Background The British Association of Perinatal Medicine (BAPM) recommends evaluating neurodevelopmental outcomes at 2 years’ corrected age for preterm births <32 weeks’ gestation or <1500g birthweight, and recording them in national database. However, dedicated neurodevelopmental follow-up service (NDFUS) provision is not available in all UK neonatal units.
Aims We aimed to assess the impact of a NDFUS on this data capture in non-research setting in a tertiary neonatal unit.
Methods Following a baseline audit in 2014 of 2 year outcomes for 2010-born infants, a NDFUS (utilising Bayley-III scales of infant and toddler development) was established in Oct 2014. We then analysed 2 year outcomes in 2015 and 2016 for infants born in 2012 and 2013. Outcomes were categorised as per BAPM’s 2008 recommendations.
Results Percentage survival at discharge remained similar for infants born <32 weeks’ gestation or <1500g birthweight in the three cohorts: 94% (2010; n=143 admissions); 90% (2012; n=163) and 90% (2013; n=140). However, the number of survivors evaluated at 2 years doubled following establishment of NDFUS; 31% (2010) to 65% (2012) and 67.5% (2013). Also, the number of standardised assessments increased significantly from 8% (2010) to 40% (2013). Disability rates (moderate and severe combined) increased from 15% (2010) to 33% (2012) and 27% (2013) in survivors assessed. In subgroup analysis of extremely preterm infants £26 weeks’ gestation, the composite outcome of death or disability increased from 44% (2010) to 55.5% (2012) and 68.5% (2013).
Language was the commonest domain of impairment, followed by cognitive. Outcome was unknown for 64% of all eligible infants born in 2010 compared with 32% in 2012 and 28% in 2013.
Conclusion A dedicated NDFUS significantly increases follow-up rates and the proportion of infants undergoing structured developmental assessments. The apparent increase in disability after NDFUS is most likely due to the increased sensitivity of the Bayley-III scales (used on 2012/2013 cohorts) as compared with a routine paediatric clinic assessment. Increased and timely detection of disabilities in these vulnerable infants will not only help in timely intervention and potentially better outcomes, but is also essential for true reflection of disability rates in the national database.
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