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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Two year neurological outcomes of Very Low Birth Weight infants
1Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya.
Insights
Neurological dysfunction was common in very low birth weight (VLBW) infants in Kenya. Neonatal illness, nutrition, slower growth, and re-hospitalization were linked to poorer outcomes at two years.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Public Health
Background:
- Very Low Birth Weight (VLBW) infants require long-term follow-up for neurological assessment.
- Data on VLBW infant outcomes in resource-constrained settings is limited.
Purpose of the Study:
- To describe the neurological outcomes of VLBW infants at two years of age.
- To identify factors associated with neurological dysfunction in this cohort.
Main Methods:
- A longitudinal descriptive survey was conducted.
- 120 VLBW infants (1000-1500g) were followed from birth to 24 months.
- Neurological assessments were performed at two years.
Main Results:
- 11.7% of VLBW infants had cerebral palsy, 9.2% had cognitive delays, and 26.7% had functional disabilities.
- Factors associated with functional disability included neonatal illness, exclusive breastfeeding, slower weight gain, re-hospitalization, and low weight percentile at two years.
Conclusions:
- Neurological dysfunction is more frequent in this VLBW cohort compared to developed countries.
- Neonatal illness, early nutrition, growth, and post-discharge morbidity are associated with neurological dysfunction.
- Further research is needed to identify interventions for improving neurological outcomes in high-risk newborns.
Background:
High risk newborns such as the Very Low Birth Weight (VLBW) require long term follow up to ascertain their subsequent survival and quality of life (based on neurological intactness). Though such data is now standard in the developed world, little is known in published literature about the situation in resource constrained countries.
Objective:
To describe the neurological outcomes of VLBW infants evaluated at two years of age.
Design:
Longitudinal descriptive survey.
Setting:
Kenyatta National Hospital's Newborn Unit during the year 2002.
Subjects:
One hundred and twenty infants born weighing 1000 grams and 1500 grams followed up until the age of 24 months.
Results:
Of the 120 infants evaluated, 14 (11.7%; 95% CI 6.2-17.1) had cerebral palsy, 11 (9.2%; 95% CI 4.8-16.9) were delayed on cognitive assessment while 32 (26.7%; 95% CI 9.3-38.1) were found to have functional disabilities. The factors associated with functional disability in the cohort included; neonatal illness (P = 0.005, 95% CI 1.26<2.43<4.69), exclusive use of breast milk in the first month (P = 0.02, 95% CI 1.10<2.04<3.78), neonatal weight gain less than 15 grams/kg/day (P = 0.014, 95% CI 1.13<2.24<4.42), history of re-hospitalisation (P<0.001, 95% CI 1.72<3.33<6.34) and weight less than the third percentile at two years (P = 0.019, 95%1.09<2.22<4.53).
Conclusions:
Neurological dysfunction was more frequent in this cohort than presently reported from other centres. The cross-tabulations indicate that history of neonatal illness, choice of early nutrition, slower growth and post discharge morbidity were associated with subsequent neurological dysfunction. The factors associated with developmental delay in this cohort should be explored further in order to determine the manipulations required in the newborn period for improvement of neurological outcomes among these high risk infants.
