Prediction of Neurodevelopmental Outcome of High-Risk Neonates: A study from a Tertiary Care Centre in Bangladesh

Abstract

Background: High-risk neonates are most vulnerable to develop neurodevelopmental impairment. Early identification and intervention can modify brain development and improve outcomes in neonates at risk for neurodevelopmental disorders. Objective: To predict the neurodevelopmental impairments (NDIs) in high-risk neonates. Methods: This observational study was conducted in the Department of Neonatology and Department of Paediatric Neurology, Institute of Paediatric Neurodisorder and Autism (IPNA), Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from July 2019 to June 2020. A total of 85 high-risk term neonates were included in this study. A neurodevelopmental evaluation was completed using the rapid neurodevelopmental assessment instrument (RNDA) at neonatal (0 to 28 days) age and again at three months of age after a comprehensive history and clinical examination. Result: Among the enrolled 85 neonates at first assessment, NDI was found in 64.7% cases. Seizure was present in 49.4% cases and affected domains were cognition (48.2%), behavior (47.1%), hearing (45.9%), gross motor (41.2%), vision (42.3%), speech (42.3%), primitive reflexes (36.5 %) and fine motor (32.9%). At the age of 3 months, NDI was found in 47.1% and affected domains were gross motor (47.1%), speech (40.0%), fine motor (37.7%), vision (36.5%), cognition (36.5%), behavior (35.3%) and hearing (30.6%). The seizure was found in 29.4% of cases. A significant difference was found between the first and second assessment. Conclusion: NDI are common sequelae of high-risk neonates. The most frequently affected domains were gross motor, fine motor and speech. Thus, RNDA can be used to predict early NDI in high-risk newborns.