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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Insights
Neonatal intensive care unit (NICU) graduates often have transient neurological issues. Early identification of subtle neurological deficits is crucial for timely intervention and support during school years.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Child neurology
Background:
- Established neurological examination methods exist for infants with NICU follow-up.
- Major neurological abnormalities in NICU graduates are usually detected during infancy, barring subsequent events like meningitis or head injury.
Purpose of the Study:
- To highlight the prevalence and impact of lesser, transient neurological abnormalities in NICU graduates.
- To emphasize the importance of recognizing subtle neurodevelopmental issues that manifest in school-age children.
- To advocate for early identification and intervention for school-related challenges.
Main Methods:
- Longitudinal follow-up studies of infants discharged from NICUs.
- Neurological examinations during infancy and into preschool/early school years.
- Observation of developmental trajectories and identification of subtle neurological sequelae.
Main Results:
- Approximately 20% of NICU graduates exhibit transient, lesser neurological abnormalities during infancy.
- These children are at risk for hyperactivity, emotional immaturity, and learning disorders in later years.
- Subtle neurological deficits become apparent when academic and behavioral demands increase in school.
Conclusions:
- Early recognition of subtle neurological deficits in NICU graduates is essential.
- Proactive identification can facilitate early intervention for behavior modification and learning support.
- Enhanced understanding and family support are critical for children with neurodevelopmental challenges.
Abstract:
Excellent methods of examining infants neurologically have been described and used in studies with follow-up to preschool or early school years. Few children discharged from NICUs returned with major neurologic abnormalities that were not noted on the infancy examinations, unless there had been an intervening event such as meningitis, head injury, or a difficult seizure disorder. Approximately 20 per cent of infants who were discharged from NICUs had lesser neurologic abnormalities on the infancy examinations, and these were transient. These children are at risk for lesser neurologic sequelae in the preschool years and school years, specifically hyperactivity, emotional immaturity, and a variety of learning disorders. There has been a tendency in follow-up studies of children from the NICU to fucus on the severe neurologic sequelae, but the bulk of the sequelae will become obvious when the school system requires compliance for behavior, rewards advancement in learning skills, and draws attention to deficits in complex coordination. For the teachers and parents of these children, these are frustrating years. In our follow-up study of school-age children, while not markedly abnormal, were not normal either. They demanded patience and extra attention that often wore thin by the time the child reached age six or seven. Early recognition of problem children by health care professionals may increase understanding and aid in early identification of children who need special services for behavior modification, remedial reading, and other school-related skills. It should also encourage much needed family support and counseling.
