NMH

NMH | 2024 59 Neonatology an NMH retrospective study looking at developmental outcomes in a cohort of 115 NE infants from 2009-2016, developmental delay was greater in the infants with abnormal MRI brain scans compared to those with normal MRIs. In the cohort of infants with normal MRIs, language delay was 27%, motor delay was 9% and cognitive delay was 9%. In the cohort of infants with abnormal MRIs, language delay was 48%, cognitive delay was 40%, and motor delay was 30% indicating a marked difference 2 . High seizure burden was also associated with poor outcome. In the Neonatal Therapeutic Hypothermia in Ireland Annual Report 2020 (national aggregate report 2016-2019) 3 , Bayley outcome follow-up data for 85 children showed that 26% had Gross Motor Delay, 21% had Receptive Language Delay, 21% had Expressive Language Delay,16% had Cognitive Delay, and 12% had Fine Motor Delay. This was a broad outcome measure without reference to MRI outcomes or degree of encephalopathy. From the data presented above, neonatal encephalopathy that is treated with therapeutic hypothermia but not followed by severe impairments such as CP, can still be associated with impairments in sensory regulation, cognitive, motor, language and educational outcomes. Hence, we need to structure our neonatal encephalopathy follow-up to identify the best interventions both in the NICU and during the recovery and development of this highly vulnerable group of infants. As these children are at 'high risk' of potentially modifiable neurodevelopmental sequelae, they should be enrolled in neonatal follow- up programmes such as in our recently introduced NMH ACORN Programme. It is hypothesized that the NE children who achieve a normal Full-Scale IQ at 4 years of age (WPPSI-IV) can still have poorer performance with regard to Verbal Information and Processing Speed Skills compared with children without NE. Why are we doing these assessments? Great advances have been made in neonatal intensive care over the past decade. Survival of infants born at 23 weeks' gestation is now increasingly reported. Unless we measure our neonatal outcomes, we cannot hope to make improvements in the care we provide. These assessments are also an important service for our babies and their families. The parents receive a detailed copy of their child's report. Copies of the report, if requested by the family, may be sent to other clinicians who are involved in the care of their child. Professional resources continue to be very limited for those children requiring developmental intervention such as speech therapy, physiotherapy and occupational therapy. This was particularly evident during the Covid pandemic when many children did not receive any follow- up at all. Waiting lists still continue to be long. There is often no service available when a therapist is on leave. There was a lack of consistency in how publicly funded services were provided throughout the country. This was addressed by the launch of a National Policy on Access to Services which was approved by the HSE in September 2021 to ensure more equitable access to services for children in need and to Children Disability Network Teams (CNDTs). The CNDT has replaced existing disability teams provided by Enable Ireland, the Health Service Executive (HSE) Early Intervention Teams and School-Aged Assessment Teams, St. Catherine's Association, St. John of Gods Services and St. Michael's House. Unfortunately, as reported in the Irish Times on 3 rd March 2023, and again recently, over one third of these services' approved posts remain vacant. We need to improve educational outcomes. Neurodevelopmental outcomes do not appear to be improving despite improved survival and neonatal care. In a UK survey, carried out in 2020, more than 90% of 426 families reported that there should be more awareness and understanding of the educational needs of children born preterm. Impairments in speech and language impact negatively on academic learning and executive functioning skills during the school years. Recognising these challenges, the PRISM E–learning resource programme 4 , consisting of 5 x1 hours sessions, with interactive multimedia content, has been devised for educational professionals in the UK.4 The sessions examine preterm birth, educational outcomes, cognitive outcomes, behavioural outcomes and social and emotional outcomes. It outlines strategies to support children with inattention, working memory difficulties, slow processing speed, poor visuospatial skills, social and emotional problems and mathematics difficulties. There is a need to bridge the gap between healthcare and education to determine what support children and families need, to understand the factors that contribute to attainment after preterm birth and to develop and evaluate intervention programmes. Our neonatal speech and language therapist (SLT) took up her post in November 2021.The importance of such roles was highlighted in the HSE Model of Care document and the NICE Guidelines.5 A speech and language therapist working with parents during the neonatal period and for the first two years is now deemed an essential service for children born "It outlines strategies to support children with inattention, working memory difficulties, slow processing speed, poor visuospatial skills, social and emotional problems and mathematics difficulties."

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