Neurological Surveillance in Moderate-Late Preterm Infants—Results from a Dutch–Canadian Survey

Abstract

Preterm birth remains an important cause of abnormal neurodevelopment. While the majority of preterm infants are born moderate-late preterm (MLPT; 32–36 weeks), international and national recommendations on neurological surveillance in this population are lacking. We conducted an observational quantitative survey among Dutch and Canadian neonatal level I–III centres (June 2020–August 2021) to gain insight into local clinical practices on neurological surveillance in MLPT infants. All centres caring for MLPT infants designated one paediatrician/neonatologist to complete the survey. A total of 85 out of 174 (49%) qualifying neonatal centres completed the survey (60 level I–II and 25 level III centres). Admission of MLPT infants was based on infant-related criteria in 78/85 (92%) centres. Cranial ultrasonography to screen the infant’s brain for abnormalities was routinely performed in 16/85 (19%) centres, while only on indication in 39/85 (46%). In 57/85 (67%) centres, neurological examination was performed at least once during admission. Of 85 centres, 51 (60%) followed the infants’ development post-discharge, with follow-up duration ranging from 1–52 months of age. The survey showed a wide variety in neurological surveillance in MLPT infants among Dutch and Canadian neonatal centres. Given the risk for short-term morbidity and long-term neurodevelopmental disabilities, future studies are required to investigate best practices for in-hospital care and follow-up of MLPT infants.

Neurodevelopmental outcome of low-risk moderate to late preterm infants at 18 months

“…There is limited data available on long-term neurodevelopmental outcome of MLP infants with an uncomplicated neonatal stay and a normal neurological exam on discharge. Institutional practices relating to pre-discharge screening including CRUS or MRI and post discharge neurological surveillance vary ( 16 ). Standardising screening practice based on findings from multicentre longitudinal research studies with expert input would identify best practice for follow up of this at risk group.…”

“…The availability of neurodevelopmental outcome data for healthy MLP infants is often hindered by the variation in follow-up between institutions internationally ( 16 ) and the belief that these infants are low risk, and hence require little developmental surveillance. This limits our ability to assess the prevalence of impairments in this healthy MLP infant group.…”