NIMS-SPECTRUM-Child Development Research Centre (CDRC) NIMS Medicity, Thiruvananthapuram, Kerala and Emeritus Professor, Allied Health Science, NICHE, Kumarakovil, Kanyakumari District, Tamil Nadu.
Chairperson, Neurodevelopment Chapter, Indian Academy of Pediatrics, Guwahati, Assam.
Indian Pediatr. 2024 Jan 15;61(1):10-23.
Neurodevelopmental disorders, as per DSM-V, are described as a group of conditions with onset in the development period of childhood. There is a need to distinguish the process of habilitation and rehabilitation, especially in a developing country like India, and define the roles of all stakeholders to reduce the burden of neurodevelopmental disorders.
Subject experts and members of Indian Academy of Pediatrics (IAP) Chapter of Neurodevelopmental Pediatrics, who reviewed the literature on the topic, developed key questions and prepared the first draft on guidelines. The guidelines were then discussed by the whole group through online meetings, and the contentious issues were discussed until a general consensus was arrived at. Following this, the final guidelines were drafted by the writing group and approved by all contributors.
These guidelines aim to provide practical clinical guidelines for pediatricians on the prevention, early diagnosis and management of neurodevelopmental disorders (NDDs) in the Indian settings. It also defines the roles of developmental pediatricians and development nurse counselor.
There is a need for nationwide studies with representative sampling on epidemiology of babies with early NDD in the first 1000 days in India. Specific learning disability (SLD) has been documented as the most common NDD after 6 years in India, and special efforts should be made to establish the epidemiology of infants and toddlers at risk for SLD, where ever measures are available. Preconception counseling as part of focusing on first 1000 days; Promoting efforts to organize systematic training programs in Newborn Resuscitation Program (NRP); Lactation management; Developmental follow-up and Early stimulation for SNCU/ NICU graduates; Risk stratification of NICU graduates, Newborn Screening; Counseling parents; Screening for developmental delay by trained professionals using simple validated Indian screening tools at 4, 8, 12, 18 and 24 months; Holistic assessment of 10 NDDs at child developmental clinics (CDCs) / district early intervention centre (DEICs) by multidisciplinary team members; Confirmation of diagnosis by developmental pediatrician/developmental neurologist/child psychiatrist using clinical/diagnostic tools; Providing parent guided low intensity multimodal therapies before 3 years age as a center-based or home-based or community-based rehabilitation; Developmental pediatrician to seek guidance of pediatric neurologist, geneticist, child psychiatrist, physiatrist, and other specialists, when necessary; and Need to promote ongoing academic programs in clinical child development for capacity building of community based therapies, are the chief recommendations.
justification: 根据 DSM-V，神经发育障碍被描述为一组在儿童发育时期发病的疾病。需要区分康复和康复的过程，特别是在像印度这样的发展中国家，并定义所有利益相关者的角色，以减轻神经发育障碍的负担。
process: 主题专家和印度儿科学会（IAP）神经发育儿科学分会成员审查了关于该主题的文献，提出了关键问题并编写了指南的初稿。然后通过在线会议由全体小组成员讨论指南，讨论有争议的问题，直到达成普遍共识。在此之后，由写作小组起草最终指南，并由所有撰稿人批准。
objectives: 本指南旨在为印度的儿科医生提供预防、早期诊断和管理神经发育障碍（NDD）的实用临床指南。它还定义了发育儿科医生和发育护士顾问的作用。
statement: 需要在印度开展全国性研究，对前 1000 天内患有早期 NDD 的婴儿进行代表性抽样，以了解其流行病学情况。在印度，特定学习障碍（SLD）已被记录为 6 岁后最常见的 NDD，应特别努力确定有 SLD 风险的婴儿和幼儿的流行病学情况，只要有措施可用。将孕前咨询作为关注前 1000 天的一部分；促进努力组织新生儿复苏计划（NRP）系统培训计划；哺乳管理；发育随访和 SNCU/NICU 毕业生早期刺激；对 NICU 毕业生进行风险分层；新生儿筛查；由经过培训的专业人员使用简单的经过验证的印度筛查工具在 4、8、12、18 和 24 个月时对发育迟缓进行筛查；在儿童发育诊所（CDCs）/地区早期干预中心（DEICs）由多学科团队成员对 10 种 NDD 进行全面评估；发育儿科医生/发育神经科医生/儿童精神病医生使用临床/诊断工具确认诊断；在 3 岁之前，为父母提供低强度多模式治疗，作为以中心为基础、家庭为基础或社区为基础的康复；发育儿科医生在必要时向儿科神经科医生、遗传学家、儿童精神病学家、物理治疗师和其他专家寻求指导；需要促进临床儿童发展的持续学术计划，以建立社区为基础的治疗能力。
