6117 Neurodevelopmental surveillance of vulnerable preterm infants – Is it time to expand the criteria?

Objectives Introduction: Current National Institute for Health and Care Excellence (NICE) guidelines recommend offering enhanced neurodevelopmental surveillance to infants who are born before 30+0 weeks gestation. Our tertiary neonatal unit has expanded this criteria and routinely offers neurodevelopmental follow-up to all infants born before 32+0 gestation, all infants with birth weight less than 1500g regardless of their gestation and infants who received inhaled nitric oxide. Objectives To review the current neurodevelopmental follow-up criteria for infants in our local hospital against NICE guidelines. To establish the clinical outcome of infants who received neurodevelopmental follow-up in our unit, but were outside the NICE criteria. Methods We retrospectively reviewed the neurodevelopmental outcomes of all infants with birth gestation between 30+0 and 31+6 weeks, all infants with birth weight less than 1500g regardless of their gestation and all infants who received inhaled nitric oxide but without a diagnosis of hypoxic-ischaemic encephalopathy (HIE). We included all assessments conducted between January 2022 and December 2022. The neurodevelopmental assessment was carried out jointly by a Consultant Neonatologist and a Specialist Neonatal Physiotherapist using the Bayley Scales of Infant and Toddler Developmental III. We identified babies who required onward referral for specialist input. Results An additional 82 babies were identified to be eligible for neurodevelopmental surveillance in the year 2022 within our local extended criteria. Median birth gestation was 31+2 weeks and median gestational age at discharge from the neonatal unit was 36+3 weeks. 49 infants had a birth weight of less than 1500g, the median birth weight being 1420g. 6% of infants were referred to a specialist service following their 9 month appointment and 24% were referred following their 2 year appointment. Median corrected ages at assessment were 9 months 4 days and 24 months 3 days respectively. 46% of patients had either expressive or receptive speech concerns, 7 patients were identified to have concerns with concentration and 3 patients had global developmental delay. Conclusion Considering the large number of infants who were identified to have challenges with development (subsequently requiring specialist referral) and who were outside the NICE guidelines eligibility criteria, we recommend that NICE expands the eligibility criteria of infants requiring neurodevelopmental follow-up and includes all infants born under 32 weeks gestation. We fully acknowledge and understand that this will mean requiring additional resources, but implementing this will ensure that this vulnerable group of infants receive the support, surveillance and specialist therapist input they really need. Reference NICE Guidelines for Developmental follow-up of children and young people born preterm. Published 18 May 2018.