPT presentan un desarrollo verbal normal<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">24&#44;25</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En cuanto al desarrollo motor&#44; se se&#241;ala que las discapacidades neuromotoras pueden aumentar a menor EG<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">10</span></a>&#46; Fern&#225;ndez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">26</span></a> describieron secuelas en el desarrollo neurol&#243;gico de ni&#241;os con antecedentes de prematuridad y extremado bajo peso al nacer&#44; concluyendo que el retraso psicomotor era una de las complicaciones m&#225;s importantes a los 2 a&#241;os&#46; Millar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">27</span></a>&#44; cuya muestra estaba constituida por muy prematuros y prematuros extremos evaluados entre los 40 y los 86 meses&#44; determinaron que presentaban alteraciones neuromotrices leves&#46; En contraposici&#243;n a esto&#44; Shapira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">24</span></a> observaron que el 68&#37; de los ni&#241;os nacidos prematuros con un peso igual o inferior a 1&#46;500<span class="elsevierStyleHsp" style=""></span>g obtuvieron una puntuaci&#243;n normal a los 3 a&#241;os&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Respecto al desarrollo de la capacidad num&#233;rica del ni&#241;o NPT&#44; los trabajos revisados que se centran en la etapa preescolar no facilitan datos sobre el nivel de competencias en el &#225;rea num&#233;rica&#46; No obstante&#44; encontramos que entre los 5 y 10 a&#241;os pueden presentar dificultades relativas a las operaciones aritm&#233;ticas<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">28&#44;29</span></a> las cuales mejoran con el paso de los a&#241;os durante la etapa de Educaci&#243;n Primaria<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">28</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Por otro lado&#44; se ha comprobado que los ni&#241;os con antecedentes de prematuridad presentan d&#233;ficits en memoria y atenci&#243;n<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">30</span></a>&#44; lo que puede afectar a la memoria a largo plazo<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">En definitiva&#44; nacer de forma prematura parece tener un efecto importante en el neurodesarrollo del ni&#241;o<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">32</span></a>&#44; pero la literatura no aporta demasiadas evidencias sobre la evoluci&#243;n del desarrollo en este periodo&#44; siendo necesario un seguimiento para poder detectar e intervenir de forma precoz en aquellos d&#233;ficits que pueden manifestarse despu&#233;s de los 2 a&#241;os&#44; y suponer un riesgo significativo de desfase al inicio de la escolarizaci&#243;n obligatoria<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">33</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La mayor&#237;a de las investigaciones centran su atenci&#243;n hasta los 24 meses&#44; existiendo poca informaci&#243;n sobre c&#243;mo evolucionan los posibles desfases en la etapa preescolar e inicio de la Educaci&#243;n Primaria<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">34</span></a>&#44; generando incertidumbre por la falta de resultados concluyentes&#46; En este estudio se plantea evaluar el desarrollo psicomotor de un grupo de ni&#241;os y ni&#241;as con antecedentes de prematuridad &#40;GP&#41;&#44; a los 4&#44; 5 y 6 a&#241;os de edad&#44; y compararlos con un grupo de ni&#241;os no prematuros &#40;GNP&#41;&#44; as&#237; como atendiendo al grado de prematuridad &#40;GP1 y GP2&#41;&#46; Los resultados obtenidos nos ayudar&#225;n a conocer el perfil de desarrollo de este grupo de riesgo en el inicio de la etapa escolar&#44; lo cual resulta imprescindible para dise&#241;ar intervenciones preventivas&#44; que ayuden a mejorar el grado de capacitaci&#243;n con el que este grupo afronta la escolarizaci&#243;n obligatoria&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes y m&#233;todo</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se ha realizado un estudio prospectivo longitudinal de tipo anal&#237;tico observacional con un dise&#241;o de casos y controles&#44; que incluy&#243; un grupo de ni&#241;os con antecedentes de prematuridad sin secuelas graves a los 4 a&#241;os y un grupo no prematuro&#44; ambos homog&#233;neos en sexo y edad cronol&#243;gica&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La muestra qued&#243; constituida por 98 participantes de una provincia del sur de Espa&#241;a&#44; distribuidos de forma uniforme en 2 