Whenever an infant requires neonatal intensive care, initial concerns about survival are followed by concerns about the infant's quality of life. Follow-up clinics are an important and necessary adjunct to neonatal intensive care because they provide feedback regarding the child's ongoing health and development to families and to their neonatologists and obstetricians.
Goals of the neonatal follow-up clinic
Early identification of developmental disability. These infants need to be referred for further diagnostic multidisciplinary evaluation or community services.
Parent counseling. Parents of children who do well can be reassured by positive feedback. If their child demonstrates signs of developing disability, parents need to know as soon as possible, and they must get honest, caring support during this period of high anxiety. Physical and occupational therapists provide valuable suggestions regarding positioning, handling, and feeding of infants. All parents of high-risk infants need anticipatory guidance for recognizing early signs of school or behavior problems and the need for further comprehensive neurodevelopmental evaluation at that time.
Identification and treatment of medical complications. Some disorders may not be anticipated at the time of discharge from the neonatal intensive care unit.
Referral for comprehensive evaluations and community services as indicated.
Feedback from neonatologists, pediatricians, obstetricians, and pediatric surgeons regarding developmental progress, medical status, and unusual or unforeseen complications in these infants is essential.
Staff of the neonatal follow-up clinic. Pediatricians, neurodevelopmental pediatricians, and neonatologists make up the regular staff of the clinic, and many clinics include neuropsychologists and physical or occupational therapists. Some infants may need to be referred for consultation with audiologists, ophthalmologists, occupational therapists, speech-language specialists, neuropsychologists, social workers, respiratory therapists, nutritionists, pediatric surgeons, orthopedic surgeons, or other subspecialists.
Risk factors for developmental disability. It is virtually impossible to diagnose developmental disability with certainty in the neonatal period, but a number of perinatal risk factors have been identified for selecting high-risk infants for close follow-up.
Preterm birth. Although the majority of preterm infants do not develop cerebral palsy or intellectual disability, they all have a higher incidence of neurodevelopmental disability than full-term neonates. The risk of disability, especially cognitive impairments, is highest in survivors born at the limit of viability (at or before 25 weeks' gestation). All preterm infants are at greater risk than full-term infants for disorders of higher cortical function, including language disorders, visual perception problems, attention deficits, and learning disabilities. The risk of disability decreases with increasing gestational age at birth but is higher than full-term infants even in late preterm infants, born at 33–36 weeks' gestation. Besides gestational age, predictors of neurodevelopmental disability include poor growth (especially head growth), asphyxia, sepsis (especially meningitis), chronic lung disease, and retinopathy of prematurity. Risk is highest in infants with signs of brain injury, including abnormal neonatal neurodevelopmental assessments and neuroimaging abnormalities, such as severe intraventricular hemorrhage, intraparenchymal hemorrhage, porencephaly, and signs of white matter injury (intraparenchymal cysts, periventricular leukomalacia, and ventriculomegaly).
Intrauterine growth restriction (IUGR). Full-term infants who are small for gestational age (SGA) have a higher ...
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