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Updated: Oct 5, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Risk stratification helps identify congenital diaphragmatic hernia (CDH) infants in need of formal neurodevelopmental
Mahdi Hassan1, Dylan Patel1, Kathryn LaRusso1
1Harvey Beardmore Division of Pediatric Surgery, Department of Pediatric Surgery, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre.
Insights
Neurodevelopmental delay (NDD) affects 26% of infants with congenital diaphragmatic hernia (CDH). Risk stratification identifies higher-risk infants for targeted NDD surveillance and intervention.
Area of Science:
- Pediatric Medicine
- Developmental Pediatrics
- Neonatology
Background:
- Congenital diaphragmatic hernia (CDH) is associated with neurodevelopmental delays (NDD).
- Early identification and surveillance of NDD are crucial for affected infants.
- Experienced developmental pediatricians and standardized assessments like the Bayley-3 are key for NDD evaluation.
Purpose of the Study:
- To risk stratify infants with CDH based on disease severity.
- To determine the incidence and types of NDD across different risk strata.
- To evaluate the utility of risk stratification in identifying infants needing NDD surveillance.
Main Methods:
- Retrospective review of a CDH long-term follow-up database (n=102).
- Risk stratification using the CDH Study Group Mortality Prediction Score and clinical criteria (ECLS, oxygen, patch repair).
- Analysis of post-discharge NDD assessments (Bayley-3) for patients over 18 months.
Main Results:
- 26% (27/102) of CDH infants experienced NDD.
- NDD incidence increased with risk stratification: 2% (low), 7% (moderate), 18% (high).
- Language delay was most prevalent; motor deficits were primarily in the high-risk group.
Conclusions:
- NDD is common in CDH infants, affecting approximately one-quarter.
- Risk stratification effectively identifies infants at higher risk for NDD.
- Structured NDD assessment is vital for high-risk CDH infants within interdisciplinary care pathways.
Background/Purpose:
Neurodevelopmental delay (NDD) affects congenital diaphragmatic hernia (CDH) infants. Initial assessment by experienced developmental pediatricians, supported by Bayley-3 tests, is a viable pathway for NDD identification and surveillance. We risk stratified CDH infants to observe differences in incidence and type of NDD based on disease severity.
Methods:
Patients from a CDH long-term follow-up database started in 2012 were reviewed (REB#2019-4583). Risk stratification into low, moderate, and high-risk cohorts was performed using the CDH Study Group Mortality Prediction Score. Patients requiring ECLS, supplemental oxygen at 30 days and patch repair were also considered high-risk (i.e. usual clinical criteria). Post-discharge NDD assessments by developmental pediatricians and occupational therapists (Bayley-3) were analyzed for all patients >18months. NDD incidence and type per risk group was determined using descriptive statistics.
Results:
Of 102 CDH patients included for study, 26% (27/102) had NDD. Risk stratification identified 2(2%), 7(7%), and 18(18%) patients with NDD in the low, moderate and high-risk groups, respectively. Language delay (2 low; 6 moderate; 10 high) was the most prevalent. Three patients had both expressive and receptive language delay. Motor deficits were observed almost exclusively in the high-risk group.
Conclusion:
Based on our experience, NDD affects one-quarter of CDH infants. Risk stratification helped identify infants at increased risk of NDD. While language delays predominated across all risk groups, multiple deficits occurred in higher risk cohorts. These patients should receive structured NDD assessment as part of an optimal interdisciplinary CDH care pathway.
