Early detection of children at neurorisk and enrolment in habilitation programs

Perinatal brain damage is the leading cause of poor neurodevelopmental outcome in children. About 10% of newborns classified as high-risk neonates are especially susceptible to brain injury. Perinatal brain damage is non-progressive, thus processes of maturation and brain plasticity accompanied by early medical intervention can lead to recovery of neuromotor function. Thus, early recognition, monitoring and habilitation are highly important in children at high neurorisk. The aim of this study was to present the project of detection and follow up of children at neurorisk and to show results of one-year follow up of children at high neurorisk as part of the pilot project of the Ministry of Health and Social Welfare named Follow Up of Children at Neurorisk. In comparison to the older Registry, study results pointed to the need of updating the survey questionnaire and program of follow up that were now implemented in the pilot project. Based on history data, clinical evaluation and early brain ultrasonography (US) findings, neonatologists classified children as low and high neurorisk at maternity ward, later sending completed questionnaire on neurorisk factors for each child by e-mail to regional center (children at high neurorisk) or county center (children at low neurorisk). Neonatologists also provided all necessary information on neurorisk factors, the need of early habilitation and date of first neuropediatric examination to the parents of children enrolled in the study. The extent of diagnostic procedures and clinical examinations depended on the risk category attributed to children. Children with deviant neurologic development were promptly included in habilitation procedures. The pilot study was performed from January 1, 2007 until August 31, 2008 and included data on 170 children at high neurorisk born at University Department of Gynaecology and Obstetrics, Zagreb University Hospital Center (Petrova). Neurodevelopmental outcome at the age of 12 months was normal in 107 and delayed in 47 children, whereas 16 children had some form of neurologic syndrome predictive for development of cerebral palsy; 75% of children with complex neuromotor disorder had pathological brain US findings; 38 children had visual disorders, and three children were blind; 14 children had abnormal electroencephalography (EEG) findings, two children suffered from West’s syndrome, and another two had febrile seizures. Data analysis of risk factors and neurodevelopmental outcome showed concordance with new achievements in the fields of perinatology and habilitation. Accordingly, early recognition, monitoring and habilitation are of utmost importance in children at high neurorisk.

Category: Original scientific paper
Volume: Vol. 55, No 2, april - june 2011
Authors: K. Bošnjak-Nađ, V. Mejaški-Bošnjak, Lj. Popović-Miočinović, S. Gverić Ahmetašević, I. Đaković, M. Čikara Mladin
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