Beyond survival: neurodevelopmental outcomes for neonatal intensive care survivors in Fiji

© 2019 Kate MacKinnon MilnerBACKGROUND In low- and middle-income countries (LMIC) where most of the 15.1 million neonates who survive prematurity and serious illness every year reside, neurodevelopmental outcome data are scarce and needed to improve neonatal care including follow-up, developmental monitoring and early intervention. In Fiji, neonatal health policy has shifted from almost exclusive focus on neonatal survival to ensuring that children are also supported to reach their developmental potential. METHODS AIM To examine early childhood neurodevelopmental and health outcomes for neonatal intensive care unit (NICU) survivors in Fiji, to inform improvements in neonatal care and follow-up including developmental monitoring and early intervention. OBJECTIVES These were, to: 1. Systematically review existing neonatal outcomes studies in LMIC to understand knowledge gaps related to neurodevelopmental outcomes for high-risk neonates and inform research design and sample size estimates for our neonatal outcomes study 2. Assess early childhood neurodevelopmental and health outcomes for neonates discharged from the Colonial War Memorial Hospital (CWMH) NICU in Suva, compared with control, term neonates born in the same hospital 3. Evaluate accuracy of nurse-led developmental screening as a potential tool for early identification of developmental delay and impairment in high-risk neonates, compared with reference standard developmental assessment RESULTS Systematic review of 60 high-risk neonatal outcome studies in LMIC provided estimates of median prevalence of neurodevelopmental impairment (NDI) for survivors of prematurity/very low birth weight (VLBW) and ‘birth asphyxia’. This highlighted a need for studies that better describe multi-domain neurodevelopment, include hearing and vision and including control data. Our neonatal follow-up study in Fiji compared early childhood outcomes for high-risk NICU patients (n=149) with those of matched term, normal birth weight neonates (n=147) discharged from Colonial War Memorial Hospital between November 2008 and April 2010. NDI was defined as at least one of; cerebral palsy, moderate to severe hearing or visual impairment, or global developmental delay using Bayley Scales of Infant and Toddler Development Third Edition (i.e. score