Neurologic development of the high-risk infant.

Excellent methods of examining infants neurologically have been described and used in studies with follow-up to preschool or early school years. Few children discharged from NICUs returned with major neurologic abnormalities that were not noted on the infancy examinations, unless there had been an intervening event such as meningitis, head injury, or a difficult seizure disorder. Approximately 20 per cent of infants who were discharged from NICUs had lesser neurologic abnormalities on the infancy examinations, and these were transient. These children are at risk for lesser neurologic sequelae in the preschool years and school years, specifically hyperactivity, emotional immaturity, and a variety of learning disorders. There has been a tendency in follow-up studies of children from the NICU to fucus on the severe neurologic sequelae, but the bulk of the sequelae will become obvious when the school system requires compliance for behavior, rewards advancement in learning skills, and draws attention to deficits in complex coordination. For the teachers and parents of these children, these are frustrating years. In our follow-up study of school-age children, while not markedly abnormal, were not normal either. They demanded patience and extra attention that often wore thin by the time the child reached age six or seven. Early recognition of problem children by health care professionals may increase understanding and aid in early identification of children who need special services for behavior modification, remedial reading, and other school-related skills. It should also encourage much needed family support and counseling.