grupos&#58; grupo prematuro GP &#40;nacidos antes de la semana 37&#41; y grupo no prematuro GNP &#40;nacidos a partir de la semana 37&#41;&#46; Ambos grupos fueron evaluados en 3 momentos diferentes &#40;4&#44; 5 y 6 a&#241;os de edad&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La poblaci&#243;n de reci&#233;n nacidos con menos de 37 semanas&#44; que ingresaron en UCIN de un hospital de tercer nivel&#44; procedentes de la misma provincia fue de 116&#44; de los cuales 14 presentaron secuelas graves&#46; La <span class="elsevierStyleItalic">N</span> fue de 102 casos&#44; de los cuales 25 familias no quisieron participar o no se les localiz&#243;&#44; y 5 no acudieron a la primera evaluaci&#243;n&#46; La muestra <span class="elsevierStyleItalic">&#40;n&#41;</span> de 72 casos resultante es representativa con un margen de error de 0&#44;05&#46; Los valores de referencia que se tomaron para la realizaci&#243;n del tama&#241;o de la muestra fueron&#58; <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#44; nivel de confianza del 95&#37; &#40;<span class="elsevierStyleItalic">z</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;96&#41; y <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;2&#46; Para calcular el valor <span class="elsevierStyleItalic">p</span>&#44; nos basamos en el trabajo de G&#243;mez et al&#46; &#40;2019&#41;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">35</span></a>&#44; donde el porcentaje de nacidos prematuros con secuelas transitorias era del 20&#37;&#46; A lo largo de los 3 a&#241;os del seguimiento&#44; se descartaron para este estudio 23 casos al no disponer de todas las medidas o encontrarse incompletas&#46; Finalmente&#44; la muestra definitiva del GP qued&#243; constituida por 20 ni&#241;os y 29 ni&#241;as&#44; con un peso medio al nacimiento de 1&#46;555&#44;05<span class="elsevierStyleHsp" style=""></span>g&#46; La edad media de la madre fue de 33 a&#241;os&#44; para un 73&#44;46&#37; era su primer embarazo y en un 71&#44;5&#37; el parto fue por ces&#225;rea &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">El GNP&#44; formado por 20 ni&#241;os y 29 ni&#241;as nacidos a t&#233;rmino y sin necesidades de salud o educativas&#44; fue seleccionado de los diferentes centros educativos donde se encontraban escolarizados los participantes del GP&#46; Fue un muestreo de conveniencia&#44; pareados por sexo y fecha de nacimiento del compa&#241;ero con antecedentes de prematuridad&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Para valorar el posible efecto del grado de prematuridad&#44; se ha tenido en cuenta la EG&#44; quedando el GP1 constituido por 12 ni&#241;os y 19 ni&#241;as &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#41; nacidos antes de la semana 32 de gestaci&#243;n &#40;muy prematuros y extremos&#41;&#44; y el GP2 constituido por 8 ni&#241;os y 10 ni&#241;as &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#41;&#44; nacidos entre las semanas 32 y 36&#44;6 de gestaci&#243;n &#40;prematuros moderados y tard&#237;os&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se evalu&#243; el desarrollo psicomotor a los 4&#44; 5 y 6 a&#241;os de edad&#44; aplic&#225;ndoles las escalas McCarthy de Aptitudes y Psicomotricidad para ni&#241;os<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">36</span></a>&#44; compuesta por 18 subtest independientes agrupados en 6 subescalas&#58; Verbal&#44; Perceptivo-Manipulativa&#44; Num&#233;rica&#44; Memoria&#44; Motricidad y un &#205;ndice General Cognitivo&#46; En todas&#44; el intervalo medio es de 50 y la desviaci&#243;n t&#237;pica de 10 &#40;40-60&#41;&#44; salvo en el &#205;ndice General Cognitivo&#44; cuyo intervalo medio es 100 y la desviaci&#243;n t&#237;pica 16 &#40;84-116&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Dicha prueba presenta un suficiente rigor psicom&#233;trico&#46; En el &#205;ndice General Cognitivo el coeficiente promedio de fiabilidad fue de 0&#44;93&#44; variando en las dem&#225;s entre 0&#44;79 y 0&#44;88&#46; Respecto a la estabilidad&#44; los coeficientes de fiabilidad oscilan entre 0&#44;75 y 0&#44;90&#46; Su validez est&#225; demostrada en distintos estudios&#44; existiendo correlaci&#243;n entre los resultados del MSCA y los del CI del WPPSI y Stanford-Binet<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">37&#44;38</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">El GP fue seleccionado en base al criterio de prematuridad de los nacidos en el citado hospital en 2 fases en un periodo de 2 a&#241;os&#46; Se contact&#243; con los padres para ofrecerles toda la informaci&#243;n relativa al