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. 2025 Jun 10.
doi: 10.1038/s41390-025-04154-2. Online ahead of print.

High-risk infant follow-up: current practice and factors determining eligibility

Danielle Clifford  1   2 , Sylke Steggerda  3 , Nathalie Maitre  4 , Linda S de Vries  3 , Deirdre M Murray  5   6   7 ; Newborn Brain Consortium
Collaborators, Affiliations

High-risk infant follow-up: current practice and factors determining eligibility

Danielle Clifford et al. Pediatr Res. .

Abstract

Background: High-risk infant follow-up (HRIF) lacks universal definition. The aim of this study was to report current practice and factors used to identify eligibility for HRIF, yielding information which may provide a basis for future consensus.

Methods: A survey was prepared for a workshop at the 15th International Newborn Brain Conference on prediction of outcome, which was subsequently distributed to all attendees (n = 426).

Results: Follow-up was offered by 97% of respondents (n = 113/116). HRIF was offered to infants born <28 weeks by 47%, to those <32 weeks by two-thirds (66%) and to preterms based on neuroimaging by 54%. For infants born full-term, HRIF was offered by 88% in neonatal encephalopathy (NE) and 86% in neonatal stroke. HRIF continued most frequently until 24 months corrected (33.6%). For guiding prognosis in preterm infants, 22% (n = 25) selected neuroimaging as the most important factor. For NE, 54% (n = 63) selected neuroimaging findings as the most important factor in guiding prognosis and 14% (n = 16) selected EEG/aEEG. Social factors are not considered by 46% in determining HRIF eligibility.

Conclusion: Significant variability in HRIF exists, without consensus. Awareness of factors predicting prognosis and the importance of social risk-factors must improve to allow accurate identification of those at highest risk. This information may act as a basis for future consensus on HRIF.

Impact: There is no clear consensus on eligibility or duration of high-risk infant follow-up. We report current practice in, and factors used to identify eligibility for same, amongst attendees of the International Newborn Brain Conference. This information on international practice may provide a basis for future consensus. Given the importance of accurate prognostication in risk-stratification, we report participants' awareness of the most important factors guiding prognosis. A disconnect between the impact of social factors on outcome and their consideration for eligibility of high-risk infant follow-up is noted. We propose the need for guidelines on follow-up of socially disadvantaged, medically high-risk infants.

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Conflict of interest statement

Competing interests: The authors declare no competing interests. Consent statement: The Emory Institutional Review Board (IRB) determined that this project did not require IRB review because it was deemed not ‘research’ as defined in the federal regulations and should be designated as ‘not human subjects research’. Consent was obtained from participants as follows; participants were given three options to select from, firstly ‘I am happy to take the survey but please do not use my answers in your publication’, second ‘I am happy for you to use my answers in the publication but do not wish to co-author’, or finally ‘I would like to co-author and am happy to edit and contribute to the manuscript preparation’. Licensing Statement: This publication has emanated from research supported in part by a grant from Science Foundation Ireland (grant number 22/SPP/11074) and the Cerebral Palsy Foundation. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.

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