Consensus Guidelines of the Indian Academy of Pediatrics (IAP)-Neurodevelopmental Pediatrics Chapter on Developmentally Supportive Follow-Up for High-Risk Infants

JustificationWith increasing neonatal survival, there is a need for trained staff for timely identification and intervention for high-risk infants. Since the foundation of neurodevelopment is laid in the first three years of life, addressing the lacunae of a robust guidelines for extended follow-up of high-risk infants needs to be formulated to avoid remediation or rehabilitation later on.ObjectivesTo develop comprehensive evidence-based consensus guidelines for developmentally supportive care and follow-up of high-risk infants in the Indian context with the aim of reducing the need for future rehabilitative services.ProcessScientific literature over the last 10 years was searched using database-specific controlled vocabularies like Emtree for Embase, MeSH terms for PubMed, Scopus, CINAHL headings for CINAHL databases, and the Cochrane Library. The available studies were analyzed based on their scientific credibility and strength of evidence. Data from meta-analysis, systematic reviews, and randomized controlled trials was extracted, and relevant statements were prepared. These were deliberated in two onsite Delphi rounds of discussion (February 19, 2023 and January 11, 2025) and one hybrid (online and onsite) Delphi round (February 6, 2025). The final draft was made under different headings and was circulated, followed by recommendations made with Grading of Recommendations Assessment, Development and Evaluation (GRADE) analysis. The final draft after incorporating all suggestions was circulated and accepted online on March 2, 2025.StatementThe recommendations propose using a color-coded system to monitor high-risk infants, risk stratification, promoting early stimulation, structured interventions, and parental involvement. Routine care should align with the infant's behavioral state and use validated screening tools and growth charts. Comprehensive follow-ups, including screening for retinopathy of prematurity, thyroid disorders, developmental dysplasia of hip, and hearing impairments, are essential, with specialized therapies provided as needed. Structured follow-up guidelines are likely to improve the selection of high-risk infants, plan follow-up, and guide pediatricians on screening, evaluation, early stimulation, intervention, and plan-specific definitive therapies with rehabilitation therapists which would ultimately decrease the childhood disability.