estudio&#44; solicit&#225;ndoles su participaci&#243;n a trav&#233;s del modelo de consentimiento elaborado ad hoc&#46; Fueron citados para realizar la evaluaci&#243;n que se llev&#243; a cabo a los 4&#44; 5 y 6 a&#241;os de edad&#46; El presente estudio fue aprobado por el Comit&#233; Coordinador de &#201;tica de la Investigaci&#243;n Biom&#233;dica de la comunidad aut&#243;noma&#44; cumpli&#233;ndose en todo momento lo establecido en la Declaraci&#243;n de Helsinki respecto a principios &#233;ticos&#46; En el caso del GNP&#44; previo consentimiento de los padres del GP&#44; se contact&#243; con los centros educativos donde estaban escolarizados&#44; solicitando su colaboraci&#243;n&#46; Posteriormente&#44; los padres de los alumnos seleccionados&#44; atendiendo a la edad y el sexo&#44; fueron informados y firmaron el consentimiento informado&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La evaluaci&#243;n de ambos grupos fue pareada en edad y tiempo&#46; Se realizaron an&#225;lisis no param&#233;tricos &#40;<span class="elsevierStyleItalic">U</span> de Mann-Whitney para las comparaciones intergrupos&#44; Wilconxon para los estudios longitudinales intragrupo&#44; y Kruskal-Wallis para realizar el estudio de la comparativa de los 3 grupos estudiados una vez subdividido el GP&#41;&#44; al no cumplir los criterios de normalidad&#46; Para todo ello&#44; se us&#243; el programa estad&#237;stico SPSS v&#46; 24&#46;0 para Windows y se determin&#243; la significatividad en <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Para calcular el tama&#241;o del efecto&#44; se realizaron an&#225;lisis <span class="elsevierStyleItalic">r</span> de Rosenthal al tratarse de pruebas no param&#233;tricas&#44; para la diferencia entre 2 variables analizadas&#44; la cual puede ser peque&#241;a &#40;0&#44;10&#41;&#44; media &#40;0&#44;30&#41;&#44; grande &#40;0&#44;50&#41; o muy grande &#40;0&#44;70&#41;&#44; dependiendo del resultado obtenido<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">39</span></a>&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0095" class="elsevierStylePara elsevierViewall">La muestra estaba formada por 98 participantes &#40;50&#37; con antecedentes de prematuridad y 50&#37; nacidos a t&#233;rmino&#41;&#46; Para valorar la influencia de la EG se subdividi&#243; el GP en GP1 &#40;63&#37;&#41; y GP2 &#40;37&#37;&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Al analizar el nivel de desarrollo en prematuros y a t&#233;rmino se encuentran resultados dentro del intervalo medio en todas las &#225;reas y en los diferentes momentos &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Al comparar GP y GNP&#44; en los diferentes momentos&#44; encontramos puntuaciones m&#225;s bajas en el GP a los 4 a&#241;os en todas las &#225;reas evaluadas&#44; excepto en la Num&#233;rica&#44; no detect&#225;ndose diferencias a los 5 y 6 a&#241;os&#46; El tama&#241;o del efecto en las &#225;reas Perceptivo-Manipulativa&#44; &#205;ndice General de Cognitivo y Motora a los 4 a&#241;os es de tipo medio &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Al realizar los an&#225;lisis intragrupo longitudinales&#44; encontramos que en el GP los logros en el &#225;rea Verbal mejoran de los 4 a los 5 a&#241;os &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;008&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;377<span class="elsevierStyleItalic">&#41;</span>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Atendiendo al grado de prematuridad&#44; las puntuaciones en los GP1 y GP2 se sit&#250;an dentro del rango medio&#44; aunque en el GP2 las puntuaciones son m&#225;s elevadas en todas las &#225;reas y tiempos de medida &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Para conocer la influencia del grado de prematuridad en el desarrollo posterior del ni&#241;o&#44; se realizaron an&#225;lisis <span class="elsevierStyleItalic">U</span> de Mann-Whitney por pares &#40;GP1 vs&#46; GNP&#59; GP1 vs&#46; GP2 y GP2 vs&#46; GNP&#41;&#46; Se encuentran resultados significativos entre los muy prematuros &#40;GP1&#41; y los moderados-tard&#237;os &#40;GP2&#41;&#44; detect&#225;ndose m&#225;s dificultades a menor EG&#44; y a mayor edad cronol&#243;gica &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Tambi&#233;n se encuentran puntuaciones significativamente m&#225;s bajas en GP1 frente al GNP en las &#225;reas Verbal&#44; Perceptivo-Manipulativa&#44; &#205;ndice General Cognitivo y Motor a los 4 y a los 6 a&#241;os &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; Por el contrario&#44; no se hallan datos estad&#237;sticamente significativos