High-risk infant follow-up: current practice and factors determining eligibility.

BACKGROUND

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.

METHODS

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).

RESULTS

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.

CONCLUSION

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.

IMPACT

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.