Neobook — clinical reference

Infants that should be brought back for follow-up

Patient categories and appropriate action

Neonatal follow-up is monthly on a Monday morning at the High Risk Clinic (POPD). Make booking with Sr Steyn or the clerk on duty (ext 3097).

Infants that should be brought back for follow-up:

Any patient who is at risk of having neurological impairment
Preterm infants born at <34 weeks
Birth weight <1500g
Those requiring invasive ventilation
Neurological problems
- Abnormal neurological examination on discharge
- Neonatal seizures
- Any form of encephalopathy including hypoxic ischaemic encephalopathy
- Meningitis
- Meningocoele/Myelomeningocoele/Encephalocoele
- Hydrocephalus
- Grade 3 or 4 IVH
- Leukomalacia
Neonatal jaundice (only needing exchange transfusion or total bilirubin>340mmol/l)
Major congenital abnormalities including patients with syndromes like T21
Persistent, severe hypoglycaemia (eg >3 Hgt’s under 2mmol/l)
NEC stage 3
Post-surgical patients (eg gastroschisis, atresias & congenital diaphragmatic hernia)

Patient categories and appropriate action

Category	Action
High Risk B/W < 1000g IPPV and between 1000-1499g IVH grade 3 or 4 HIE grade 2 or 3 Hydrocephalus, leukomalacia/porencephaly Neonatal seizures Neurodevelopmental delay, hearing or visual problems Meningitis Complicated TORCH infection Chromosomal abnormalities/syndromic Exchange transfusion Chronic lung disease Ventilated > 5 days	F/U for at least 9-12 months CGA As soon as neurological impairment is clinically recognisable, F/U in neuro clinic Should’ve has ROP screening at TBH before discharge Cranial ultrasound on all <1000g, HIE grade 2 or 3, neonatal seizures, TORCH infections, syndromic babies, ventilated > 5 days or encephalopathy of unknown cause babies before discharge Should get hearing screen before discharge
Intermediate risk B/W 1001-1500g (uncomplicated) IPPV and >1500g IVH grade 1 or 2 HIE grade 1 Bilirubin > 340mmol/l Symptomatic congenital syphilis Birth trauma Definite NEC (grade 2 or 3) Septicaemia Congenital abnormalities eg cleft lip Babies with surgical problems	Follow-up for at least 6-9 months corrected age As soon as neurological impairment is clinically recognisable, F/U in neuro clinic Cranial ultrasound on babies < 1200g before discharge Should get hearing screen before discharge
Low risk B/W 1601-1800g 2B1 F/U babies (should have letter if asked to come back) Asphyxia without encephalopathy	Discharge after first visit unless there are problems Should get hearing screen before discharge

Patents should be followed up at 3, 6 and 12 months corrected gestational age unless a specific complication is expected eg hydrocephalus with abnormally increasing H/C. Consider flu vaccination at 6 months of age.