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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Prematurity and parental expectations: too early and now too much
Jack Maypole1, Maria Trozzi, Marilyn Augustyn
1From the *Comprehensive Care Clinic, Boston Medical Center, Boston University, School of Medicine; †The Good Grief Program, Boston Medical Center; ‡Division of Developmental and Behavioral Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA.
Insights
This case study follows Hami, a 3-year-old former premature infant experiencing developmental delays, particularly in language and activity levels. It highlights parental concerns and early intervention strategies as he transitions to public school.
Area of Science:
- Pediatric developmental neurology
- Neonatal intensive care outcomes
- Early childhood intervention
Background:
- A 3-year-old boy, born at 25 weeks gestation, with a history of intraventricular hemorrhage and anemia requiring transfusions.
- Smooth Neonatal Intensive Care Unit (NICU) course with intubation and discharge on room air; normal brainstem auditory evoked potential and no retinopathy of prematurity.
Observation:
- Delayed developmental milestones including walking at 17 months and first words at 2 years.
- Slow language development, with 2-word combinations emerging at 2.5 years; increased early intervention services initiated.
- Parental concerns regarding Hami's language progression and high activity level compared to peers, impacting family dynamics and childcare arrangements.
Findings:
- Hami exhibits significant delays in expressive language and social-emotional regulation, characterized by high activity levels.
- Early intervention services have been intensified, including speech-language therapy and playgroups, to address developmental needs.
- Parents express anxiety regarding the transition to public schooling, citing concerns about Hami's age, activity level, and behavioral challenges.
Implications:
- The case underscores the importance of comprehensive early intervention for premature infants with developmental delays.
- It highlights the need for tailored support systems for families navigating complex childcare needs and developmental concerns.
- Effective transition planning to public school requires addressing Hami's specific needs and parental anxieties for successful integration.
Case:
Hami is a 3-year-old boy who is a former premature 25-week infant with a birth weight of 1 pound 9 ounces. He had a relatively smooth Neonatal Intensive Care Unit (NICU) course; he required intubation for 1 month and went home on room air. He had a left Grade I intraventricular hemorrhage that was resolved by 2 months of life. He had 7 blood transfusions for anemia over the first 3 months of life. A brainstem auditory evoked potential test was normal at hospital discharge, and he showed no evidence of retinopathy of prematurity. He never had seizure activity.He was discharged to home at 3 months where he did well and thrived on a high calorie formula. He walked at 17 months and spoke his first words at 2 years. He was enrolled in Early Intervention at the time of discharge from hospital; monthly home visits were increased to weekly visits by an early childhood educator at 12 months. When he was 12 months, he was enrolled in a family day care with 4 other children younger than 3 years. Hami's language development was slow; at 2.5 years of age, he was beginning to make 2 word combinations. Early intervention services were increased to include an additional hour of speech and language therapy as well as a play group.Hami's mother is 33 years old, and this is her first child. She worked as an accounting assistant, but she was able to be home with Hami for the first year of his life. She returned to full-time work on his first birthday. Hami's father is 35 years old and works for the national electrical grid as a manager. They are not married but have lived together for the last 5 years. Dad works evenings and cares for Hami from 4 to 6 pm after childcare; mom returns from work at 6 pm. Dad leaves for work at 7 pm and works till 2 am. Their relationship has been strained by the child care demands, their work schedules, and Hami's developmental progress.Hami's primary care pediatrician specializes in children with complex medical problems. The parents express concern at the 3-year-old visit that Hami's language is not progressing as it should be. They are concerned that he is much more active than the other 3 year olds in his child care setting. Early intervention has initiated the transition process to a public school placement, and the parents are very concerned that he is too young, too active, and too much of a handful to be "in the big public school." What would you do next?
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