entre los GP2 y GNP&#46; El tama&#241;o del efecto es medio en todas las relaciones se&#241;aladas&#44; a excepci&#243;n del &#205;ndice General Cognitivo a los 5 a&#241;os entre GP1 y GP2&#44; que es peque&#241;o&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Por &#250;ltimo&#44; en el an&#225;lisis intragrupo&#44; comprobamos que en GP1 existen diferencias tanto en el &#225;rea Verbal &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;011&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;459&#41; como en la Perceptivo-Manipulativa &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;030&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;389&#41; entre los 4 y los 5 a&#241;os&#44; con un tama&#241;o del efecto medio en ambos casos&#46; En el caso de la Verbal&#44; los resultados mejoran a los 5 a&#241;os&#44; mientras que en Perceptivo-Manipulativa sucede lo contrario&#46; En el resto de &#225;reas y medidas no encontramos hallazgos rese&#241;ables&#44; salvo una tendencia al descenso en las puntuaciones del GP1 a la edad de 6 a&#241;os&#46; En el GP2 no se observan discrepancias intragrupo&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">Algunas investigaciones afirman que los ni&#241;os con antecedentes de prematuridad pueden presentar dificultades en el desarrollo<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">13&#44;15</span></a>&#46; Los resultados obtenidos en este estudio coinciden parcialmente&#44; ya que las puntuaciones alcanzadas por el grupo de prematuros se encuentran en el rango medio&#46; No obstante&#44; al compararlos con sus iguales se encuentran diferencias significativas&#44; que se hacen m&#225;s notables cuando se atiende al grado de prematuridad&#46; Es a los 4 a&#241;os cuando las diferencias con respeto a los no prematuros son m&#225;s evidentes&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">En lenguaje&#44; los resultados hallados apoyan los encontrados por Ment et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">21</span></a>&#44; donde las diferencias entre prematuros y no prematuros a los 4 a&#241;os no se mantuvieron en el tiempo&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En cuanto al &#225;rea Motora&#44; los datos se relacionan parcialmente con los obtenidos en otras investigaciones<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">20&#44;26&#44;29</span></a>&#44; detect&#225;ndose diferencias entre prematuros y no prematuros&#44; aunque solo a los 4 a&#241;os&#46; Es posible que las alteraciones neuromotrices leves<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">27</span></a> o de percepci&#243;n visual<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">29</span></a> encontradas a edades similares se relacionen con las diferencias obtenidas en el &#225;rea Perceptivo-Motriz&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Los resultados hallados en Memoria solo muestran diferencias a los 4 a&#241;os&#44; pero es a partir de los 6 cuando es b&#225;sica para aprendizajes de mayor nivel de exigencia&#46; Por ello&#44; es posible que se presenten m&#225;s dificultades a edades superiores<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">28&#44;30</span></a>&#46; Estos datos sugieren la necesidad de una evaluaci&#243;n con pruebas espec&#237;ficas de memoria&#44; despu&#233;s de los 6 a&#241;os&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Cuando el nacimiento es antes de la semana 32 el nivel de desarrollo es inferior respecto a los nacidos a t&#233;rmino&#44; mientras que no existen diferencias entre los prematuros moderados o tard&#237;os y los a t&#233;rmino&#46; Estos resultados apoyan estudios en la misma etapa evolutiva<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">9&#44;14</span></a> donde se evidencian dificultades cognitivas y en el desarrollo neurol&#243;gico cuanto mayor es el grado de prematuridad<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">11&#44;12</span></a>&#46; Es decir&#44; nacer muy prematuro se relaciona con peores competencias cognitivas y motoras durante la etapa preescolar&#44; no siendo tan evidente en los moderados o tard&#237;os<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">16&#44;17</span></a>&#46; Estos datos hacen previsible que los muy prematuros necesiten mayores apoyos al inicio de Educaci&#243;n Primaria&#44; puesto que muestran logros significativamente m&#225;s bajos a esta edad en la mayor&#237;a de las &#225;reas evaluadas&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Por &#225;reas&#44; los resultados en Lenguaje apoyan lo planteado por