Clinical update

Preterm births

New guidelines published by National Institute for Health and Care Excellence aim to identifiy the developmental problems in children born prematurely. 


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What’s new?

New guidance from the National Institute for Health and Care Excellence aims to improve the identification of developmental problems in children born prematurely by setting standards for follow-up, reducing variation and enabling benchmarking of neonatal care. It also offers advice for parents when their baby is discharged from hospital.

NICE calls for developmental surveillance up to and at two years (corrected age, that is the original due date) to identify major problems. A later developmental assessment for children at high risk aims to identify issues more apparent at school age.

Healthcare professionals providing community care for babies born preterm should be able to recognise and address concerns about sleeping, provide feeding support and help parents interact with their baby.

Signs and symptoms

Among the disorders nurses should be looking out for in preterm children are cerebral palsy, motor function disorders, autism spectrum disorders, executive function problems plus attention deficit, impulsivity and hyperactivity. There can also be feeding and sleeping problems and higher rates of visual and hearing impairment.

The risk and prevalence of impairments that affect educational attainment rise sharply in children born before 28 weeks' gestation. 

Impact on nurses

Staff should provide enhanced developmental support from a multidisciplinary team up to two years (corrected age) for children born preterm who have a development problem or disorder or who are at increased risk, including all those born before 30 weeks gestation.

Any face-to-face visits should include assessment of whether the child is showing signs of a range of disorders, including cerebral palsy, global developmental delay and learning disability, autism, communication problems and emotional and behavioural problems.  The guidance recommends using the Parent Report of Children's Abilities – Revised (PARCA-R) to identify if the child is at risk of global developmental delay, learning disability or language problems and the Gross Motor Function Classification System score if cerebral palsy has been diagnosed.

A face-to-face developmental assessment should be offered at four years (uncorrected age) for all children born before 28 weeks' gestation.

Expert comment

 Elaine McInnes is a consultant in children and young people's health and well-being

‘All the professionals involved in a preterm child’s care should follow this guidance to improve the outcomes for the baby and family. Gaining experience in acute and community settings can help children’s nurses enhance their knowledge and understanding of the importance of the family unit and home environment to the longer-term outcomes for these babies. The health visitor should be at the centre of the multidisciplinary team supporting families.

'Nurses should ensure the family are fully informed and at the centre of any decision making. They should be familiar with specific assessment tools for children born before 28 weeks’ gestation. All families with a child born preterm should be offered emotional and psychological support, plus information on the risks and prevalence of developmental problems for short- and long-term development. Nurses should encourage families not to compare their own baby's developmental progress against a baby born at term.’

 

Further information


Erin Dean is a health writer

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