General University Hospital in Prague

www.vfn.cz

In April 2011, within the Paediatrics and Adolescent Medicine Clinic (hereinafter “PAMC”) of GUH Prague, a Centre of Comprehensive Care (hereinafter “CCC”) for children with perinatal burden was opened. Children with perinatal burden represent a large group of children with serious difficulties in the period around their birth. The largest part consists of children born prematurely, whose number is growing and in recent years it represents about 8.3% of all newborns. This is about 8,500 children needing specific approach during their development. Worldwide the number of premature infants grows depending on various factors. The number of premature infants released from Perinatal Centres (hereinafter “PC”) is steadily increasing thanks to new approaches in intensive care. In connection with it, the long-term morbidity of these children also changes during the time and the children grow into school age. This also implies the need for the introduction of further age-linked diagnostic and therapeutic procedures. This highly vulnerable population is burdened with relatively severe long-term morbidity and a number of dysfunctions. They can manifest themselves in a number of areas. Above all, they are reflected in behavioral, cognitive and emotional areas. Thus, they adversely affect not only the development of the children themselves, but may have impact on the whole family. Therefore, the objective is the earliest possible diagnosis of deviations in the development and an early therapeutic intervention. Since the opening of the CCC three years ago more than 900 new patients have gone through it. According to our experience, the current situation of a continuous increase in new patients with a gradual increase of the age of monitored children necessarily requires the expansion of still used diagnostic and therapeutic methods in the areas such as: 1. Psychology- Psychiatry - screening for early neurodevelopment deviations and the cognitive rehabilitation, 2. Auxology - creating growth charts to monitor anthropometric data of premature infants, 3. Pneumology – tracking the dynamics of lung function tests up to the early school-age, 4. Rehabilitation - new diagnostic and therapeutic methods in the rehabilitation of premature infants. The project professional activities will provide these outputs: 1. Psychology-psychiatry - the introduction of the reference psychiatric and neuropsychological examination methodology in premature infants. The introduction of cognitive rehabilitation aimed at improving working memory. The cognitive training reduces the risk of school failure and allows the children to use their right to education. An integral part of these activities is also the long-term counselling for their families. 2. Auxology – the premature infants have a different growth rate up to 2 years of age. This must be taken into account when monitoring their growth and well-being. The anthropometric data of these children must always refer to the corrected growth charts. The hitherto used corrected charts have been based on foreign population. Therefore, one of the project objectives is to create growth charts based on Czech population. The necessary anthropometric data will be obtained from cards of dispensary premature infants in the PAMC over the past 15 years. It also includes the creation of original software for computer assessment of the growth and nutritional condition in the neonatal and paediatric practice. The utilization of the output will cover not only the CCC, but all PCs and High-Risk Newborn Aftercare Counselling Centres in the Czech Republic. 3. Pneumology - early detection of deviations in lung function and abnormal development of the respiratory system of children with perinatal burden through expansion of medical instrumentation. Timely adjustments of medication and indication for respiratory rehabilitation in premature infants based on individual needs. 4. Rehabilitation - timely detection of deviations of neuromotor development of premature infants after discharge from the PC. Early initiation of adequate physiotherapy and ergotherapy including the stimulation of communication expressions. Linking the comprehensive rehabilitation with needs that emerged from the examination of lungs and the psychological-psychiatric examination. All activities will be provided by the applicant, respectively by members of the implementation team. The project will contribute to the prevention of disease consequences by improving the quality of diagnostic and therapeutic care for premature infants not only within the CCC, but also across the entire Czech Republic.

Approximately 187 727 EUR