Collaborative Services of Pediatric Neurosciences Department for the Early Detection of Neurodevelopmental High-Risk Neonates in Dhaka Shishu (Children) Hospital (DSH)

Abstract

Introduction: A majority of neonates present with histories of brain insult in the antenatal, natal and post-natal periods. Identification, appropriate assessment and intervention are crucial for best neurodevelopmental outcomes. In DSH the Pediatric Neuroscience Department (PND) is working in this regard in the neonatal ward as well as in its Child Development Center (CDC) with a multi-disciplinary team of professionals. Objectives: To describe the activities of PND in the management of high risk neonates. Methods: This was an observational study. From July 2017- December 2017every high risk neonate admitted in the neonatology department of Dhaka Shishu Hospital, the largest children hospital was assessed for neurodevelopmental assessment by the Rapid Neurodevelopmental Assessment (RNDA) tool by a Developmental Therapist. RNDA is a validated tool for neurodevelopmental assessment applied for ages between 0-16 Years. Different domains like gross motor, fine motor, vision, hearing, speech, cognition, behavior and seizures are seen and categorized into normal, mild, moderate and severe impairments. Neonates with moderate to severe impairments are then referred to the CDC for a general developmental assessment under the supervision of a pediatric neurologist; with regular follow ups. Interventions for different comorbidities are provided nutritional and feeding advice. Mild groups are also followed up by developmental therapists up to a maximum of 2 years. In the walk-in OPD of the department this same protocol is followed. Result: Approximately 650 patients were seen; among them 220 needed general developmental assessment on the basis of moderate to severe impairment. Among the impaired and non-impaired group there were difference in Term, preterm, birth weight and gestational age, Soocoidemography showed irregular antenatal care, bad obstetrical history and malnutrition has important impact. Conclusion: Every neonate who is at high risk needs assessment, evaluation,