SENSORY PROCESSING DURING CHILDHOOD IN PRETERM INFANTS: A SYSTEMATIC REVIEW

The search of the available literature on the theme was held in the following electronic databases: Medical Literature Analysis and Retrieval System Online (Medline)/PubMed, Latin American and Caribbean Literature in Health Sciences (Lilacs)/Virtual Library in Health (BVS), Índice Bibliográfico Español de Ciencias de la Salud (IBECS)/BVS, Scopus, and Web of Science. We included only original indexed studies with a quantitative approach, which were available in full text on digital media, published in Portuguese, English, or Spanish between 2005 and 2015, involving children aged 0-9years.

Data synthesis:

581 articles were identified and eight were included. Six studies (75%) found high frequency of dysfunction in sensory processing in preterm infants. The association of sensory processing with developmental outcomes was observed in three studies (37.5%). The association of sensory processing with neonatal characteristics was observed in five studies (62.5%), and the sensory processing results are often associated with gestational age, male gender, and white matter lesions.

Conclusions:

The current literature suggests that preterm birth affects the sensory processing, negatively. Gestational age, male gender, and white matter lesions appear as risk factors for sensoryprocessing disorders in preterm infants. The impairment in the ability to receivesensory inputs, to integrateand to adapt to them seems to have a negative effect on motor, cognitive, and language development of these children. We highlight the feasibility of identifying sensory processing disorders early in life, favoring early clinical interventions.

Keywords:
Sensation disorders; Infant, premature; Review

Author, year	Country	Study design
Rahkonen et al.,³⁵35. Rahkonen P, Lano A, Pesonen A, Heinonen K, Raikkonen K, Vanhatalo S, et al. Atypical sensory processing is common in extremely low gestational age children. Acta Paediatr. 2015;104:522-8.2015	Finland	Prospective
Adams et al.,³⁶36. Adams JN, Feldman HM, Huffman LC, Loe IM. Sensory processing in preterm preschoolers and its association with executive function. Early Hum Dev. 2015;91:227-33.2015	United States of America	Cross-sectional
Cabral et al.,³⁷37. Cabral TI, Silva LG, Tudella E, Martinez CM. Motor development and sensory processing: a comparative study between preterm and term infants. Res Dev Disabil. 2015;36:102-7.2015	Brazil	Cross-sectional
Chorna et al.,³⁸38. Chorna O, Solomon JE, Slaughter JC, Stark AR, Maitre NL. Abnormal sensory reactivity in preterm infants during the first year correlates with adverse neurodevelopmental outcomes at 2 years of age. Arch Dis Child Fetal Neonatal Ed. 2014;99:F475-9.2014	United States of America	Prospective
Eeles et al.,³⁹39. Eeles AL, Anderson PJ, Brown NC, Lee KJ, Boyd RN, Spittle AJ, et al. Sensory profiles of children born <30 weeks' gestation at 2 years of age and their environmental and biological predictors. Early Hum Dev. 2013;89:727-32.2013	Australia	Prospective
Eeles et al.,⁴⁰40. Eeles AL, Anderson PJ, Brown NC, Lee KJ, Boyd RN, Spittle AJ, et al. Sensory profiles obtained from parental reports correlate with independent assessments of development in very preterm children at 2 years of age. Early Hum Dev. 2013;89:1075-80.2013	Australia	Cross-sectional
Wickremasinghe et al.,⁴¹41. Wickremasinghe AC, Rogers EE, Johnson BC, Shen A, Barkovich AJ, Marco EJ. Children born prematurely have atypical sensory profiles. J Perinatol. 2013;33:631-5.2013	United States of America	Cross-sectional
Bart et al.,⁴²42. Bart O, Shayevits S, Gabis LV, Morag I. Prediction of participation and sensory modulation of late preterm infants at 12 months: a prospective study. Res Dev Disabil. 2011;32:2732-8.2011	Israel	Cross-sectional

