Authors (including presenting author) :
AU ILY(1), Chan KSK(1), Leung AKP(1), Chan SY(2), Kwan KF(2), Siu KL(2), Law CW(2), Chan ACM(1)
Affiliation :
(1)Physiotherapy Department, Queen Elizabeth Hospital, (2)Department of Paediatrics, Queen Elizabeth Hospital
Introduction :
Infants of very low birth weight are well-known to be at risk of mortality and morbidity, including respiratory distress syndrome (RDS) and intraventricular hemorrhage (IVH). Infants of prematurity are also shown to be at risk of cerebral palsy and developmental delay. These “high-risk infants (HRIs)” are susceptible to hospitalization and physical disabilities, causing caregiver stress and healthcare burden. Early Physiotherapy intervention is well-established beneficial in promoting the neuromotor development of premature infants. An enhanced Physiotherapy program for the HRIs in Neonatal Intensive Care Unit (NICU) in the Queen Elizabeth Hospital (QEH) has been implemented since 2018. This program aims to enhance risk stratification of delay in development for infants of very low birth weight or of prematurity. Structured Physiotherapy interventions will be provided accordingly with regular re-assessment and follow-up in both NICU and post-discharge out-patient setting.
Objectives :
To review the clinical outcomes of the enhanced physiotherapy program for the HRIs in the QEH
Methodology :
A retrospective study was conducted. Infants admitted to the NICU of the QEH and referred for Physiotherapy with out-patient follow-up were reviewed. Infants who fulfilled one of the following criteria were included.
1) Gestational age ≤32 weeks or birthweight ≤1,500grams
2) Special needs (e.g. RDS, IVH>Grade II)
3) Undergone major surgery.
Test of Infant Motor Performance (TIMP) at corrected age (CA) 1-month and 4-month, Alberta Infant Motor Scale (AIMS) at CA 4-month, 8-month and 12-month, and Peabody Developmental Motor Scales, 2nd edition (PDMS-2) at ≥24-month were reviewed. Prevalence of developmental delay was recorded. Correlations among TIMP, AIMS and PDMS-2 were evaluated by Spearman’s rank correlation coefficient. Receiver operating characteristic analysis was used to estimate the cut-off points of TIMP and AIMS for the prediction of developmental delay.
Result & Outcome :
Eighty-eight patients (57 males, 31 females) were reviewed. Median of their gestational age was 28week (range: 23week4day to 41week). Their birthweight was 1,390±825grams. Prevalence of developmental delay was 20.0%, with Total Motor Quotient of PDMS-2 scored <80.
Significant correlations were found between TIMP at CA 4-month and AIMS at CA 12-month (r=0.636, p=0.005), and between AIMS at CA 8-month and AIMS at CA 12-month (r=0.785, p<0.001), implying that early Physiotherapy follow-up could assist the identification of major functional abnormality.
For predicting developmental delay, no significant results could be found, which could probably be caused by dropout or re-scheduling of out-patient appointments during the COVID-19 pandemic.
In conclusion, enhanced Physiotherapy program for the HRIs in NICU of QEH could assist the early identification of major functional abnormality or developmental delay and facilitate the implementation of early intervention.
