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NMH | 2024 58 Neonatology when children are tired or challenged (especially for those travelling for more than 2-3 hours for the assessment). During the testing session, the child's emotional and behavioural reactions are noted. A full report is documented. The scores generated allow for a comparison between a child's performance over time and in relation to peers of the same age range. The scale identifies children with developmental delay and hence provides information for intervention planning. What is the PARCA-R (Parent Report of Children's Abilities–Revised)? The PARCA-R is a standardised, UK norm-referenced assessment of children's cognitive and language development at 24 months of age. It can assess a child's developmental level and can classify delayed development of any severity as well as advanced development. The children need to be assessed at 23.5 to 27.5 months to derive the standardised scores. There are separate scores for Non-Verbal Cognition and Language. The outcomes, 'above average', 'average', 'mild', 'moderate' and 'severe delay' can be calculated as used in conventional standard deviation (SD-banded) cut-offs. It is available in 14 languages. The PARCA-R is free and is immediately available to download www.parca-r.info. Since its first validation study was published in 2004, it has been used as an outcome measure in clinical trials, observational studies, and as a screening tool in child development clinics and neonatal follow-up services. The PARCA-R is a well-researched tool that took 20 years to develop. It was the popular substitute for the Bayley Scales during the pandemic. It has been recommended by the NICE Guidelines as an assessment tool to screen for developmental delay. It has validity and reliability ratings providing standardised scores. It has been accepted as producing standard scores similar to other IQ/ developmental tests. It has been favourably compared with the Bayley-lll. Extreme Preterm Birth Preterm birth can be associated with high rates of adverse neurodevelopmental outcomes. The risk of having a disability increases with decreasing gestational age for example, the overall risk of neurodevelopmental impairment (NDI) for extremely preterm infants <27 weeks gestation is 36%-40% and has been static for the past 2 decades. They are at greater risk of cerebral palsy particularly if they have a Grade 3 or 4 IVH (intraventricular haemorrhage) or PVL (periventricular leukomalacia). Other risk factors include cognitive impairment (low IQ - especially non-verbal, poor working memory, slow processing speed and deficits in executive functions), attention problems/ADHD, peer relationship problems/Autistic Spectrum Disorder, anxiety/emotional disorders as well as subtle learning difficulties. Neurosensory issues are increasingly recognised. ADHD (attention deficit disorder) is more frequently encountered in those less than 28 weeks gestation. These children are 3-10 times more likely to require assistance during the early school years. The preferred Bayley assessment enables the clinician to identify specific developmental delays, early signs of poor attention skills, poor auditory processing skills, poor sensory integration skills and poor motor/coordination skills. All of these factors are relevant in terms of later classroom performance. The process of administering the scale alone generates valuable information about a child's learning potential. Identifying and managing these issues at an early age is important to facilitate optimum long-term outcome. The assessment experience is also educational for parents as it gives them an insight into the range of developmental activities from which their child can benefit. The process can strengthen a child's potential by bringing about a change in parent attitude, knowledge and behaviour. Providing Bayley Assessments is a valuable service in terms of assessing two-year outcomes for preterm babies and the data is used to counsel parents when their babies are admitted to the Neonatal Intensive Care Unit (NICU). Over the years we have noted that attention and sensory processing skills are two notable challenges for the preterm child, who despite having a good outcome, is not achieving his/ her potential in terms of learning and language development. We looked at a home intervention programme to address these issues in a small cohort of infants. Our research paper titled 'Therapeutic Listening for Preterm Children with Sensory Dysregulation, Attention and Cognitive Problems' was published in January 2020. 1 The research showed this home intervention programme to be a feasible intervention for preterm children improving their attention levels and sensory processing skills. These skills, as we know, are very important for future learning and language development. The NMH ACORN Early Developmental Programme is now an established early intervention programme for our at-risk newborn preterm infants which should help to support these challenges. We need more research so that we can get a better understanding of the needs of our preterm population in terms of attention and sensory processing skills. Neonatal Encephalopathy (NE) Diagnosis Term infants with NE are at high risk of long-term disability. The National Neonatal Encephalopathy collaborative is of increasing importance for these infants, particularly since the advent of therapeutic hypothermia (January 2009). Outcome is improving since the introduction of therapeutic hypothermia as evidenced by our follow-up and international studies. However, we have seen from our small cohort over the years that neonatal encephalopathy impacts neurodevelopmental outcomes, and that outcome is mainly determined by the extent of injury to the brain. In

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