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For Babies at Risk: Intervene Early and Monitor Often, Through Early Childhood

For babies born prematurely, or who spend time in a Neonatal Intensive Care Unit (NICU), therapies to help them heal and develop are more successful than ever. 

Even so, for parents leaving the hospital with a fragile newborn, questions abound: Will my baby thrive? How will I know if development is on track? Will I be alert to the right signals?

Research has shown that young brains are very receptive to therapies that help maximize physical and cognitive development, especially when initiated early.

“The brain of a baby is remarkable and able to recover [from trauma at birth or other injury],” explains Jennifer R Benjamin, MD, a neonatologist in the Brigham and Women’s Hospital (BWH) Department of Pediatric Newborn Medicine. “If we can notice a deviation in a child’s development and can intervene early and provide that child with additional therapies or resources, we can maximize their potential and help that child reach the best that they can be.”

One step toward optimizing child development comes via early intervention programs, required in each state. These programs typically assist children age zero to three years who have, or are at risk of, developmental delays due to early birth or low birthweight, feeding difficulties and other early challenges.

Some hospitals are taking an additional step, extending the services of their neonatologists and other experts into outpatient visits that closely follow babies born in their hospitals.

Follow-up Programs through the Toddler Years

A new NICU Follow-Up Program at BWH provides a comprehensive, multidisciplinary outpatient clinic for newborns discharged from the hospital’s 60-bed, state-of-the-art Level 3 NICU, as well as from other NICUs in the region. Other children are referred to the program by pediatricians who are concerned about a child’s growth or development.

“It's important for us to follow high-risk infants and children closely in the first few years of life because ongoing medical complications that they may have left the hospital with can affect their long-term growth or developmental progress,” says Dr. Benjamin, director of the NICU Follow-Up Program.

Children in the program typically are evaluated at the clinic every four to six months, from soon after hospital discharge until age three years or so. Each visit includes a medical and neurodevelopmental assessment. Depending on a child’s needs, he or she may be assessed by a nutritionist, a physical therapist, a speech and language pathologist, a feeding therapist, and a clinical psychologist – each of whom provides feedback to the parent and pediatrician and can recommend further specialty care if a child would benefit from it.

It's important for us to follow high-risk infants and children closely in the first few years of life because ongoing medical complications that they may have left the hospital with can affect their long-term growth or developmental progress.

Follow-up Research and Observations Improve Care

In addition to providing care and resources for individual young patients, the Follow-Up program helps the BWH NICU improve care, says Dr. Benjamin. With many new technologies available to premature infants, following these children over the subsequent years – and collecting the data into large studies – reveals more about what works best for fragile newborns.

In the few months since the program began, Dr. Benjamin and colleagues also have learned from families in the Follow-Up program ways to improve the NICU, particularly through better feeding instructions and more support after discharge.  

“Now we plan to call families to see how they are doing – not just those who are formally in our Follow-Up program, but everyone,” she says.

If You Have Concerns About Your Child

The BWH NICU Follow-up Program focuses initially on three major areas of development that parents also can be alert to:

  • Motor Development: Sitting, crawling, standing, and using hands to grasp objects.
  • Language: Includes receptive language (what a child hears and understands) and expressive language (how a child communicates with sounds or gestures).
  • Cognition:  How a child thinks, remembers and solves problems.

If your child is not reaching milestones in these areas, or if you have other concerns about your child’s development, alert your pediatrician, who may refer you to an Early Intervention program in your area. If your child was in a NICU, that hospital may have a follow-up program.

Parents and health care providers in New England who wish to learn more about the BWH NICU Follow-Up program can call (617) 525-4120 or email for more information.

-Sandy J.

In this video, Dr. Benjamin addresses infant development after NICU discharge and the BWH NICU Follow-Up Program.