• Gestation <30 weeks
• Gestation ≤31⁺⁶ weeks if capacity available locally to do so
• Gestation 30–36⁺⁶ weeks and ≥1 of the following:
  
  • grade 3 or 4 IVH, cystic PVL or other brain lesion likely to be associated with developmental disorders 
  • grade 2 or 3 HIE
  • neonatal bacterial meningitis 
  • neonatal herpes simplex infection

• Initial unit of booking is responsible for performing assessment 
• NNU discharging baby to document unit responsible for follow-up in BadgerNet discharge summary
• NNU to use BadgerNet to confirm which babies are their responsibility for assessment
  
  • if baby listed incorrectly use standard network proforma to contact follow-up lead in appropriate unit (see network website https://www.networks.nhs.uk/nhs-networks/west-midlands-neonatal-operational-delivery/neonatal-guidelines/supporting-links-guidelines-book-2019-2021) to ensure baby is seen by appropriate NNU  

Timings

• Two face-to-face meetings that focus on development at corrected age of 3–5 months and by 12 months 
• Details face-to-face assessment at aged 2 yr (corrected age) (see below)

Checks at each developmental visit

• Discuss any parental concerns regarding development 
• Measure length, weight and head circumference
• Check for signs and symptoms of developmental problems, such as
  
  • cerebral palsy
  • global developmental delay and learning disability
  • autism spectrum disorder
  • visual impairment
  • hearing impairment
  • feeding problems
  • sleep problems, including sleep apnoea
  • speech, language and communication problems
  • motor problems
  • problems with inattention, impulsivity or hyperactivity
  • emotional and behavioural problems
  • executive function problems
  • potential special educational needs 
• Possible early signs of cerebral palsy include:
  
  • delayed motor milestones, e.g.: late sitting, crawling or walking 
  • unusual (abnormal or absent) fidgety movements or other abnormalities of movement including asymmetry or paucity of movement
  • abnormalities of tone including hypo-or hypertonia
  • persisting feeding difficulties 
• If problem suspected, refer child as per local pathway

Assessment at 2 yr (corrected age)

• As a minimum NICE advises all aspects listed above plus:
  
  • use Parent Report of Children’s Abilities – Revised (PARCA-R) to identify if child is at risk of global developmental delay, learning disability or language problem 
  • use Gross Motor Function Classification System (GMFCS) if cerebral palsy has been diagnosed 
  • ensure vision and hearing checks have been carried out in line with national recommendations 
• National Neonatal Audit Programme (NNAP) analysis includes whether standardised assessment (Schedule of Growing, Bayley III or Griffiths) has been performed
• If Bayley III assessment is used:
  
  • send parental questionnaire before assessment and request parents complete and bring to assessment 
  • send copy of assessment outcome summary to GP, health visitor and parents. Include copy of network booklet Explanation of assessment scores: Information for parents and carers (available at https://www.networks.nhs.uk/nhs-networks/west-midlands-neonatal-operational-delivery/neonatal-guidelines/supporting-links-guidelines-book-2019-2021) with parents’ summary 
• Complete 2 yr follow-up form in BadgerNet
• Children born ≥28 weeks:
  
  • if development is normal and no physical health issues, discharge 
  • if continuing physical health problems, follow-up with general paediatrician or appropriate specialist 
  • if neurodevelopmental problems identified, refer to relevant allied professionals and community paediatrician 

Assessment at 4 yr (uncorrected age)

• Indicated for children born <28 weeks’ gestation 
• As a minimum NICE recommends all the checks listed for every visit plus:
  
  • request parents complete Strengths and Difficulties Questionnaire (SDQ) and Ages and Stages Questionnaire (ASQ) 48-month questionnaire in advance and discuss results at appointment
  • review previous assessments and information from all other relevant sources
  • use standardised test to assess IQ e.g., Wechsler Preschool and Primary Scales (WPPSI)
  • GMFCS score if cerebral palsy diagnosed 
  • ensure child has been offered orthoptic vision screening 
• Provide a comprehensive summary, including a plan for any necessary intervention and support, in a format accessible to parents 

• http://pathways.nice.org.uk/pathways/developmental-follow-up-of-children-and-young-people-born-preterm