Follow-up after high-risk birth and NICU discharge — viva

Stem

Examiner-led viva on the follow-up of the high-risk NICU graduate. [1]

Examiner: This former 26-week infant is now five months corrected age. How do you apply corrected age, and why does it matter? [11]

Strong answer: Corrected age is chronological age minus the weeks born before forty weeks. This infant was born fourteen weeks early, so at five months corrected age I plot growth on Fenton charts to a post-menstrual age of fifty weeks then WHO or INTERGROWTH-21st standards, and I interpret milestones as a five-month-old, not a six-month-and-a-bit chronological infant. I continue correcting milestones for at least two years. Without correction I would either falsely alarm or falsely reassure the family, and both harm. [11]

Examiner: The General Movements Assessment shows absent fidgety movements and the HINE scores 38. What do you conclude, and on what evidence? [3]

Strong answer: This triad — absent fidgety General Movements at nine to twenty weeks post-term, a Hammersmith Infant Neurological Examination score under the 40 to 60 range, and a known grade 3 intraventricular haemorrhage — meets the international criteria for an early, accurate diagnosis of cerebral palsy before six months corrected. Prechtl established that absent or abnormal fidgety movements carry a high positive predictive value for cerebral palsy, and the Novak 2017 and Morgan 2021 guidelines established that the combined GMA-plus-HINE-plus-MRI approach diagnoses cerebral palsy accurately far earlier than waiting for delayed walking. I would not wait and see. [3] [4] [5]