Neurodevelopmental follow up care of high-risk new-borns: High-risk infants and new-borns are susceptible to neurodevelopmental delay. The objective of neurodevelopmental follow-up care of high-risk new-borns is to detect the delay early and identify the associated perinatal factors. This will help in the prevention of disability in later life.

There is obviously lots of improvement in the survival rate of the high-risk new-borns due to much improved perinatal care. But for a better assessment of growth and neurodevelopmental outcome, follow up care is mandatory. It is a rather multidisciplinary follow-up, assessment and monitoring programme, but the role of a paediatric neurologist is indispensable.

High-risk Infants’ Categories

High-risk new-born babies fall under these categories – low birth weight babies, infants with metabolic problems – such as hypoglycaemia and hypocalcaemia, perinatal asphyxia, babies with infections like meningitis, chronic lung disease, inborn errors of metabolism, major malformations, neurological abnormalities genetic disorders and seizures.

Neurodevelopmental Disorders

Infants with intracranial pathologies may be presented with hypotonia and seizures, hydrocephalus, bleeds, strokes and brain asphyxia. The most common central nervous system condition includes hypoxic-ischemic encephalopathy – which is associated with inadequate oxygenation. Neonatal stroke is another major diagnosis that requires long-term follow-up

The Role of paediatric Neurologists

Paediatric neurologists specialize in the systematic monitoring of general health and neurodevelopmental outcomes of the new-borns. This sort of early intervention and monitoring through regular neurodevelopmental follow up care ensure early detection of debilitating neurological and other health issue and early rehabilitation as well for better outcomes in the future life of the new-born babies.

Specialists not only follow-up and monitor neurological development or disability, but also assess ongoing illnesses and growth failure equally.

Paediatric neurologists perform a formal neurodevelopmental assessment, screen and assess for behavioural problems and then deal with long-term management of neurological illnesses and seizures. The neurodevelopmental follow up care for developmental disorders and congenital neurological disorders should begin before discharge from the hospital.

High-Risk Infants Care Before Discharge

The team caring for the new-borns must identify the newborn’s status before the discharge process begins. New-borns who are at risk of neurodevelopmental conditions requires extensive follow-ups and interventions to minimize the risk of future complications and improve the quality of life of the infants and their families. Empowering nurses to play a key role in discharge planning will open doors to optimize survival and outcomes of vulnerable infants.

The outcomes of the systematic evaluations done by the NICU team are absolutely necessary for paediatric neurologists for the further course of follow-ups and management of the neurodevelopmental disorders if a new-born is at increased risk. This will help clinicians in the decision-making process and also in the identification of behavioural and neurodevelopmental issues.

Furthermore, the information can also be used to help guide parents of the new-born for comprehensive neurodevelopmental follow-up care and early intervention

What Factors Affect Neurodevelopmental Delay in High-risk New-borns

In premature or preterm infants many factors impact behavioural, cognitive, sensorimotor and language outcomes. Even environmental factors such as medical equipment, bright lights, noise and NICU environment can affect developmental outcomes. Other factors such as family functioning, structure, parental mental health, parenting style, parental education, and social demographics and the home environment too affect developmental outcomes. Therefore, empowering caretakers, nurses and families will help in improving the quality of life of high-risk newborns and their families.

Bottom line

An early intervention programme for high‐risk infants typically begins before discharge and continues thereafter. Neurodevelopmental intervention during this period positively impacts neurodevelopmental outcomes with a huge potential for exemplary results. Caregiving relationship between a specialist paediatric neurologist and the family of the new-born for social and emotional development – is indispensable for growth and cognitive, motor and language skills.

An experienced paediatric neurologist intervenes early with an aim to promote new-borns health and well-being. Early intervention help remediate existing and future delay and potential disabilities. It will also help prevent functional deterioration and promote emerging competencies, adaptive parenting and overall family function.