After the NICU: Monitoring for developmental delays and cerebral palsy

March 24, 2022 | by Pediatrix® Medical Group
After the NICU: Monitoring for developmental delays and cerebral palsy

In recognition of Developmental Disabilities Awareness Month, guest bloggers and developmental clinicians with Pediatrix® Medical Group, Priscilla Rieves, Ph.D., CPNP, and Fadiyla Dopwell, M.D., provide insight on routine follow-up care of high-risk infants and associated developmental effects.

More than one in six U.S. children are diagnosed with developmental disabilities, such as motor delays, cerebral palsy, speech and language delays, global developmental delays, autism and intellectual challenges. Children born premature (less than 37 weeks) or with genetic and neurological risk factors are at higher risk for developmental concerns and warrant careful surveillance. As specialists in developmental medicine, we are typically consulted by the neonatology team to provide developmental follow up to high-risk infants. This typically begins while the infant is hospitalized, with comprehensive neurodevelopmental examination and recommendations to support development.

Following discharge, infants are monitored in our long-term NICU follow-up clinic at various intervals with standardized assessments of each developmental domain. During each visit, we provide individualized recommendations, including anticipatory guidance and therapeutic interventions, such as speech and language therapy, occupational therapy and physical therapy.

We perform standardized neurological examinations as part of our routine developmental monitoring, inpatient and outpatient. In the outpatient setting, over time, examinations may reveal concerns and motor delays suggestive of cerebral palsy. Cerebral palsy is a motor disorder that typically results from an injury, infection or abnormality within the brain. It affects a child’s movement, balance or tone (e.g., passive muscular resistance) in various ways and produces different symptoms for each child.

Early findings of cerebral palsy often involve motor delays, and symptoms evolve as the child grows. Comorbidities with this evolving diagnosis may include seizures, impaired cognition, fine motor delays, speech and language delays, vision and hearing impairment, abnormal pain tolerance and behavioral concerns. As such, care of children diagnosed with cerebral palsy involves ongoing neurodevelopmental management in collaboration with other disciplines, including but not limited to neurology, physical medicine and rehabilitation, orthopedics, neuro-ophthalmology and therapy providers.

The American Academy of Pediatrics also stresses the benefits of early detection, because treatment can have a lasting positive impact in areas involving movement, cognitive development, social interaction, and behavior. In its clinical report “Motor Delays: Early Identification and Evaluation,” the AAP notes that early interventions, generally before the age of three, are especially critical, as a child’s brain is still developing and making valuable connections. According to the AAP, offering treatment early can not only prevent complications but improve overall outcomes.

Regarding all developmental disabilities, including cerebral palsy, we not only work with other specialties and therapeutic agencies, but we work alongside primary care providers, preschools/childcare centers and schools to optimize each child’s developmental outcome. Our primary goal as developmental clinicians is to help each child reach their maximum potential, provide resources and support families on their journey.

Fae DopwellPatricia Rieves

Priscilla Rieves, Ph.D., CPNP, is a board-certified pediatric nurse practitioner with a Ph.D. in child development. Fadiyla Dopwell, M.D., is a board-certified developmental-behavioral pediatrician.

They are clinicians at Pediatrix Developmental Medicine of Dallas in Dallas, Texas, a developmental practice that provides care to infants and children at high risk of neurodevelopmental disorders.