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Rosie S.1
1Chris Hani Baragwanath Academic Hospital, Physiotherapy, Soweto, South Africa
Background: Neonatology has made astounding advances in intensive care which has improved outcomes and survival of infants with serious medical and surgical conditions. During the most critical stage of an infant's neurodevelopment, they may be exposed to the harsh environment of a neonatal intensive care unit (NICU) and are extremely vulnerable to the adverse effects of medical complications and certain life-saving procedures. Developing countries such as South Africa readily adopt the aforementioned advances in neonatal care but fail to provide the adequate follow up that is needed for high risk infants.
Purpose: The aim of this study was to assess the neurodevelopmental outcomes of infants discharged from the Chris Hani Baragwanath Academic Hospital NICU when attending the neonatal follow up clinic (NNFUC).
Methods: Forty participants were assessed according to corrected age, using the Bayley Scales of Infant and Toddler Development Third edition. Birth and hospital admission history were recorded.
Results: Data from 20 male and 20 female participants were analysed. The mean corrected age at time of assessment was 147 days (±38). The mean cognitive score was 87 (Low average), mean language score was 96 (Average) and mean motor score was 93 (Average). Participants with sepsis (P=0.018) during NICU admission showed risk of abnormal cognitive development at a 5% level of significance. At a 10% level of significance, intraventricular haemorrhage (P=0.058) was associated with a higher risk of abnormal cognitive development. On the language scale, patent ductus arteriosus (P=0.076) and respiratory distress syndrome (P=0.057) were found to be risk factors for abnormal language development at a 10% level of significance. Participants born via normal vaginal delivery (P=0.004) and those diagnosed with anaemia (P=0.038) during NICU admission were found to be at risk of abnormal motor development, at a 5% level of significance. Twenty one percent of participants had confirmed neurological fallout. The rate of cerebral palsy was five percent.
Conclusion(s): In this study, participants who had fewer complications during NICU admission had higher neurodevelopmental scores on the Bayley-III. Participants who had many complications or a long duration of stay in NICU were more likely to have lower scores on the Bayley-III. However, the mean Bayley-III scores of the population presented in this study (low average to average) would suggest that all infants who are discharged from the NICU are at risk for a degree of neurodevelopmental delay and should undergo neurodevelopmental assessment.
Implications: The mean neurodevelopmental assessment scores in this population were not favourable, showing low average or average performance. As shown, it is imperative for this high-risk population of infants to attend a follow up service where their neurodevelopment can be assessed by a therapist. In cases where intervention is necessary, it can be initiated during these follow up visits and further planning of therapy services can be done. Time and resources are limited in the NNFUC setting at CHBAH and at many other state hospitals in South Africa, therefore this research may serve as a guide to therapists and doctors when prioritising infants in need of neurodevelopmental assessment and therapeutic services.
Funding acknowledgements: None.
Topic: Paediatrics
Ethics approval: Ethical clearance was obtained from the Committee for Research on Human Subjects of the University of the Witwatersrand, (No. M140865).
All authors, affiliations and abstracts have been published as submitted.
