Rapid neuro-developmental screening in clinical practice

When babies with severe problems of respiration and birth asphyxia are discharged home after stormy hospital stay, those with more problems may suffer later from a wide range of problems like cerebral palsy, vision, speech and hearing problems.

Journal of Neonatology
Authors: Kumari Sudershan, Dadhich JP
Address: Neonatal Division, Sunderlal Jain Hospital, Ashok Vihar - III, New Delhi - 110052

Improved survival of high-risk neonates has been noted during last decades, this is also shown in NNF Perinatal Data Base between 1995 and 2000 (1). During last two decades, with efforts of National Neonatology Forum, the problem of neonates are being recognized along with increasing availability of neonatal intensive care beds, equipments and improved skills of pediatricians caring forneonates.

As the neonates with severe problems of respiration, birth asphyxia, sepsis and VLB W are being discharge home after stormy NICU stay, those with more problems may suffer later from a wide range of problems like cerebral palsy, vision, speech and hearing problems and developmental delay etc (1,2).

All these babies need a close follow-up, as some conditions like tone abnormalities, hearing and vision problems etc can benefit from early intervention. As the pediatrician is actively involved with infants and their families up to about 2 years of age, they are in a position to have a significant impact on early screening for neuro-developmental handicaps, in addition to medical care of infants (3,4).

It is ideal to track all nursery graduates for follow-up till 4 months of age, as by this time the influence of NICU problems has weaned off and primary reflexes have disappeared. Neurological assessment at 4 months if normal, indicates almost normal later developmental outcome in most babies. If it is not possible to follow periodically, then assessment at 2 months and 7 months have been suggested by Amiel Tison (5). Several studies have shown that 1-year of age in most infants and by 2 year in almost all; a prediction of later adverse outcome can be precisely made (6,7). A minimum follow-up is needed afterdischarge as follows:

3 months: Detection of early NDA for early intervention
7-8 months: Transitory tone abnormalities. They start disappearance by 9-18 months but have significant impact in child at school age.
12 months: DQ < 80 associated with later low IQ
2 years: Catch up growth, developmental status

Subsequently minimum follow-up would be at school age and 8-9 years age for learning disabilities and other behavioral problems. However neurological abnormality in NICU that lasts for more than 7 days or persists till discharge indicates close follow up with early developmental intervention.

Assessment should be performed with history, physical examination and age appropriate mile stones with specific objective of developmental testing, depending on pediatrician's suspicion of the problem (8). Emphasis should be laid on developmental history, observation and parents opinion.