The Women’s and Children’s service at the Sunshine Coast University Hospital (SCUH) has transformed a low value, high volume blanket follow-up pathway into a streamlined prioritised model of care focused on providing early detection of adverse neurodevelopmental outcomes and excellence in service delivery for families impacted by preterm birth.
Our team researched clinical assessment tools that would allow clinicians to make early prediction about motor and cognitive outcomes. After national benchmarking, literature search and training, SCUH was the first hospital in Queensland to implement the General Movement Assessment (GMA) in the Neonatal Unit and Paediatric outpatient setting. The GMA had proven predictive accuracy for early detection of cerebral palsy and we were excited about additional early research findings suggesting that GMA may have strong negative predictive value and potential to predict milder developmental delays.
The result was the PREMTiME study: a multidisciplinary research initiative incorporating neonatal and paediatric medical and allied health teams. Study methods were in two parts. Firstly, a systematic review of all clinical tools, used at six months corrected age (CA) or younger, to predict motor and cognitive delay (not cerebral palsy) at 24 months CA in infants born very preterm or very low birth weight. Secondly, a prospective longitudinal cohort of study of very preterm and very low birth weight infants on the Sunshine Coast, Australia. All infants were assessed between 34-35 weeks and 16 weeks corrected age using the Premie-Neuro Examination, the General Movement Assessment, the Alberta Infant Motor Scale, and the Infant Sensory Profile 2. At 24 months corrected age delays were identified using the Bayley III and Neurosensory Motor Developmental Assessment (NSMDA).
The PREMTiME Study
Summary
Aim
The PREMTiME study aimed to identify early clinical biomarkers from birth to 16 weeks corrected age to predict typical outcome and mild motor and cognitive delays at 24 months corrected age in very preterm and very low birth weight (VLBW) infants. As early delays are difficult to differentiate from typical development, impacted infants often miss out on crucial intervention during the critical period of brain neuroplasticity experienced in the first days and months following birth. As risk for adverse neurodevelopmental outcome is higher in the very preterm and VLBW population, clinicians require robust biomarkers they can rely on to prioritise follow up services, prevent overservicing and inform referral pathways to early intervention.
Benefits
Benefits for families:
By six months corrected age we can now provide parents with an estimate of their child’s risk for adverse outcome. Our findings demonstrated that GMA trajectories can predict and differentiate between very low, low, moderate and high risk for motor or cognitive delay. As a result, we are reassuring families where risk is low and facilitating early intervention and transition to NDIS funded therapies for high-risk infants.
Benefits for services:
Earlier prediction of developmental delay has translated into a cost effective, customised follow up pathway for very preterm and very low birth weight infants. Improved prioritisation is allowing redirection of essential resources towards very early intervention for infants with high risk for cerebral palsy.
Background
In the late 2000s we were engaged in traditional follow up practices. All infants born less than 1500g or less than 32 weeks were attending developmental screening at multiple timepoints between birth and two years corrected age. Without prognostic indicators we were unable to prioritise or streamline the pathway or provide reassurance to families until children were two years of age or older. The model was unsustainable. With our growing population and limited resources, we could see that we needed to change and improve our practice.