Rodr&#237;guez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">22</span></a> y S&#225;nchez-Joya et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">14</span></a> donde los muy prematuros ten&#237;an peores resultados&#44; o tambi&#233;n los de Aarnoudse-Moens et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">23</span></a> que observaban una peor fluidez verbal en comparaci&#243;n con los no prematuros&#46; Situaci&#243;n similar a la anterior encontramos en el &#225;rea Motora<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">10&#44;27</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Es destacable la escasez de estudios de preescolares nacidos muy prematuros que eval&#250;en las &#225;reas de Memoria y Num&#233;rica&#46; Por lo que habr&#237;a que considerar las diferencias halladas&#44; muy significativas en Memoria&#44; tanto a los 4 como a los 6 a&#241;os&#44; ya que pueden condicionar los logros posteriores&#46; Respecto a las habilidades matem&#225;ticas&#44; se han se&#241;alado diferencias entre los muy prematuros y los a t&#233;rmino<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">29</span></a>&#44; donde la percepci&#243;n visual podr&#237;a tener un papel mediador en la etapa escolar<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">28</span></a>&#46; En este caso&#44; tambi&#233;n se evidencian dificultades num&#233;ricas atendiendo a la EG&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Los datos obtenidos en el an&#225;lisis intragrupo no arrojan hallazgos concluyentes&#46; Aunque s&#237; se observa que en el grupo de muy prematuros las puntuaciones descienden a medida que aumenta la edad y el nivel de exigencia&#46; Por el contrario&#44; en el grupo de prematuros moderados y tard&#237;os las puntuaciones van mejorando y tienden a situarse al nivel de los nacidos a t&#233;rmino&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Al inicio de la presente investigaci&#243;n nos planteamos valorar la influencia de la prematuridad a lo largo de la etapa preescolar&#44; lo que supone una fortaleza&#44; que enriquece el trabajo realizado&#44; dadas las escasas oportunidades para evaluar todo este periodo&#46; Podemos concluir que el desarrollo psicomotriz de los prematuros queda condicionado por la EG al nacimiento&#46; Por lo que aquellos estudios que no toman en consideraci&#243;n esta variable pueden darnos una idea no realista del funcionamiento del grupo en esta etapa&#46; Analizando los logros seg&#250;n el grado de prematuridad&#44; podemos obtener informaci&#243;n m&#225;s ajustada sobre su perfil de desarrollo psicomotor&#46; As&#237;&#44; a los 6 a&#241;os los muy prematuros o extremos s&#237; presentan un rendimiento m&#225;s bajo no solo respecto a los nacidos a t&#233;rmino&#44; sino tambi&#233;n respecto a los prematuros moderados o tard&#237;os&#46; Estos datos pueden afectar en el inicio de la Educaci&#243;n Primaria&#44; donde el nivel de exigencia aumenta&#44; y el grupo de mayor prematuridad puede encontrar m&#225;s dificultades&#46; Por todo ello&#44; se considera necesario que la atenci&#243;n a esta poblaci&#243;n desde el contexto sanitario contin&#250;e m&#225;s all&#225; de los 6 a&#241;os&#44; etapa clave en la adquisici&#243;n de habilidades y aprendizajes que pueden condicionar su rendimiento escolar posterior&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Finalmente&#44; consideramos relevante indicar algunas limitaciones del estudio&#44; como el reducido n&#250;mero de casos al distribuir el grupo de prematuros atendiendo a la EG al nacimiento&#46; Para futuras investigaciones ser&#237;a interesante ampliar la muestra inicial para&#44; tras la mortalidad experimental&#44; mantener una potencia adecuada&#46; Adem&#225;s&#44; se deber&#237;a tomar en consideraci&#243;n la influencia de otras variables m&#233;dicas y&#47;o sociodemogr&#225;ficas&#59; analizar de forma pormenorizada las diferentes subescalas de las Escalas McCarthy y completar la evaluaci&#243;n psicom&#233;trica con pruebas m&#225;s espec&#237;ficas para cada &#225;rea de desarrollo&#44; especialmente lenguaje&#44; memoria&#44; funciones ejecutivas&#44; y utilizar pruebas de neuroimagen&#44; lo que podr&#237;a revelar conclusiones m&#225;s concretas sobre las funciones cerebrales m&#225;s afectadas&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Financiaci&#243;n</span><p id="par0175" class="elsevierStylePara elsevierViewall">Consejer&#237;a de Salud&#46; Junta de Andaluc&#237;a&#46; C&#243;digo&#58; PI-0397&#47;2007&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Junta de Andaluc&#237;a&#46; C&#243;digo&#58; 