Neurodevelopmental Follow-up for High-Risk Infants

Introduction

As the name implies, high-risk infants encompass a group of babies prone to develop complications. Preterm (early born) babies, low-birth weight babies, and newly born babies identified with other developmental problems all fall under high-risk babies. Babies marked as high-risk infants entail specific follow-up protocols and periodic monitoring, and such follow-ups often continue for years to ensure normalcy in the growth pattern. High-risk babies are more susceptible to eliciting unexpected diseases or abnormalities in the neonatal stage or the long run.

Babies delivered or given birth before the estimated delivery date are generally termed premature or preterm babies. Such babies often lack the indented growth and development that a baby should have at birth. The 37 weeks of complete gestation (pregnancy) period provides the necessary time for the baby to grow within the mother’s womb. Preterm babies are often delivered a few weeks before the actual delivery date. Such babies are vulnerable to elicit delays in the developmental process and are exposed to developing infections. Prematurity often reflects in a compromised immune response, which enhances the risk of infection.

Low birth weight babies are another frequently reported category of high-risk infants, where the baby lacks the average weight that a newborn should possess at birth. Five pounds, eight ounces is estimated to be borderline for identifying low birth weight babies, with the baby’s weight falling below the specific limit. Prematurity is identified to be the leading cause behind low birth weight babies.

Babies with genetic issues or predisposed to develop certain inborn conditions due to favorable familial backgrounds also come under high-risk infants. Babies likely to elicit hearing deficits, visual impairment, and other congenital deformity require rigorous perinatal assessment. At times, full-term babies develop alarming infections in the newborn stage, and such babies are also identified as high-risk infants.

Hypoxic ischemic encephalopathy is another condition that can develop in newly delivered babies, in which the baby suffers an insult to the brain cells due to compromised oxygen delivery to the brain. It can happen either before or immediately following birth. Hypoxic ischemic encephalopathy can develop in otherwise healthy full-term babies, and later, they will be identified as high-risk infants.

What Is the Need for Neurodevelopmental Follow-Ups for High-Risk Infants?

High-risk infants often need prolonged hospital admission and long-term, meticulous follow-ups that extend into adulthood. These neurodevelopmental follow-ups aid in encountering developmental errors and deviations at the earlier stage. Timely detection of neurological issues reinforces prompt interventions to guide the development and mitigate the extent of developing impairments or neurodevelopmental disabilities.

The follow-up for each high-risk infant is designed individually, considering their risk and susceptibility. An integrative and interdisciplinary approach is advised for the periodic evaluation of the child, typically performed by a panel of doctors, including a pediatric neurosurgeon. The level and frequency of the follow-up visits are often devised by considering the foreseen neurodevelopmental complications or risks. High-risk infants are typically provided with a follow-up regimen before leaving the hospital after the initial care in the neonatal intensive care units.

Studies have concluded that there is an appreciable enhancement in neonatal survivability following proper adherence to the neurodevelopmental follow-up regimen. Hence, it is crucial to pick out infants more susceptible to neurodevelopmental impairment. These follow-ups also aid in assessing the long-term success rate and efficacy of perinatal therapies and other practices in bypassing the development of neurological or behavioral impairments. In addition to the enhanced survival rate of high-risk infants, it also offers counseling for the parents regarding the possibility of certain health risks for the child.

How Is Neurodevelopmental Follow-up of High-Risk Infants Carried Out?

Neurodevelopmental follow-ups for a baby identified to be in the high-risk category are often carried out by a doctor’s panel encompassing neonatologists, pediatric neurologists, pediatric surgeons, speech therapists, geneticists, occupational therapists, endocrinologists, and orthopedics. The follow-ups are often supervised and directed by a neonatologist. During each follow-up, the child will be subjected to the following assessments:

• Medical Examination: It includes evaluation of the child’s head circumference, general skeletal growth, body weight, level of nutrition, immunization, and persisting medical conditions, if any. The medical examination is often backed up with specific laboratory tests, like routine blood profile. Assessing the calcium and phosphate concentration in the blood also aids in evaluating the bone health of the child. Baby’s head circumference is a direct reflection of their brain's growth.

• Neurological Assessment: Neurological assessment aids in figuring out any neurological impairments or disabilities. It also helps in evaluating neurological and behavioral health. Numerous assessment techniques and tests are employed for carrying out the neurological assessment. There are separate assessment techniques for babies born preterm and full-term. The child’s alertness, cry, orientation, reflexes, tone, posture, sleep, and movements are assessed to check for abnormality or deviation from what is identified to be expected for a baby of that particular age. Neuroimaging techniques like ultrasound, computed tomography, and magnetic resonance imaging also aid in exposing neurological deficits.

• Developmental Assessment: Apart from neurological assessment, neurodevelopmental follow-up also includes evaluating and gauging the child’s general development. Deflections or variations from normalcy can be easily tracked with this assessment.

• Speech and Hearing Assessment: Assessment should be made to ensure proper auditory functioning. Hearing deficit can directly impact speech and language development. Speech therapists in the follow-up team look for defects, abnormalities, or delays in the baby’s speech.

• Ophthalmologic Assessment: By ophthalmologic assessment, any compromise in the eyesight and visual errors can be identified and exposed. It aids in checking the development of certain ocular defects like squint, where the eyes fail to point to the same side.

• Cognitive Assessment: Here, the child’s thought process, intelligence, understanding skills, reasoning, and judgmental skills are being assessed. Compromised cognitive functions can result in learning disability and altered mental health status.

Conclusion

With the evolution of extended perinatal care and advancement in fetal monitoring systems, there was a revolutionary improvement in the survival rate of high-risk babies. The mortality rate associated with such babies has projected a steep decline for the last few years. Neurodevelopmental follow-ups are crucial for high-risk babies as they are essential to keep track of the baby’s developmental progression. Periodic monitoring and evaluation of the baby’s development flag any developmental irregularity or deviations incurred within the developmental period. The individualized approach to designing the follow-up regimen enhances the scope for interventions to address alarming developmental disabilities in the baby. It offers promising outcomes with enhanced surveillance, ultimately fruitful for high-risk infants.