“Know more about your preterm baby’s neurodevelopmental follow up”

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Babies born before completing 37 weeks of pregnancy are called premature or preterm. They may be born anytime between 24 weeks to 37 weeks. The earlier a baby is born more immature is the baby and more treatment and support is required soon after birth. Some babies may require several weeks of treatment and support in intensive care. For example, support for breathing is required due to immaturity of lungs. This may be for a few days to many weeks. Vital parameters of breathing, oxygen saturation of blood, blood pressure, heart rate, temperature are monitored regularly. Feeds are introduced gradually. Majority of babies have to be fed through a NG tube that is a tube that is passed through the nose into the stomach. Gradually babies are introduced to breast feeding. Parents of prematurely born babies would have experienced and be familiar with these already.

Another aspect of preterm care after discharge is the neurodevelopmental follow up. This is mandatory in all preterm babies barring those born close to 37 weeks.

If your baby

Was born before 34 weeks,
Birth weight less than 2 kg
Required intensive care like ventilation, support to maintain blood pressure
Had infection for which antibiotics were given, had infection or inflammation of the bowel
Had a bleed in the brain
Had heart problem
Had poor weight gain
then, a neurodevelopmental follow up is required.

What is neurodevelopmental follow up?

Neurodevelopmental follow up is a term used for a method of systematic examination of the baby which includes a neurological examination, evaluation of the baby’s movements, posture, muscle tone, body control, disappearance and appearance of reflexes and age appropriate milestones. Hearing and vision are checked informally. Baby’s weight and head circumference are measured and plotted in the growth charts. Follow up visits are at 3 – 4monthly intervals. These follow ups may be conducted by your baby’s doctor or by a team specialized in this type of care. The first follow up visit will be when the baby reaches the expected date of delivery. Subsequent visit are at 3, 6, 9 and 12. Some units in order to reduce the number of visits may follow up at 4, 8 and 12 mo of corrected age.

How long should these follow up visits be continued?

In all babies born before completing 34 weeks of pregnancy, follow up is recommended till 7 years of age. After the first year, follow up is at intervals of 6 months that is at 18mo, 24mo, 30mo, 36mo, 42mo, 48mo, 54mo, 60mo. After this the follow up can be once a year.

What is the purpose of these visits?

Preterm babies are at higher risk of developmental delay compared to full term babies. The earlier a baby is born, lesser the birth weight, and more the intensity of care they required, higher the risk of delay. The purpose of the follow up visits is to make sure the baby is developing well, achieving milestones at the expected ages, and to monitor the progress. Any lags or delays in milestones is identified and action is taken to correct these. If the baby is found to be developing normally, then suggestions are given for the next set of milestones.

Why should the baby be followed up till 7 years of age?

Many problems or delays may become obvious only as the child grows. In the first and second years, delays in the development of body balance and control are easier to identify but speech delay may become apparent only between 12 – 24 months. Concentration and memory problems, deficits in social skills, hyperactivity etc are some which appear around the preschool age. Learning difficulties become obvious when the child starts schooling. Therefore long term follow up is required.

Is anything else required from the developmental point of view?

Baby’s ROP check up should be completed as per the recommendations. If there is no ROP, then eye check at one year and then at school entry is required.

Hearing screening is usually completed at the time of discharge from the hospital. Some babies will require a repeat hearing evaluation. At all times make sure that your baby’s hearing is normal. If you have any doubts, then have a hearing evaluation.

What is the parents’ role in preterm baby’s development?

First and foremost is to be aware that the child is at higher risk for developmental delay. Secondly, good home environment, responsive interaction with the baby, adequate attention to nutrition and growth is important. Adequate stimulation, opportunities for exploration and stimulation also help baby’s development. Your baby’s doctor will be able to guide you on these.

Do all premature babies develop developmental delays later?

No. Not all premature babies develop developmental delays. A small percentage of babies will develop delays in one or more areas of development.