What are the recommended eye and ENT (Ears, Nose, and Throat) check-up schedules for a baby who has experienced birth asphyxia at discharge?

Eye and ENT Follow-Up for Birth Asphyxia at Discharge

Babies with birth asphyxia should receive comprehensive ophthalmologic examination before discharge or within the first week after discharge, with repeat evaluations every 3 months for the first 2 years of life, then every 6 months during the third year, and annually thereafter indefinitely. While the provided guidelines do not specifically address ENT screening for birth asphyxia, routine newborn hearing screening should be confirmed, and any concerns about neurological sequelae warrant ENT evaluation.

Ophthalmologic Follow-Up Schedule

The most rigorous follow-up protocols come from European cohorts managing infants with potential neurological injury, which provide a framework applicable to birth asphyxia cases:

Initial Assessment

• Ophthalmologic examination should be performed at birth or before discharge to establish baseline retinal and visual pathway status 1
• This initial examination is critical as neurological injury from hypoxic-ischemic encephalopathy can affect visual pathways 1

First Year of Life

• Monthly ophthalmologic follow-up is recommended for the first year in infants with documented moderate to severe hypoxic-ischemic encephalopathy 1
• This intensive monitoring allows early detection of cortical visual impairment, optic nerve abnormalities, or other sequelae of perinatal brain injury 1

Second Year of Life

• Ophthalmologic examinations every 2 months during the second year continue surveillance for delayed manifestations 1
• Visual problems may emerge as the child's visual system matures and developmental demands increase 1

Third Year and Beyond

• Every 3 months during the third year of life 1
• Every 3-6 months thereafter indefinitely 1
• This extended surveillance is justified because visual abnormalities can manifest years after the initial injury, with some cases detected after 8-10 years of age 1

ENT and Hearing Evaluation

Hearing Screening

• Confirm that newborn hearing screening was completed before discharge 2
• If not performed or if results are abnormal, arrange immediate audiology referral 2
• Birth asphyxia with hypoxic-ischemic encephalopathy is a risk factor for sensorineural hearing loss 1

Follow-Up Hearing Assessment

• Repeat hearing evaluation should be considered at 3-6 months if initial screening was abnormal or if there are concerns about auditory responsiveness 2
• Children with documented moderate to severe HIE warrant audiologic follow-up even with normal newborn screening, as delayed-onset hearing loss can occur 1

ENT Examination

• Routine ENT examination is not specifically mandated by guidelines for birth asphyxia alone unless there are specific concerns about:
  • Feeding difficulties suggesting cranial nerve dysfunction 3
  • Stridor or other airway abnormalities 3
  • Recurrent infections 2

Integration with Neurological Follow-Up

Comprehensive Developmental Surveillance

• All infants with birth asphyxia requiring resuscitation should have pediatric check-ups with neurologic development assessment every 3 months for at least the first year 1
• Visual and hearing function should be assessed as part of this comprehensive evaluation 1

Post-Hypothermia Protocol

• Infants who received therapeutic hypothermia for moderate to severe HIE require particularly close ophthalmologic and audiologic monitoring 1
• These infants are at highest risk for sensory impairments 1

Practical Discharge Instructions

For Parents/Caregivers

• Educate families to watch for signs of visual problems: lack of eye contact, failure to track objects, abnormal eye movements, or persistent light sensitivity 2
• Instruct on signs of hearing concerns: lack of startle to loud sounds, failure to turn toward voices, or delayed speech development 2
• Provide written schedule of follow-up appointments before discharge 2

For Primary Care Providers

• Ensure clear communication about the need for specialist referrals 2
• Document birth asphyxia severity and any HIE staging to guide follow-up intensity 1, 3
• Coordinate multidisciplinary care including neurology, ophthalmology, and audiology 1

Common Pitfalls to Avoid

• Do not assume normal newborn screening eliminates the need for ongoing surveillance - sensory deficits can emerge months to years after birth asphyxia 1
• Do not delay ophthalmologic referral until symptoms appear - early detection allows for intervention during critical periods of visual development 1
• Do not rely solely on parental report of visual or hearing function - formal testing is essential as subtle deficits may be missed 1, 2
• Do not discharge without confirmed follow-up appointments - loss to follow-up is a significant risk in this vulnerable population 2