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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurodevelopmental follow-up of preterm infants: current practice for infants at a tertiary neonatal centre
Meghan Ealish Sandle1, Maria Saito Benz2, Laura Port3
1Community Child health trainee, Capital and Coast/Hutt valley DHB; MSc Student, University of Otago.
Insights
Neurodevelopmental surveillance for high-risk infants shows high follow-up rates. Early assessment tools could better target resources for infants needing developmental support.
Area of Science:
- Neonatal care
- Developmental pediatrics
- Neurodevelopmental disorders
Background:
- Infants born preterm or with low birth weight are at increased risk for adverse neurodevelopmental outcomes.
- Effective neurodevelopmental surveillance is crucial for early identification and intervention in vulnerable infants.
Purpose of the Study:
- To characterize neurodevelopmental surveillance, assessment, and outcomes for high-risk infants.
- To inform targeted surveillance strategies for infants discharged from a tertiary neonatal center.
Main Methods:
- Retrospective review of local health records for 106 infants (born preterm or low birth weight) admitted to a tertiary Neonatal Intensive Care Unit (NICU).
- Analysis of neurodevelopmental follow-up, interventions, and outcomes up to five years corrected postnatal age.
- Exclusion of infants transferred out of the region before two years corrected age.
Main Results:
- 98% of high-risk infants received at least one follow-up visit by a neurodevelopmental therapist.
- 73% received early developmental follow-up aligning with international recommendations.
- At five years, 26% of infants remaining in the region were diagnosed with a developmental disability, most commonly global developmental disability (19%).
Conclusions:
- Routine neurodevelopmental surveillance in this tertiary setting demonstrates high coverage.
- Universal screening is resource-intensive, and diagnosed impairment rates were relatively low.
- Earlier assessment tools could improve risk stratification, optimize resource allocation, and reduce follow-up burden for lower-risk infants.
Aim:
To characterise neurodevelopmental surveillance, assessment and outcomes for infants at risk of adverse neurodevelopment and inform targeted surveillance of infants discharged from a regional tertiary neonatal centre.
Methods:
A retrospective study of developmental follow-up of 106 vulnerable infants born either preterm (23-29 weeks gestation, n=96) or at ≥30 weeks gestation with low birth weight (<1,200 grams n=10) admitted to our tertiary Neonatal Intensive Care Unit between January 2011 and December 2015. Infants transferred to other regions before two-years corrected postnatal age were excluded. Local health records were reviewed to determine neurodevelopmental follow-up, input and outcomes.
Results:
Almost all (98%) of high-risk infants received at least one follow-up visit by a visiting neurodevelopmental therapist following discharge from the neonatal unit, and 73% of infants received early developmental follow-up in line with international recommendations. Ninety infants (87%) were seen until at least two years post term, at which point 61 (68%) had typical development. At five-years post term, 23 (26%) of the 89 infants remaining in the region had been diagnosed with a developmental disability, for which global developmental disability was the most common diagnosis (19 infants).
Conclusion:
Routine neurodevelopmental surveillance of vulnerable infants from our tertiary catchment has high coverage, with most infants receiving regular developmental assessment. However, universal developmental screening is resource intense, and overall rates of diagnosed neurodevelopmental impairment are relatively low. Better early identification of infants most at risk using earlier assessment tools may help to stratify and target follow-up to allow resources to be allocated more effectively and reduce the follow-up burden for infants at lower risk of developmental concerns.
