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Community supports after surviving extremely low-birth-weight, extremely preterm birth: special outpatient services in early childhood.

TitleCommunity supports after surviving extremely low-birth-weight, extremely preterm birth: special outpatient services in early childhood.
Publication TypeJournal Article
Year of Publication2008
AuthorsHintz SR, Kendrick DE, Vohr BR, W Poole K, Higgins RD
Corporate AuthorsNational Institute of Child Health and Human Development(NICHD) Neonatal Research Network
JournalArch Pediatr Adolesc Med
Volume162
Issue8
Pagination748-55
Date Published2008 Aug
ISSN1538-3628
KeywordsAmbulatory Care, Child, Child Health Services, Child, Preschool, Community Health Services, Confidence Intervals, Continuity of Patient Care, Developmental Disabilities, Disability Evaluation, Female, Humans, Infant, Infant, Extremely Low Birth Weight, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases, Intensive Care Units, Neonatal, Logistic Models, Male, Multivariate Analysis, Needs Assessment, Odds Ratio, Quality of Health Care, Retrospective Studies, Risk Assessment, Survivors, United States
Abstract

OBJECTIVE: To determine special outpatient services (SOS) use, need, associated factors, and neurodevelopmental and functional outcomes among extremely preterm infants at 18 to 22 months' corrected age.

DESIGN: Retrospective analysis.

SETTING: National Institute of Child Health and Human Development (NICHD) Neonatal Research Network.

PARTICIPANTS: Infants younger than 28 weeks' gestational age who had been born weighing less than 1000 g at an NICHD Neonatal Research Network center from January 1, 1997, to December 31, 2000, and who were receiving follow-up at 18 to 22 months' corrected age.

INTERVENTIONS: Questionnaires were administered at the 18- to 22-month follow-up visit regarding SOS use since hospital discharge and the current need for SOS (social work, visiting nurse, medical specialty, early intervention, speech and language services, occupational therapy and physical therapy, and neurodevelopmental and behavioral services).

MAIN OUTCOME MEASURES: The use of and need for SOS were analyzed by gestational age. Logistic regression analysis identified factors independently associated with the use of more than 5 services and with the need for any services.

RESULTS: Of 2315 infants, 54.7% used more than 3 SOS by 18 to 22 months, and 19.1% used 6 to 7 SOS. The need for any SOS was reported by approximately 37%. The following variables that were commonly associated with adverse neurodevelopmental outcomes were also associated with the use of more than 5 SOS: sepsis, birth weight, postnatal corticosteroid use, bronchopulmonary dysplasia, and cystic periventricular leukomalacia or grade 3 or 4 intraventricular hemorrhage. Male sex was associated with the need for any SOS. Although high SOS use was more likely among children with adverse neurodevelopmental outcomes, a reported need for SOS was common even among those with mild developmental impairment (39.7%) and mild cerebral palsy (42.2%).

CONCLUSIONS: High SOS use is common, has identifiable neonatal risk factors, and is associated with neurodevelopmental impairment. Extremely preterm survivors have substantial need for community supports regardless of their impairment level. Efforts to improve comprehensive delivery of family-centered community-based services are urgently needed.

DOI10.1001/archpedi.162.8.748
Alternate JournalArch Pediatr Adolesc Med
PubMed ID18678807
PubMed Central IDPMC2748992
Grant ListU10 HD027880-16 / HD / NICHD NIH HHS / United States
U10 HD27851 / HD / NICHD NIH HHS / United States
U10 HD027856 / HD / NICHD NIH HHS / United States
U10 HD40689 / HD / NICHD NIH HHS / United States
U10 HD021373 / HD / NICHD NIH HHS / United States
M01 RR00039 / RR / NCRR NIH HHS / United States
U10 HD021385 / HD / NICHD NIH HHS / United States
M01 RR00997 / RR / NCRR NIH HHS / United States
U10 HD 21373 / HD / NICHD NIH HHS / United States
M01 RR00044 / RR / NCRR NIH HHS / United States
U01 HD036790 / HD / NICHD NIH HHS / United States
U10 HD34216 / HD / NICHD NIH HHS / United States
M01 RR00125 / RR / NCRR NIH HHS / United States
U10 HD027880 / HD / NICHD NIH HHS / United States
U10 HD040521 / HD / NICHD NIH HHS / United States
M01 RR000039 / RR / NCRR NIH HHS / United States
U10 HD40521 / HD / NICHD NIH HHS / United States
U10 HD27880 / HD / NICHD NIH HHS / United States
M01 RR008084 / RR / NCRR NIH HHS / United States
U10 HD27904 / HD / NICHD NIH HHS / United States
U10 HD040461 / HD / NICHD NIH HHS / United States
U10 HD40498 / HD / NICHD NIH HHS / United States
U10 HD27871 / HD / NICHD NIH HHS / United States
M01 RR000044 / RR / NCRR NIH HHS / United States
M01 RR000750 / RR / NCRR NIH HHS / United States
U10 HD040689 / HD / NICHD NIH HHS / United States
M01 RR00750 / RR / NCRR NIH HHS / United States
U10 HD027853 / HD / NICHD NIH HHS / United States
U10 HD027904 / HD / NICHD NIH HHS / United States
U10 HD27856 / HD / NICHD NIH HHS / United States
M01 RR08084 / RR / NCRR NIH HHS / United States
U10 HD40461 / HD / NICHD NIH HHS / United States
U10 HD27853 / HD / NICHD NIH HHS / United States
UL1 TR000454 / TR / NCATS NIH HHS / United States
U10 HD027871 / HD / NICHD NIH HHS / United States
U10 HD027851 / HD / NICHD NIH HHS / United States
U01 HD36790 / HD / NICHD NIH HHS / United States
M01 RR000997 / RR / NCRR NIH HHS / United States
U10 HD21415 / HD / NICHD NIH HHS / United States
M01 RR000070 / RR / NCRR NIH HHS / United States
M01 RR0039-43 / RR / NCRR NIH HHS / United States
U10 HD21385 / HD / NICHD NIH HHS / United States
U10 HD034216 / HD / NICHD NIH HHS / United States
U10 HD040498 / HD / NICHD NIH HHS / United States
M01 RR00070 / RR / NCRR NIH HHS / United States
U10 HD27881 / HD / NICHD NIH HHS / United States
M01 RR000125 / RR / NCRR NIH HHS / United States