Clinical Outcomes of High‑Risk Infant Follow‑Up Program in a Tertiary Care Centre

Kayvan Mirnia, Forouzan Akrami, Behzad Jodeiry, Mohammad Heidarzadeh, Sima Safavinia


Background: High‑risk infant follow‑up (HRIF) program is necessary for early detection, timely intervention, and promotion of health outcomes in vulnerable infants, ethically. The present study was carried out to assess the clinical outcomes of the HRIF Program in Alzahra hospital as a tertiary care centre, in Iran.

Materials and Methods: In this cohort study, 5840 neonates were born at Alzahra hospital, from June 1, 2011 to 30th February 2012. Among those who were admitted to neonatal intensive care unit (NICU), 253 infants were recruited by census according to HRIs criteria. After doing necessary measurements and family education, information was recorded in HRI health certificate and then entered in the access database for analysis.

 Results: From 253 eligible HRIs registered, 241 (95%) infants attended the follow‑up clinic after discharge. A total of180 cases were recalled for further visits, 110 of which attended the clinic. Anthropometric indices had an increasing trend in the first 6 months of life. There was no significant relation between ages and stages questionnaire (ASQ) results and infant birth weight, height, and head circumference. The ratios of intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP) were 8.7% and 3.1%, respectively. The incidence of congenital hypothyroidism was 2:341 in HRIs.

Conclusions: Although some outcomes, such as ROP, improved in our study compared to similar studies, the findings indicate an impairment of the current follow‑up processes and highlight the necessity to modify the current HRIF program. Ethically, we insist on integrating HRIF program in child health services to promote early childhood development.


Ethics; follow up; infant development; Iran; high risk; tertiary care center

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You D, Hug L, Ejdemyr S, Idele P, Hogan D, Mathers C, et al. Global, regional, and national levels and trends in under 5 mortality between 1990 and 2015, with scenario based projections to 2030: A systematic analysis by the UN Inter agency Group for Child Mortality Estimation. Lancet 2015;386:2275 86.

Purdy IB, Melwak MA. Who Is at Risk? High Risk Infant Follow up. Newborn Infant Nurs Rev 2012;12:221 6.

Damari B, Akrami F. Analysis of Early Childhood Development Policy; Necessity of a Play oriented Approach. J Mazandaran Univ Med Sci 2016;26:205 6.

Marmot M, Friel S, Bell R, Houweling TA, Taylor S. Closing the gap in a generation: Health equity through action on the social determinants of health. Lancet 2008;8:1661 9.

Poon WB, Ho SK, Yeo CL. Short and long term outcomes at 2, 5, and 8 years old for neonates at borderline viability An 11 year experience. Ann Acad Med Singapore 2013;42:7 17.

Hagan JF, Duncan PM. Maximizing Children’s Health: Screening, Anticipatory Guidance, and Counseling. In: Kliegman RM, et al., editors. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders; 2011. p. 13 7.

Heidarzadeh M, Jodeiry B, Mirnia K, Akrami F, Hoseini MB, Heidarabadi S, et al. Creating the Action Model for High Risk Infant Follow Up Program in Iran. Iran J Public Health 2013;42:1309 15.

Jodeiry B, Heidarzadeh M, Mirnia K, Akrami F, Heidarabadi S, Ebadi A. Innovation of high risk infants follow up surveillance system in Iran. Int J Prev Med 2015;6:35.

Soleimani F, Vameghi R, Dadkhah A. High risk infants referred to health care centers in North and East of Tehran and risk factors of motor developmental delay. Hakim Res J 2009;12:11 8.

Goyen TA, Lui K. Longitudinal motor development of “apparently normal” high risk infants at 18 months, 3 and 5 years. Early Hum Dev 2002;7:103 15.

Eskandari M, Abbaszadeh A, Borhani F. The outcomes of health care process in Iran’s rural society. Iran J Nursing Midwifery Res 2013;18:384 90.

Heidarzadeh M, Jodeiry B, Hosseini MB, Mirnia K, Akrami F, Habbibollahi A, et al. High Risk Infants Follow Up: A Case Study in Iran. Int J Pediatr 2015;2015:817540.

Glasson EJ, Bower C, Petterson B, de Klerk N, Chaney G, Hallmayer JF. Perinatal factors and development of autism. Arch Gen Psychiatry 2007;61:618 27.

Amir Ali Akbari S, Montazeri S, Torabi F, Amiri S, Soleimani F, Alavi Majd H. Correlation between anthropometric indices at birth and developmental delay in children aged 4–60 months in Isfahan, Iran. Int J Gen Med 2012;5:683 7.

El Atawi K, Elhalik M, Kulkarni T, Abdelsamed A, Alexander L,Satyan A. Risk Factors, Diagnosis, and Current Practices in the Management of Intraventricular Hemorrhage in Preterm Infants: A Review. Acad J Ped Neonatol 2016;1:555 61.

Klebermass Schrehof K, Czaba C, Olischar M, Fuiko R, Waldhoer T, et al. Impact of low grade intraventricular hemorrhage on longterm neuro developmental outcome in preterm infants. Childs Nerv Syst 2012;28:2085 92.

Jodeiry B, Heidarzadeh M, Sahmani Asl S, Hoseini M, Javaherizadeh H, Eliasi S, et al. Study of intraventricular hemorrhage in VLBW neonates admitted in Al Zahra Hospital, Tabriz, Iran. Niger J Med 2012;21:92 7.

Batool S, Shaheen A, Naeem M, Jabeen R, Ahsan Raza SM. To Study the Prevalence of Intra ventricular Hemorrhage in Preterm Infants. Pak J Med Sci 2011;5.

Fayyazi A, Heidarzadeh M, Fayzalahzadeh H, Golzar A, Sadegi K. Prevalence of Retinopathy of Prematurity in Preterm Infant Hospitalized in Tabriz Alzahra Hospital’s NICU. Tabriz Univ Sci J 2009;30:63 6.

Bayat Mokhtari M, Pishva N, Attarzadeh A, Hosseini H, Pourarian S. Incidence and risk factors of Retinopathy of prematurity among preterm infants in Shiraz/Iran. Iran J Pediatr 2010;20:303 7.

Babaei H, Ansari MR, Alipour AA, Ahmadipour S, Safari Faramani R, Vakili J. Incidence and Risk Factors for Retinopathy of Prematurity in Very Low Birth Weight Infants in Kermanshah, Iran. World Appl Sci J 2012;18:600 4.

Feghhi M, Altayeb S, Haghi F, Kasiri A, Farahi F, Dehdashtyan M, et al. Incidence of retinopathy of prematurity and risk factors in the South Western region of Iran. Middle East Afr J Ophthalmol 2012;19:101 6.

Akçakaya AA, Yaylali SA, Erbil HH, Sadigov F, Aybar A, Aydin N, et al. Screening for retinopathy of prematurity in a tertiary hospital in istanbul: Incidence and risk factors. J Pediatr Ophthalmol Strabismus 2012;49:21 5.

Zin A, Gole GA. Retinopathy of prematurity incidence today. Clin Perinatol 2013;40:185 200.

Baf MM, Baf MM, Noorollahi F, Baf MM, Bandarian F, Sara Y. Neonatal Screening for congenital hypothyroidism in Razavi Khorasan Province, Iran. J Clin Res Pediatr Endocrinol 2016;8:1308 5735.

Dilli D, Özbaş S, Acıcan D, Yamak N, Ertek M, Dilmen U. Establishment and development of a national newborn screening programme for congenital hypothyroidism in Turkey. J Clin Res Pediatr Endocrinol 2013;5:73 9.


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