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Abstract(s)
A agressividade é o comportamento que surge transversalmente como queixa isolada
ou a par de outras queixas na maioria das crianças com e sem doença, que procuram
apoio em saúde mental infantil. Nessas crianças, e a partir da recolha dos dados
anamnesicos, tem-se verificado a constância de registo, no Livro do Bebé, de Índice
de Apgar ≤ 9 ao primeiro minuto.
Este estudo exploratório pretendeu analisar a hipótese teórica de que o Índice de
Apgar abaixo de 10 ao primeiro minuto pode ser representativo de sofrimento fetal
intraparto ou perinatal e assim fragilizar os circuitos neuronais das emoções tendo
como consequência o surgimento, ao longo do desenvolvimento infantil e juvenil, de
dificuldades na capacidade de gestão ou controlo das emoções, com comportamentos
opositivos e/ou agressivos, como resposta defensiva de luta e fuga.
Utilizou-se uma amostra de crianças inscritas no serviço de consulta externa de saúde
mental infantil e juvenil, e verificou-se se as queixas de perturbação do comportamento
com agressividade, formuladas no momento do acolhimento ao serviço, estão
relacionadas com o Índice de Apgar ≤ 9 ao primeiro minuto e/ou com os registos de
sofrimento fetal.
Procurou-se, numa amostra aleatória de crianças sem queixa formulada no serviço de
consulta externa de saúde mental infantil e juvenil, perceber as diferenças ou
semelhanças dos registos de nascimento relativamente à amostra de crianças
inscritas. Foi ainda auscultada a opinião dos profissionais dos serviços de obstetrícia e
neonatologia – pediatria, mediante a aplicação de um questionário, no sentido de
recolher as opiniões dos profissionais de saúde que lidam com o parto, que avaliam o
Índice de Apgar dos recém – nascidos e que os seguem durante as primeiras horas ou
dias de vida.
Das conclusões a que chegamos, salienta-se que o sofrimento fetal intraparto pode
ser predictor de dificuldades de controlo emocional traduzidas em alterações do
comportamento com agressividade em situações de stress. Não se conclui que o
Índice de Apgar ≤ 9 pode ser predictor de alterações do comportamento com
agressividade em situações de stress, uma vez que os registos de ocorrências de
sofrimento fetal intraparto e os registos do Índice de Apgar ao primeiro minuto são, na
amostra de crianças com queixa, díspares, relacionando-se no entanto de modo
estatisticamente significativo na amostra de crianças sem queixa.
III
No entanto, e apesar das dificuldades metodológicas, fica a certeza de haver mais
percursos a percorrer nesta direcção para a compreensão dos distúrbios emocionais e
a agressividade.
Aggressiveness is a behavioral trait which comes across as a complaint by itself or together with other symptoms in most children, with or without disease, who seek support in child mental health services. Among those children and from the collection of histories given, it has been possible to check the constancy of the ≤ 9 Apgar in the first minute, recorded in the Book of the Baby. This exploratory study sought to examine the theoretical hypothesis that the Apgar score less than 10 in the first minute may be representative of intrapartum or perinatal fetal distress and thus weaken the neural circuitry of emotion resulting in the emergence along the child and youth development process difficulties in the ability to manage or control of emotions with oppositional and/or aggressive behaviors as a defensive response of fight or flight. It was used a sample of children enrolled in the outpatient service for child and youth mental health and found that complaints of disturbance of conduct with aggressiveness made at the time of the reception service are related to the Apgar score at first minute and or with records of fetal distress. A random sample of children without complaint in the service of external consultation was investigated in order to understand the differences or similarities of birth records for the sample of children enrolled. The views of neonatology, obstetrics and pediatrics services professionals were also requested by applying a questionnaire to collect the opinions of health experts who deal with childbirth, assess the Apgar score of newborns and follow them during the first hours or days of life. Of the conclusions reached should be noted that the intrapartum fetal distress may be predictor of difficulties in emotional control translated into behavioral changes in aggressiveness under stress. It wasn´t possible to conclude that the Apgar score ≤ 9 may be predictor of behavioral changes with aggressiveness under stress since the records of occurrences of intrapartum fetal distress and records of Apgar score in the first minute are very disparate in the sample of children with complaints. IV However, despite the methodological difficulties is to make sure there are more paths to go in this direction for the understanding of emotional disorders and aggressiveness.
Aggressiveness is a behavioral trait which comes across as a complaint by itself or together with other symptoms in most children, with or without disease, who seek support in child mental health services. Among those children and from the collection of histories given, it has been possible to check the constancy of the ≤ 9 Apgar in the first minute, recorded in the Book of the Baby. This exploratory study sought to examine the theoretical hypothesis that the Apgar score less than 10 in the first minute may be representative of intrapartum or perinatal fetal distress and thus weaken the neural circuitry of emotion resulting in the emergence along the child and youth development process difficulties in the ability to manage or control of emotions with oppositional and/or aggressive behaviors as a defensive response of fight or flight. It was used a sample of children enrolled in the outpatient service for child and youth mental health and found that complaints of disturbance of conduct with aggressiveness made at the time of the reception service are related to the Apgar score at first minute and or with records of fetal distress. A random sample of children without complaint in the service of external consultation was investigated in order to understand the differences or similarities of birth records for the sample of children enrolled. The views of neonatology, obstetrics and pediatrics services professionals were also requested by applying a questionnaire to collect the opinions of health experts who deal with childbirth, assess the Apgar score of newborns and follow them during the first hours or days of life. Of the conclusions reached should be noted that the intrapartum fetal distress may be predictor of difficulties in emotional control translated into behavioral changes in aggressiveness under stress. It wasn´t possible to conclude that the Apgar score ≤ 9 may be predictor of behavioral changes with aggressiveness under stress since the records of occurrences of intrapartum fetal distress and records of Apgar score in the first minute are very disparate in the sample of children with complaints. IV However, despite the methodological difficulties is to make sure there are more paths to go in this direction for the understanding of emotional disorders and aggressiveness.
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Instituto Politécnico do Porto. Escola Superior de Tecnologia da Saúde do Porto