Clifford Danielle, Steggerda Sylke, Maitre Nathalie, de Vries Linda S, Murray Deirdre M
INFANT Centre, University College Cork, Cork, Ireland.
Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
Pediatr Res. 2025 Jun 10. doi: 10.1038/s41390-025-04154-2.
High-risk infant follow-up (HRIF) lacks universal definition. The aim of this study was to report current practice and factors used to identify eligibility for HRIF, yielding information which may provide a basis for future consensus.
A survey was prepared for a workshop at the 15th International Newborn Brain Conference on prediction of outcome, which was subsequently distributed to all attendees (n = 426).
Follow-up was offered by 97% of respondents (n = 113/116). HRIF was offered to infants born <28 weeks by 47%, to those <32 weeks by two-thirds (66%) and to preterms based on neuroimaging by 54%. For infants born full-term, HRIF was offered by 88% in neonatal encephalopathy (NE) and 86% in neonatal stroke. HRIF continued most frequently until 24 months corrected (33.6%). For guiding prognosis in preterm infants, 22% (n = 25) selected neuroimaging as the most important factor. For NE, 54% (n = 63) selected neuroimaging findings as the most important factor in guiding prognosis and 14% (n = 16) selected EEG/aEEG. Social factors are not considered by 46% in determining HRIF eligibility.
Significant variability in HRIF exists, without consensus. Awareness of factors predicting prognosis and the importance of social risk-factors must improve to allow accurate identification of those at highest risk. This information may act as a basis for future consensus on HRIF.
There is no clear consensus on eligibility or duration of high-risk infant follow-up. We report current practice in, and factors used to identify eligibility for same, amongst attendees of the International Newborn Brain Conference. This information on international practice may provide a basis for future consensus. Given the importance of accurate prognostication in risk-stratification, we report participants' awareness of the most important factors guiding prognosis. A disconnect between the impact of social factors on outcome and their consideration for eligibility of high-risk infant follow-up is noted. We propose the need for guidelines on follow-up of socially disadvantaged, medically high-risk infants.
高危婴儿随访（HRIF）缺乏统一的定义。本研究的目的是报告当前的实践情况以及用于确定HRIF资格的因素，从而获取可为未来达成共识提供依据的信息。
为第15届国际新生儿脑会议上关于结局预测的研讨会准备了一份调查问卷，随后将其分发给所有参会者（n = 426）。
97%的受访者（n = 113/116）提供随访服务。47%的受访者为孕周<28周的婴儿提供HRIF，三分之二（66%）的受访者为孕周<32周的婴儿提供HRIF，54%的受访者根据神经影像学检查结果为早产儿提供HRIF。对于足月儿，88%的受访者为患有新生儿脑病（NE）的婴儿提供HRIF，86%的受访者为患有新生儿卒中的婴儿提供HRIF。HRIF最常持续至矫正年龄24个月（33.6%）。在指导早产儿预后方面，22%（n = 25）的受访者选择神经影像学检查作为最重要的因素。对于NE，54%（n = 63）的受访者选择神经影像学检查结果作为指导预后的最重要因素，14%（n = 16）的受访者选择脑电图/振幅整合脑电图（EEG/aEEG）。46%的受访者在确定HRIF资格时未考虑社会因素。
HRIF存在显著差异，尚未达成共识。必须提高对预测预后因素的认识以及社会风险因素的重要性，以便准确识别高危人群。这些信息可为未来关于HRIF的共识奠定基础。
关于高危婴儿随访的资格或持续时间尚无明确共识。我们报告了国际新生儿脑会议参会者当前的实践情况以及用于确定资格的因素。这些关于国际实践的信息可为未来达成共识提供依据。鉴于准确预后在风险分层中的重要性，我们报告了参与者对指导预后最重要因素的认识。注意到社会因素对结局的影响与在高危婴儿随访资格考量方面存在脱节。我们提议需要制定针对社会处境不利、医学上高危婴儿随访的指南。
