Indian J Pediatr 1992; 59 : 675-680
Early Intervention Programme Through The High Risk Clinic-Pune Experience Anand Pandit, Sudha Chaudhari, Sheila Bhave and Sujata Kulkarni
Division of Neonatology, Department of Pediatrics, K.E.M. Hospital Pune The K.E.M. Hospital, Pune, committed itself to the care of handicapped children in 1979, with the inception of the TDH Rehabilitation Centre. Over the years, tile Centre has grown into a major multidisciplinary unit providing diagnostic and therapeutic services to all handicaps, under one roof. Approximately 2000 new patients are now assessed annually. While investigating the causes of handicaps, it was soon realised that a large number of them arise from problems in the perinatal period. In an effort to improve the perinatal care and outcome, tile neonatal services were upgraded in 1982 with the establishment of a Neonatal Intensive Care Unit (NICU), which now caters to about 900 admissions per year. Though the resultant increase in survival of the small, preterm and high risk infant was heartening, tile eventual outcome remains a cause of great concern. With a view to monitor their outcome, as also to provide an extension of neonatal services, a High Risk Clinic (HRC) was started in 1987. The following discussion is based primarily on intervention programmes conceived and developed through High Risk Clinics with the back up services of file Rehabilitation Centre and NICU of the K.E.M. Hospital, Pune. Reprint requests : Dr. Anand Pandit, Director, Department of Pediatrics, K.E.M. Hospital, Rasta Peth, Pune-411 011.
What Exactly is Early Intervention? Early intervention consists of identifying a baby who already has a handicapping condition or is at a potential risk for developing one, and then providing services to lessen the effects of that condition. The term encompasses a range of stimulation and training activities over and above the minimal care traditionally provided for all babies. 1 But Can Intervention be Really Effective? The amazingly improved intellectual performance of an orphan, adopted into a stimulating home is a well known example of environmental intervention at its best. Right upto the 80's, it was felt that this did not hold true for a child with brain damage, as neurons are "not regenerable". However, recent animal studies in neurophysiology have shown that synapses if not neurons are regenerable. The concept of synapse sculpturing indicates that neurotransmission can be improved by selectively stabilizing one type of impulse at the expense of otimrs? Both these processes are enhanced by training) This modifiability of the brain at the molecular level, forms tile basis of early intervention in high risk infants. Who Needs Intervention? Ideally all graduates of NICU's are candi-
676
THE INDIAN JOURNAL OF PEDIATRICS
dates for early intervention programme. Approximately 600 babies are discharged from 8m NICU, at tile K.E.M. Itospital, Pune, '.:ach year and are followed regularly at the High Risk Clinic (ttRC). A cohort of 404 babies (birth dates October 87 to April 89) however, have been selected for special studies and their diagnoses at discharge are given in Table t .Tim different types of interventions have been classified in Table 2.
Vol. 59, No. 6
TABLE1. Diagnoses (at discharge) of a Cohort of 404 NICU Graduates (1987-89) Followed up at High Risk Clinic at K.E.M. ttospital, Pune Diagnosis Prem aturity VLBW(
Early Intervention Programme Through The High Risk Clinic-Pune Experience Anand Pandit, Sudha Chaudhari, Sheila Bhave and Sujata Kulkarni
Division of Neonatology, Department of Pediatrics, K.E.M. Hospital Pune The K.E.M. Hospital, Pune, committed itself to the care of handicapped children in 1979, with the inception of the TDH Rehabilitation Centre. Over the years, tile Centre has grown into a major multidisciplinary unit providing diagnostic and therapeutic services to all handicaps, under one roof. Approximately 2000 new patients are now assessed annually. While investigating the causes of handicaps, it was soon realised that a large number of them arise from problems in the perinatal period. In an effort to improve the perinatal care and outcome, tile neonatal services were upgraded in 1982 with the establishment of a Neonatal Intensive Care Unit (NICU), which now caters to about 900 admissions per year. Though the resultant increase in survival of the small, preterm and high risk infant was heartening, tile eventual outcome remains a cause of great concern. With a view to monitor their outcome, as also to provide an extension of neonatal services, a High Risk Clinic (HRC) was started in 1987. The following discussion is based primarily on intervention programmes conceived and developed through High Risk Clinics with the back up services of file Rehabilitation Centre and NICU of the K.E.M. Hospital, Pune. Reprint requests : Dr. Anand Pandit, Director, Department of Pediatrics, K.E.M. Hospital, Rasta Peth, Pune-411 011.
What Exactly is Early Intervention? Early intervention consists of identifying a baby who already has a handicapping condition or is at a potential risk for developing one, and then providing services to lessen the effects of that condition. The term encompasses a range of stimulation and training activities over and above the minimal care traditionally provided for all babies. 1 But Can Intervention be Really Effective? The amazingly improved intellectual performance of an orphan, adopted into a stimulating home is a well known example of environmental intervention at its best. Right upto the 80's, it was felt that this did not hold true for a child with brain damage, as neurons are "not regenerable". However, recent animal studies in neurophysiology have shown that synapses if not neurons are regenerable. The concept of synapse sculpturing indicates that neurotransmission can be improved by selectively stabilizing one type of impulse at the expense of otimrs? Both these processes are enhanced by training) This modifiability of the brain at the molecular level, forms tile basis of early intervention in high risk infants. Who Needs Intervention? Ideally all graduates of NICU's are candi-
676
THE INDIAN JOURNAL OF PEDIATRICS
dates for early intervention programme. Approximately 600 babies are discharged from 8m NICU, at tile K.E.M. Itospital, Pune, '.:ach year and are followed regularly at the High Risk Clinic (ttRC). A cohort of 404 babies (birth dates October 87 to April 89) however, have been selected for special studies and their diagnoses at discharge are given in Table t .Tim different types of interventions have been classified in Table 2.
Vol. 59, No. 6
TABLE1. Diagnoses (at discharge) of a Cohort of 404 NICU Graduates (1987-89) Followed up at High Risk Clinic at K.E.M. ttospital, Pune Diagnosis Prem aturity VLBW(
