Clinical update

Premature babies: identifying problems and planning support

Guidance from the National Institute for Health and Care Excellence aims to improve early identification of developmental problems in children born prematurely by setting standards for follow-up


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Guidance from the National Institute for Health and Care Excellence aims to improve early identification of developmental problems in children born prematurely by setting standards for follow-up

Essential facts

Almost 49,000 babies are born preterm, or before 37 weeks’ gestation, in the UK every year. About 5% of these are before 28 weeks. Preterm birth is associated with an increased risk of developmental problems and disorders including developmental challenges, physical, sensory, cognitive and learning disorders, and emotional and behavioural problems. These may extend into adolescence and can be lifelong.

What’s new

Guidance from the National Institute for Health and Care Excellence (NICE) aims to improve the identification of developmental problems and disorders in children born prematurely by setting standards for follow-up. NICE says the guidance should improve outcomes for these children by reducing variation in follow-up and enabling benchmarking of neonatal care.

Developmental surveillance up to and at an adjusted age of two, based on the original due date, is recommended for identifying major problems and disorders. A later developmental assessment for children at high risk aims to identify problems that are more apparent at school age.

Signs and symptoms

Learning disability is described by NICE as deficits in general cognitive abilities such as reasoning and abstract thinking, and impairment of adaptive function that affects several aspects of daily life.

Causes and risk factors

Children born preterm are at increased risk of learning disability and of having special educational needs. Several factors increase the risk of learning disability, including the mother being from a low-income background, the baby being small for its gestational age, neonatal sepsis and severe retinopathy of prematurity in babies born before 28 weeks. The risk rises as the gestational age decreases.

How you can help your patient

Provide enhanced developmental support by a multidisciplinary team up to an adjusted age of two for children born preterm who have a development problem or disorder or who are at increased risk, including all those born before 30 weeks.

Face-to-face visits should include an 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. Provide a face-to-face developmental assessment at an unadjusted age of four for all children who were born before 28 weeks.

Expert comment

 Joann Kiernan is a learning disability consultant nurse at Alder Hey Children’s NHS Foundation Trust in Liverpool

‘As the guidance recognises, there is a need for ongoing monitoring of children who may start life with some of the risk factors for learning disability and other conditions associated with preterm birth.

‘Nurses should recognise the important role of families in identifying behaviours or developmental issues that are of concern. As with all children, developmental norms can vary greatly. Access to the usual developmental checks and monitoring should provide evidence of milestones and areas where support from multidisciplinary expertise may be needed.

‘All professionals working in child health have a role to play in supporting families and their children through the assessment, diagnosis and planning of ongoing support to maximise people’s potential.’


Further information

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