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The high-risk infant
1Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Infants with biologic or environmental risk factors face higher developmental disability risks. Identifying and monitoring high-risk infants ensures timely intervention and resource allocation for better outcomes.
Area of Science:
- Neonatal care
- Developmental pediatrics
- Public health
Background:
- Many infants are born with risk factors for developmental disability.
- Specific factors like brain injury and abnormal exams indicate higher risk.
- Multiple risk factors compound the risk of disability.
Purpose of the Study:
- To identify infants at high risk for developmental disability.
- To guide resource allocation for developmental follow-up and early intervention.
- To establish a system for tracking high-risk infants.
Main Methods:
- Review of biologic and environmental risk factors in infants.
- Assessment of risk levels associated with specific factors and their combinations.
- Analysis of the need for targeted developmental screening and monitoring.
Main Results:
- Certain risk factors (e.g., intraparenchymal hemorrhage, periventricular cysts) significantly increase disability risk.
- Infants with multiple risk factors have a substantially greater risk.
- Selective comprehensive follow-up for highest-risk infants is resource-efficient.
Conclusions:
- Pediatric follow-up and developmental screening are crucial for high-risk infants.
- Prioritizing the highest-risk infants optimizes limited resources for early intervention.
- A robust tracking system facilitates early identification and referral for developmental delays.
Abstract:
A large number of infants are born each year with biologic or environmental risk factors that put them at increased risk for developmental disability, although most do not go on to have major disabilities. Some risk factors, for example, intraparenchymal hemorrhage, periventricular cysts, encephalomalacia, and abnormal neurodevelopmental examination, carry a much higher risk of developmental disability than others. There is much overlap among risk factors, and infants with multiple risk factors generally have a greater risk of disability than infants with just a single risk factor. All high-risk infants should receive careful pediatric follow-up that includes developmental screening, but efficient use of so far quite limited resources argues for selection of the highest risk infants for comprehensive developmental follow-up or early intervention programs. A system of tracking and monitoring high-risk infants during infancy and childhood would allow for early identification of developmental delay and appropriate referral for community resources.