Abstract
Background: Despite serious neonatal morbidity, the neurodevelopmental outcome of NICU (Neonatal Intensive Care Unit) graduates is often reasonably good. Infants with neurodevelopmental abnormality need to start therapy early, and hence, they should be detected as soon as possible. Therefore we need well designed follow-up services. Objectives: To study the outcome of growth and development till one year of age of NICU graduates from a tertiary care centre in eastern India. Design and setting: A prospective neurodevelopmental follow-up study on graduates from the Calcutta National Medical College and Hospital NICU. Methodology: We selected a cohort of 177 consecutive NICU graduates according to high-risk criteria and followed them up at the high risk clinic of Paediatrics department up to 1 year of age on a predetermined schedule. Growth monitoring (weight, length, head circumference measurements), neurologic examination by Amiel-Tison method, developmental assessment using Denver Development Screening Test (DDST) as screening tool and Developmental Assessment Scale for Indian Infants (DASII) as a definitive test, neuroimaging (cranial ultrasound or magnetic resonance imaging of brain) and electrophysiological investigations visual evoked potential (VEP), brainstem auditory evoked response (BAER), and electroencephalogram (EEG) were done. Early stimulation and physiotherapy were advised as per need. Ongoing illnesses were identified and treated. Results: Out of 177 consecutive NICU graduates enrolled in the study, 155 were followed up to 1 year of age. There were no statistically significant difference in the occurrence of growth failure, and neurodevelopmental delay between term and preterm and between appropriate for gestational age (AGA) and small for gestational age (SGA) infants. However growth failure was significantly higher among infants with neurodevelopmental delay. Conclusion: Persistence of abnormalities in tone, BAER, EEG & neuroimaging strongly predicted adverse neurodevelopmental outcome. Recurrent respiratory tract infection was found to be the most common morbidity among NICU graduates followed by seizure disorder.
Highlights
Improving outcomes beyond survival for high-risk newborns in resource-limited countries is an emergingManuscript received: 2nd February 2017 Reviewed: 8th February 2017 Author Corrected: 14th February 2017 Accepted for Publication: 21st February 2017 challenge
177 consecutive neonatal intensive care unit (NICU) graduates were enrolled in the study
17 babies were lost to follow-up and 5 babies died during the study period
Summary
Improving outcomes beyond survival for high-risk newborns in resource-limited countries is an emergingManuscript received: 2nd February 2017 Reviewed: 8th February 2017 Author Corrected: 14th February 2017 Accepted for Publication: 21st February 2017 challenge. As the survival rate of high risk newborns improve with advancing perinatal care services, the total number of infants with unique follow-up needs increase. Neurodevelopmental impairments include motor function deficits such as cerebral palsy, cognitive delay and sensory impairments such as visual and auditory deficits. This highlights the paramount importance of monitoring the growth and neurodevelopmental outcome of NICU graduates through a multidisciplinary approach [1,2]. The neurodevelopmental outcome of NICU (Neonatal Intensive Care Unit) graduates is often reasonably good. Objectives: To study the outcome of growth and development till one year of age of NICU graduates from a tertiary care centre in eastern India. Recurrent respiratory tract infection was found to be the most common morbidity among NICU graduates followed by seizure disorder
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