Author	Sample	Objectives	Age,assessments, and instruments
Rahkonen et al.³⁵35. Rahkonen P, Lano A, Pesonen A, Heinonen K, Raikkonen K, Vanhatalo S, et al. Atypical sensory processing is common in extremely low gestational age children. Acta Paediatr. 2015;104:522-8.	44 preterm infants (GA <28 weeks)	- To investigate the SP and its association with neonatal risk factors, neuroanatomical data and neurodevelopment	- Age term: brain neuroanatomical assessment (MRI) - Two years of corrected age: evaluation of SP (ITSP); neurological assessment (Hempel); assessment of mental development (GMDS); assessment of cognition and language (BSID)
Adams et al.³⁶36. Adams JN, Feldman HM, Huffman LC, Loe IM. Sensory processing in preterm preschoolers and its association with executive function. Early Hum Dev. 2015;91:227-33.	54 preterm infants (GA <34 weeks) and 73 full terminfants (GA>37 weeks)	- To compare the SPof preterm and full term infants and to check the association of SPwith executive and adaptive functions in preterm infants	- Between 3 and 5 years old: evaluation of SP (SSP); assessment of executive function (BRIEF-P and performance in six interactive tasks); evaluation of adaptive function (Vineland-II)
Cabral et al.³⁷37. Cabral TI, Silva LG, Tudella E, Martinez CM. Motor development and sensory processing: a comparative study between preterm and term infants. Res Dev Disabil. 2015;36:102-7.	15 preterm infants (GA <37 weeks) and 15 full term infants (37> GA>42 weeks)	- To compare and investigate the association between SP and motor development in preterm and full terms infants	- Between 4 and 6 months of corrected age: evaluation of SP (TSFI); evaluation of motor development by AIMS.
Chorna et al.³⁸38. Chorna O, Solomon JE, Slaughter JC, Stark AR, Maitre NL. Abnormal sensory reactivity in preterm infants during the first year correlates with adverse neurodevelopmental outcomes at 2 years of age. Arch Dis Child Fetal Neonatal Ed. 2014;99:F475-9.	40 preterm infants (GA <30 weeks)	- To assess the outcome of SP and its association with neurodevelopment	- Corrected age of 4-12 months: evaluation of SP (TSFI) - Two years of corrected age: evaluation of cognition, motor skills,and language (BSID).
Eeles et al.³⁹39. Eeles AL, Anderson PJ, Brown NC, Lee KJ, Boyd RN, Spittle AJ, et al. Sensory profiles of children born <30 weeks' gestation at 2 years of age and their environmental and biological predictors. Early Hum Dev. 2013;89:727-32.	253 preterm infants (GA <32 weeks) and 65 full term infants (GA>36 weeks)	- To examine the SP and its environmental and biological influences	- Age at full term: neuroanatomical assessment (MRI) - Two years of corrected age: evaluation of SP (ITSP)
Eeles et al.⁴⁰40. Eeles AL, Anderson PJ, Brown NC, Lee KJ, Boyd RN, Spittle AJ, et al. Sensory profiles obtained from parental reports correlate with independent assessments of development in very preterm children at 2 years of age. Early Hum Dev. 2013;89:1075-80.	241 preterm infants with GA<30 weeks	- To examine the SP and its association with neurodevelopment	- At two years of corrected age: evaluation of SP (ITSP) and neurodevelopment (BSID)
Wickremasinghe et al.⁴¹41. Wickremasinghe AC, Rogers EE, Johnson BC, Shen A, Barkovich AJ, Marco EJ. Children born prematurely have atypical sensory profiles. J Perinatol. 2013;33:631-5.	107 preterm infants (GA≤32 weeks)	- To check the outcome of SP and its association with neurodevelopment	- Between 1-8 years: evaluation of SP (ITSP and SSP); evaluation of neurodevelopment (BSID, WPPSI, and WISC)
Bart et al.⁴²42. Bart O, Shayevits S, Gabis LV, Morag I. Prediction of participation and sensory modulation of late preterm infants at 12 months: a prospective study. Res Dev Disabil. 2011;32:2732-8.	124 preterm infants (34> GA<36 weeks and 33 full term infants (GA>37 weeks)	- To compare the SP and participation in daily activities and to verify the association of SP with neonatal characteristics in preterm infants	- One year of chronological age: evaluation of SP (ITSP and TSFI) and of the participation in daily activities (own questionnaire).