1999&#47;07&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicto de intereses</span><p id="par0185" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">En las &#250;ltimas d&#233;cadas&#44; el nacimiento de ni&#241;os prematuros se ha incrementado notablemente&#44; siendo importante conocer sus efectos&#46; El objetivo del estudio es determinar el perfil de desarrollo psicomotor de ni&#241;os con antecedentes de prematuridad&#44; a los 4&#44; 5 y 6 a&#241;os&#44; y compararlos con un grupo de ni&#241;os nacidos a t&#233;rmino para detectar posibles desajustes&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La muestra estaba constituida por 98 participantes&#44; distribuidos uniformemente en 2 grupos&#44; prematuros y a t&#233;rmino&#46; Se realiz&#243; un estudio de cohorte prospectivo longitudinal anal&#237;tico observacional con un dise&#241;o de casos y controles&#46; Se ha considerado la divisi&#243;n del grupo prematuro en muy prematuros y prematuros moderados y tard&#237;os&#46; Las evaluaciones se realizaron con las Escalas McCarthy de Aptitudes y Psicomotricidad para ni&#241;os&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Los datos muestran logros dentro de los intervalos medios&#46; No obstante&#44; se evidencian m&#225;s dificultades en el desarrollo a los 4 a&#241;os en el grupo de prematuros&#46; Atendiendo a la edad gestacional&#44; los muy prematuros &#40;edad gestacional menor de 32 semanas&#41; muestran puntuaciones significativamente m&#225;s bajas con respecto a los prematuros moderados y tard&#237;os&#44; fundamentalmente a los 6 a&#241;os&#44; y con los nacidos a t&#233;rmino&#44; a los 4 y 6 a&#241;os&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A menor edad gestacional&#44; son mayores las dificultades&#44; pudiendo afectar en la etapa de Educaci&#243;n Primaria&#46; Se considera la necesidad de efectuar un seguimiento a todos los prematuros en la etapa preescolar&#44; as&#237; como evaluar habilidades m&#225;s espec&#237;ficas y continuar con la atenci&#243;n desde equipos especializados&#46;</p></span>"
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            "titulo" => "Introducci&#243;n"
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            "identificador" => "abst0010"
            "titulo" => "Pacientes y m&#233;todos"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The rate of premature births has significantly increased&#44; and it is important to determine its effects&#46; The objective of this study is to determine the psychomotor development profile of a group of children born prematurely&#44; at the age of 4&#44; 5 and 6&#44; and to compare them with a group of full-term birth children&#44; in order to detect any differences&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The sample consisted of 98 participants&#44; evenly distributed into two groups&#44; premature and full-term born children&#46; A prospective longitudinal observational analytical study&#44; with a design of cases and controls&#44; was carried out&#46; For some analyses&#44; the separation into early pre-term&#44; moderate pre-term&#44; and late pre-term was considered&#46; The evaluations were performed using the McCarthy Scale of Aptitudes and Psychomotor skills for children&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The data shows achievements within the middle intervals&#46; However&#44; there are more difficulties in development at 4 years in the group of premature children&#44; according to gestational age&#46; Early pre-term &#40;gestational age less than 32 weeks&#41; showed significantly lower scores compared to moderate and late pre-term&#44; mainly at 6 years&#44; and with those born at term&#44; at 4 and 6 years&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Development difficulties are greater at a lower gestational age&#44; and may affect the Primary Education stage&#46; The need to monitor all premature children in the preschool stage is suggested&#44; as well as to evaluate more specific skills and continue with the care from specialist teams&#46;</p></span>"
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">35 &#40;71&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;73&#44;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Uno&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 &#40;20&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;6&#44;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">N&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 16954033
Idioma original: Español
DOI:10.1016/j.anpedi.2019.10.003
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