Follow-up after high-risk birth and NICU discharge — OSCE

Objectives

1. Explain in plain language what a normal two-year Bayley score does and does not mean for a child born extremely preterm. [2] [9]
2. Explain why follow-up must continue through school age, citing the late-emerging cognitive and behavioural burden. [2] [9]
3. Reassure the family about the encouraging current findings while maintaining an honest, probabilistic frame about the future. [2]
4. Outline the corrected-age follow-up plan and the sensory surveillance, and invite the family into shared understanding. [1] [7] [11]

Candidate brief

12-minute station. The parents of a former 25-week, 650-gram infant are at the two-year corrected-age follow-up visit. The baby had respiratory distress syndrome but an otherwise uncomplicated neonatal course. Today's Bayley-III shows an average cognitive, language and motor profile, and the child is walking and talking. The parents are delighted and ask: "Does this mean she's out of the woods? Can we stop coming to the clinic? What should we watch for, and when do we come back?" They are engaged, hopeful and ready to move on. [2]

Expected actions

• Validate the parents' relief and celebrate the genuinely encouraging findings: their child is growing, moving and talking well at two years corrected. [2]
• Explain in plain language that the Bayley is a snapshot of today, not a guarantee of school-age thinking and behaviour, and that the largest challenge of being born very early — learning, attention and organisation of thinking — often shows up only at four to seven years, even when the early scores are average. [2] [9]
• Explain corrected age in plain terms: because she was born fifteen weeks early, we have been assessing her as a younger baby, and that continues to matter as she grows. [11]
• Outline the plan: a review at three to four years looking at language, behaviour and social development, and a cognitive and learning assessment at school age (four to six years), so that if any support is needed it is in place early rather than after a child has struggled. [1] [9]
• Confirm that retinopathy of prematurity follow-up is complete to vascular maturity and that hearing has been re-checked, because a single normal newborn hearing screen does not rule out later or progressive loss. [7]
• Offer honest, hopeful, probabilistic language and invite questions, rather than either over-reassuring or alarming the family. [2]

Examiner prompts

• "Does a normal Bayley mean she's caught up?" — Explain what the Bayley measures, its snapshot nature, and why school-age outcomes are the real test. [2] [9]
• "Can we stop coming?" — Explain why follow-up continues to school age and what each visit adds; frame it as light-touch reassurance, not a heavy burden. [1]
• "What should we watch for at home?" — Give concrete signs: language, attention, learning, vision and hearing, and when to bring her in early. [9]
• "What about her eyes and hearing?" — Confirm ROP follow-up to maturity and ongoing hearing surveillance. [7]

Marking foci

• Clear, plain-language explanation of what a normal two-year Bayley does and does not mean [2] [9]
• Honest framing of the school-age cognitive and behavioural burden without alarm [2] [9]
• Correct description of corrected age and its continued application [11]
• Accurate plan for continued follow-up and sensory surveillance, with family invited into shared understanding [1] [7]