1. Developmental Monitoring: do 28-29 weekers deserve close monitoring?
Debbie Paris
Specialist Physiotherapist
Aneurin Bevan University Health Board
October 2014

2. Background
Physiotherapists are experts in age appropriate movement and postural control, allowing early identification of gross motor dysfunction and optimisation of brain development…. (BAPM, 2010)
National guidelines state neonatal units should have access to physiotherapists for neurodevelopmental, orthopaedic, respiratory, and follow up roles (All Wales Neonatal Standards 2013; NHS & Department of Health, 2009; BAPM, 2010).
But….the amount of input required to provide sufficient quality of care has not been ascertained and provision of services varies greatly.
The evolution of medicine has seen survival of
preterminfants increase to 66% (EPIcure, ),
and with this comes additional medical and
developmental sequelae. A study of infants (n=810)
born at <25 weeks gestation demonstrated that upon
reaching one year of age 18% had developmental
problems and 17% had neurological impairments
(EPIcure, ). At 30 months of age a larger
proportion of infants (51%) had a disability of which
22% were classified as ‘severe’ (Wood et al, 2005).
With early and timely physiotherapy intervention
the problems associated with an immature nervous
system can be addressed (Symington and Pinelli,
2001) to improve functional outcomes in later
childhood (Blackman, 2002; Gardner, 2005).

3. Developing Referral Criteria
Physiotherapy Review – (Eldridge, 2011)
Consensus
<30 weeks gestation
<1200g birth weight
IVH grade III/IV, PVL
HIE II or III
IUGR <2nd centile
CLD/home O2
Persistent neurological signs, abnormal posturing/tone, any condition/syndrome affecting GM development
These babies are reviewed by PT until walking

4. Service Review
Would reducing referral criteria to <28 weeks decrease referral numbers, but remain as clinically effective?
Parental Feedback

5. Method
All babies referred routinely reviewed at 1 yr corrected age (CGA)
Babies with emerging neurological or significant developmental delay (<5th percentile Alberta Infant Motor Scale) requiring regular Physiotherapy, were identified
Anonymous Parental Feedback questionnaires distributed

6. Results n=128 Gestation No. Babies 23-27+6 wks 49 28-29+6 wks 4113
38-42 wks 25

7. Cerebral Palsy 14%

8. Results 17 diagnosed with Cerebral Palsy
8 of whom were weeks GA
6 of those would not have been identified as
‘at risk’ (from CUSS, <1200g birth wt or CLD)
29 had significant motor delay
5 of whom were weeks GA
2 of those would not have been identified as ‘at risk’

9. Gestation and Input Received

10. Parental Feedback
13 of 15 forms returned (CGA 12.7, range months)
100% rated service as
Helpful to understand motor development
Advice given useful
Appt frequency ‘about right’

11. Comments included….
..like to say how fantastic I have found service, help for my daughter has been wonderful, as well as advice and support for me, forever grateful this service has been absolutely vital to my daughter and our family
…overall this service has been invaluable, very grateful to personal service we received...to know your children are progressing and understand their development is key as parents, very helpful tips and exercises to aid development
… correct information and advice needed to keep us on track with his development.. …offers advice on how child should be developing….keeps you understanding where your child should be in developmental status….gives you advice so all these things can be constructive  
… sessions extremely valuable, specific exercises helped her development… supported and relieved my anxieties surrounding development, as well as providing strategies on how to promote developmental milestones …gave me such reassurance knowing physical development being closely monitored and I could seek advice about his development play ideas. Thank you for a great service!

12. Conclusions
Service Aim - early identification and more importantly early therapy input
Service Review shown -
13 babies (8 with CP) may not have received early intervention if referral criteria revised to <28 wks
Service highly valued by parents