Organisation of Early Intervention for Preterm Infants: Experience of Structured Coordination Between a Follow-Up Clinic and a Rehabilitation Department

Aim. To evaluate how structured coordination between the follow-up clinic and the rehabilitation department affects the timeliness of referral of preterm infants to the multidisciplinary rehabilitation team (MDRT) and their AIMS and HINE dynamics. Materials and Methods. A partly retrospective comparison of two cohorts with a historical control group (2023–2026; n = 148; gestational age 24–36 weeks): the intervention group (IG, n = 84, discharged 2024–2025, structured coordination protocol) and the control group (CG, n = 64, discharged 2023, without systematised interaction). All infants underwent the General Movements Assessment (Prechtl) in the NICU and AIMS and HINE assessment. Where delay was identified, an electronic referral to the MDRT was issued and an outpatient course of active function-based rehabilitation (10–14 sessions) with parent training and a home programme was prescribed, without passive neurodevelopmental techniques. Results. At baseline the groups did not differ in pathological general movements (p = 0.61) or HINE score (46.3 ± 5.4 versus 44.8 ± 6.2; p = 0.12), but the IG contained more infants born before 28 weeks (29.8 % versus 10.9 %; p = 0.006). Timely referral to the MDRT was received by 91.7 % of the IG versus 46.9 % of the CG (p < 0.001), and the mean interval from discharge to the first physical therapist appointment was 7.2 ± 1.4 versus 14.6 ± 3.8 weeks (p < 0.001). At the 6-month repeat assessment the mean HINE score rose by 12.1 points in the IG (to 58.4 ± 5.1; paired t = 17.60; df = 83) and by 6.4 in the CG (to 51.2 ± 6.8; paired t = 9.06; df = 63), remaining in both groups below the 64-point cut-off for preterm infants at this age; the between-group difference was significant (p < 0.001). Age-appropriate AIMS scores were reached by 52.4 % versus 31.3 % at 6 months (p = 0.010) and 71.4 % versus 45.3 % at 12 months of corrected age (p = 0.001). Missed follow-up visits occurred in 11.9 % versus 39.1 % (p < 0.001), decreasing to 7.3 % among IG families with high parental compliance; it covers only children who completed the 12-month observation. Conclusions. In a single centre, structured interdepartmental coordination combined with active function-based rehabilitation and parental involvement was associated with earlier referral and better motor and neurological outcomes. A causal conclusion requires a prospective study with a concurrent control group.