NMH

NMH | 2024 57 Neonatology this. Speech delay and gross motor delay can present as co-morbidities in this cohort of children (this year at 8.3% compared with 11.3% in 2023) when cognitive, receptive, and fine motor skills fall within the normal range. When assessing the developmental profiles for this cohort 23.6% showed global developmental delay, (6 children within the severe delayed range, 4 within the moderate delayed range and 7 within the mild delayed range). Hence, it is so important to be aware of how these children are doing in terms of their follow-up. As the national REDCap* data grows, trends and patterns will begin to emerge which will enable us to build profiles of key issues to build better predictive models to inform clinical practice and to provide vital information for service provision. Term Babies and the Neonatal Encephalopathy Group Fifteen term babies were listed for assessment. Eleven babies who had Neonatal Encephalopathy and were cooled, 3 who had seizures at birth and 1 independent referral following NAS. Fourteen were assessed in NMH. One NE baby was assessed in Limerick (as guided by the National Psychology Neonatal Forum) indicating follow-up at 100%. This baby's results are included in this report. Table 3 shows that the NE group of children did well overall in terms of their individual profile scores. Seven children (63.6%) showed Normal and Advanced profiles (some very advanced) across all parameters measured for their Cognitive, Language and Motor Development which was very encouraging. Four children (36.4%) indicated Mild / Moderate Delayed profiles. Of the 3 children who had seizures at birth two showed normal outcome. One child showed severe delay across all three parameters. An underlying genetic syndrome was queried. Tables 4 and 5 demonstrate how the group of NE children performed as a group in terms of their Composite and Scaled Score outcomes. The tables show the different outcome categories to indicate advanced /normal/delayed outcomes across the different parameters. Seven children (63.6%) showed Normal and Advanced Cognitive Performance (with three very advanced performance). Three children (27.3%) showed Mild Cognitive Delay, and 1 child showed (9.1%) Moderate /Severe Cognitive Delay. In terms of Cognitive Performance 54.5% (6/11 children) showed Normal / Advanced Performance, 27.3% (3/11) showed Mild Delay while 9.1% (1/11) showed Moderate / Severe Cognitive Delay. The outcomes for Expressive Communication were better than for Receptive Communication Skills. This year 72.7% (8/11) of children showed Normal / Advanced Expressive Communication Performance compared with 54.5% (6/11 children) for Receptive Communication Performance. There was more Receptive Speech Delay at 36.4% (4/11) than Expressive Delay at 18.2% (2/11 children). In terms of Motor Outcomes, 72.7% (8/11) of children performed within the Normal/Advanced Range for Fine Motor Development while 81.8% (9/11) showed Normal /Advanced Gross Motor Development which was a good outcome. Mild Fine Motor Delay (18.2%) was noted for 2/11 children. Severe Gross Motor Delay (9.1%) was measured for 1/11 children. What are the Bayley Scales of Infant and Toddler Development? The Bayley Scale is a clinical tool that is used to identify developmental delay in early childhood. It comprises of a series of play tasks and language stimulus books broken up into 3 composite scales with 5 sub-categories – cognitive development (Cognitive Scale), receptive and expressive communication (Language Scale) and fine motor and gross motor development (Motor Scale). It can classify delayed or advanced development within the specific sub-categories. The standardised score across each of the 5 domains is 100 (SD15). Scores below 85 indicate mild delay, scores below 70 indicate moderate / severe delay. The assessment session can take 2 hours or more to complete depending upon toddler cooperation, duration of assessment feedback and discussion with parents. The process can be tedious as the children are only 2 years of age, active and busy. It can be demanding In summary, by analysing the scaled scores, it is evident that delays in gross motor skills were more prevalent than delays in fine motor skills in our preterm population." In terms of Composite Language Outcomes, 6 children (54.5%) showed Normal /Very Advanced Language Performance, 3 (27.3%) showed Mild Language Delay, while 2 (18.2%) showed Moderate/Severe Delay. In terms of Composite Motor Outcomes 7 (63.6%) children showed Normal/ Advanced Motor Performance. Three children (27.3%) showed Mild Motor Delay and 1 (9.1%) showed Moderate/Extreme Motor Delay. One baby was diagnosed with CP. Table 5 shows the breakdown of the Composite scores to allow us to examine the Scaled Score outcomes. For example, a child might have a normal Fine Motor/ Receptive Communication score but delayed Gross Motor/ Expressive Communication score that can mask outcome.

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