 My name is Dr. Ravishankar Swamy. I'm a senior consultant, a neonatologist at Manipal Hospital, Whitefield. Babies who are admitted to NICU, especially the preterm babies, have some issues with their brain development. And the most common reason why these babies are followed up are because if they develop something called intraventricular hemorrhage. Preterm babies' brain until the age of 30-34 weeks have got some immature blood vessels and they bleed in the brain. And these are graded from grade 1 to grade 4. Similarly, some babies who sustain hypoxia or ischemia will develop something called as perimentricular leukomalacia. Term babies also develop a condition called as hypoxic ischemic encephalopathy. There are various conditions where the brain is injured and the whole idea of the Neurodorbent program is to identify those babies who have got some form of delayed development and which we can pick up these babies early and commence early intervention. The most common interventions what we do is the way we nurse these babies. So we try to mimic the inutero environment. So we keep the noise levels down, we keep the light levels down, we keep the babies prone, we keep them on their tummy and we nurse them in a nest with the flexed postures. So all these are helpful for the babies' development and it is called developmental supportive care. And as the babies are approaching 32-33 weeks, we start early intervention program. We put several cards which are black and white color so that the babies can focus on these cards. We stimulate their muscles so that they can help in sucking and swallowing. And these are all the interventions which we do in the newborn intensive care. This is completely led by our team which will include the speech and language therapist and the doctors from the physical rehabilitation team. Most babies are discharged around the age of 34-35 weeks once they develop about 1.4-1.5 kg. And this stays some more days in the postnatal mode and parents feel confident in managing these babies, they go home. Post discharge we ideally tend to see them immediately within a week. But for the neurodevelopment practical purposes we need to see them around 6 weeks, 3 months, 9 months, also 6 months, 9 months, 12, 18 and 24. During all these visits, apart from just taking the general history, we also look into their medications, we look into their growth and we look into their immunizations. Specifically looking for neurodevelopment, we will do something called as a daily screener test or a Denver development screener test, whichever is easier. And we screen these babies do look for if there is any milestones which the child is not achieving. These are early warning signs for us that there is some issues with the child and as a result the child needs formal assessment in the form of a full daily assessment. And if it comes as the child has some delays then we start early intervention program. Most babies we will be doing a screener test which is the Bailey screener test or the Denver development screener test. And apart from that we also do a neurological examination using the Hammersmith scoring of the infant neurological examination. Or sometimes people do also use amyltisum. These are the two important tests which we do. We also look at the newborn screening result, we look at the hearing test. We also do a Berard assessment for hearing at a later stage for preterm babies and an ophthalmological evaluation. And these are the common tests which we do as a part of the neurodevelopment screening program. So as I told the brain can sustain injuries during if the babies are born early or if there is a lack of oxygen or blood supply. Usually we classify the neurodevelopment problems into broadly into five regions. The first one is related to cognition. Cognition is your IQ equivalent to your IQ. So any children who have problems with their cognition will have learning disability. The second most common problem what children have is related to speech and language. So these children find it difficult to understand which is called as the receptive defect. And some children will have difficulty in talking that is expressive communication. So children who have receptive communication errors, children who have expressive communication errors. These are the children who will require further assessment and interventions in the form of speech and language therapy. The third most common problem we do see is related to their motor abilities. So the common term which is related here is called as cerebral palsy where children are unable to walk, unable to move certain parts of their limbs, unable to feed for themselves and so on. Some children also have problems with their fine motor abilities which is basically unable to coordinate their hand-eye coordination, unable to eat, feed themselves with a spoon or finger foods and unable to draw. So these are all the children who will have fine motor disabilities. So these are three main issues which we assess. The other two issues which are related to the neurodevelopment are related to their behaviors. One of the most common problem what we see is called as autism. And autism is the children, it's a pervasive disorder that has varied spectrum. So children who find it isolated speech delays, children who do not make eye contacts to various form where they are completely do their own world and they live in their own world to draw and mingle with others. So it's a varied spectrum and this needs further assessment by the psychologist. The other problem which we do see is the attention deficit hyperactive disorder is also behavioral disorders where children are usually inattentive in the classroom, do not do their homeworks and are usually quite disruptive even when they come to the clinic. And these children will need further assessment by psychologists and medications as per that. But these are the broad five headings where we look into neurodevelopmental program and we assess all these using a various form of test which I've told and we pick up these children so that early interventions are commenced. So it is no good just identifying the children who have developmental delay but why should we, we should also treat. The question people ask is that what is the benefit of treatment? Do you think if we treat then will the child get better? And the thing I always explain to parents is that every early intervention, every intervention we repeated interventions help for further neurons to develop in the brain. There's something called as the brain plasticity which usually the human brain is growing until the age of 2 years and sometime up to the age of 5 years, 90% of done by 2 years. So the more stimulation you give to these children, more neurons fire and as a result the brain plasticity you do see that where the damage was expected to be about 100%, we can help out with minimizing this damage and as a result we should aim for these children to lead an independent life. So the various form of treatment which is available in the hospital goes the way how I described in terms of the problems. For cognitive problems we usually have psychologists who will be able to look into autism, ADHD and difficulty in learning, helping with the school and so on. For motor problems we have a physiotherapist and an occupational therapist who will help with the various balancing exercises, developing the various muscles, increasing the core strength of the child using various forms of artefacts which can help for the child to lead an independent life. And the third important thing which I told is the speech and language therapist. So these therapists help in not only help in receptive communication but also expressive communication. Apart from that we also will have a social worker, we have special education needs, teachers, we also recommend the various special schools in and around Whitefield where we work with them and so that these children are given the special attention which they deserve. Thank you.