Author	Main results
Rahkonen et al.³⁵35. Rahkonen P, Lano A, Pesonen A, Heinonen K, Raikkonen K, Vanhatalo S, et al. Atypical sensory processing is common in extremely low gestational age children. Acta Paediatr. 2015;104:522-8.	There was a high frequency of altered SP. SP outcome was associated with white matter lesions and surgical closure of patent ductus arteriosus. No association was found between SP and neurodevelopment.
Adams et al.³⁶36. Adams JN, Feldman HM, Huffman LC, Loe IM. Sensory processing in preterm preschoolers and its association with executive function. Early Hum Dev. 2015;91:227-33.	Preterm infants had significant lower scores on SSP compared to full term infants, with higher frequency of altered sensory processing. GA was associated with SP. Association was found between SP and executive function in preterm infants. There was no association between SP and adaptive function in preterm infants.
Cabral et al.³⁷37. Cabral TI, Silva LG, Tudella E, Martinez CM. Motor development and sensory processing: a comparative study between preterm and term infants. Res Dev Disabil. 2015;36:102-7.	Preterm infants are different from their full term peers in relation to the SP, especially regarding the reactivity to deep tactile pressure. No difference was found between the groups with regard to motor development. There was no statistically significant association of SP with motor development in both groups.
Chorna et al.³⁸38. Chorna O, Solomon JE, Slaughter JC, Stark AR, Maitre NL. Abnormal sensory reactivity in preterm infants during the first year correlates with adverse neurodevelopmental outcomes at 2 years of age. Arch Dis Child Fetal Neonatal Ed. 2014;99:F475-9.	There was a high frequency of abnormal SP, especially regarding reactivity to vestibular stimulation and reactivity to deep tactile pressure. GA, male gender, white matter lesions, and caregiver education were associated with SP outcomes. SP was associated with motor and language development.
Eeles et al.³⁹39. Eeles AL, Anderson PJ, Brown NC, Lee KJ, Boyd RN, Spittle AJ, et al. Sensory profiles of children born <30 weeks' gestation at 2 years of age and their environmental and biological predictors. Early Hum Dev. 2013;89:727-32.	Preterm infants showedhigher frequency of SPalterations when compared to peers at term. Male gender, white matter lesions, and hospital stay were associated with SP outcomes.
Eeles et al.⁴⁰40. Eeles AL, Anderson PJ, Brown NC, Lee KJ, Boyd RN, Spittle AJ, et al. Sensory profiles obtained from parental reports correlate with independent assessments of development in very preterm children at 2 years of age. Early Hum Dev. 2013;89:1075-80.	An association of SP outcomes with motor, cognitive, and languagedevelopment was found.
Wickremasinghe et al.⁴¹41. Wickremasinghe AC, Rogers EE, Johnson BC, Shen A, Barkovich AJ, Marco EJ. Children born prematurely have atypical sensory profiles. J Perinatol. 2013;33:631-5.	There was a high frequency of altered SP, with similar prevalence at age ranges 1-4 years and 4-8 years. The most affected areas were the auditory, vestibular, and tactile processing. No association was observed between SP, neonatal characteristics, and neurodevelopment.
Bart et al.⁴²42. Bart O, Shayevits S, Gabis LV, Morag I. Prediction of participation and sensory modulation of late preterm infants at 12 months: a prospective study. Res Dev Disabil. 2011;32:2732-8.	Preterm infants are different from the peers born at term in relation to the SP. There was a significant difference between groups in the frequency of participation in all areas of activities, except for leisure. The groups were also different with respect to the satisfaction of parents, except for social participation. Association was found between SP, GA, and head circumference. Days at hospital and multiple births were predictors of participation in daily activities and parental satisfaction.

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[1] *Corresponding author. E-mail: carolaraxa.acm@gmail.com (A.C.C.P. Machado).