One-Year Follow-up Study of High-Risk Neonates With Tone Abnormalities

Haridharshan Gunavanthe Jayakumar, Vijay Kulkarni


Background: As a result of the vast progress in perinatal and neonatal care, an increased survival rate of high-risk neonates (HRNs) has been observed. At the same time, the number of HRNs with chronic morbidities has increased. Hence, HRNs require regular follow-ups for early recognition of tone abnormalities, so as to provide early interventions.

Aim: To know the final outcome of HRNs (at 1 year of age) who were discharged from the neonatal intensive care unit (NICU) of Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital (Dharwad, Karnataka, India)

Materials and Methods: The neonates who met the inclusion criteria were considered HRNs and were assessed for tone abnormalities at 3, 6, 9, and 12 months of corrected age. Active tone was assessed based on spontaneous movements and the 180° flip test. Passive tone was assessed by the Amiel–Tison method. Based on these examinations, the neonates were categorized into 3 groups, as having hypertonia, hypotonia, and minor tone abnormalities. All neonates found to have tone abnormalities were given occupational therapy at the earliest.

Results: Of the 107 HRNs discharged from our NICU, 89 (83.17%) were followed up for 1 year, 13 (12.15%) did not come for follow-ups, and 5 (4.67%) died. Of the 89 neonates, 59 (66.29%) were preterm and 30 (33.71%) were term neonates. At 1 year of age, upon examination, 59 (66.29%) neonates were considered normal, 25 (28.09%) had transient tone abnormalities (TTAs), and 5 had cerebral palsy (CP; 5.62%). Normalization of abnormal tone was seen in 83.3% of cases. The survival rate of HRNs was 95.32%.

Interpretation and Conclusion: Our study showed a prevalence of 35.2% for TTAs. Many of the tone abnormalities detected within 6 months of age resolve by 12 months; hence, hasty diagnosis of CP should not be made, till the latter part of the first year. Therefore, HRNs should have a proper follow-up protocol so as to detect tone abnormalities at the earliest and provide early intervention.

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