ABSTRACT
AIM: To identify factors associated with compliance of scheduled outpatient developmental follow-up appointments in an effort to better ensure future care. METHODS: This retrospective observational cohort study looked at patients born between January 7(th) 2006 and June 30(th) 2007 and discharged from a regional neonatal intensive care unit (RNICU). Discharge summaries were reviewed to attain information regarding 16 patient descriptives and 12 patient morbidities. Data were recorded and analyzed utilizing the statistical software SPSS 11.5. RESULTS: Children of older mothers were more likely to attend follow-up (compliant: 30 years vs. non-compliant: 27 years). Factors which significantly improved compliance with follow-up care were patient contact after discharge (compliant: 65% vs. non-compliant: 35%) and early intervention referral (compliant: 64% vs. non-compliant: 36%). Factors which significantly hindered compliance were maternal drug use during pregnancy (compliant: 11.8% vs. non-compliant: 88%), and patient transfer to outside NICUs [(transferred out: compliant: 3 (10.3%), non-compliant 25 (89.3%)]. CONCLUSIONS: Several factors associated with compliance have been identified. Direct patient contact after discharge positively correlated with improved follow-up attendance. The severity of patient disease in the NICU did not impact follow-up rates. As a result close attention needs to be paid to factors which influence compliance with outpatient follow-up for developmental screening.
Subject(s)
Child Development , Continuity of Patient Care , Intensive Care Units, Neonatal , Patient Compliance , Adult , Appointments and Schedules , Cohort Studies , Female , Follow-Up Studies , Humans , Infant, Newborn , Infant, Premature , Maternal Age , New York , Patient Compliance/psychology , Patient Compliance/statistics & numerical data , Patient Discharge , Patient Transfer , Pregnancy , Pregnancy Complications , Professional-Patient Relations , Referral and Consultation , Retrospective Studies , Substance-Related Disorders/complications , Young AdultABSTRACT
OBJECTIVE: To determine the requirement for therapeutic services of late-preterm infants (34 to 36 weeks' gestation) and morbidities associated with their developmental delays compared with their very preterm (<32 weeks' gestation) counterparts. METHODS: We used a retrospective cohort study of former preterm children admitted to the neonatal unit who were evaluated at the Regional Neonatal Follow-up Program of Westchester Medical Center in New York at 12 +/- 2 months' corrected age from January 2005 through October 2006. Logistic regression was used to compare odds ratios between late-preterm and very preterm children who qualified for early intervention services. Antenatal, demographic, and neonatal factors were compared between subgroups. RESULTS: Of the 497 preterm infants evaluated at the Regional Neonatal Follow-up Program, 127 met inclusion criteria (77 very preterm and 50 late-preterm infants). Of the late-preterm infants, 30% qualified for and received early intervention services, 28% physical therapy, 16% occupational therapy, 10% speech therapy, and 6% special education. In the very preterm subgroup, 70% qualified for and received early intervention services, 66% physical therapy, 32% occupational therapy, 32% speech therapy, and 21% special education. Very preterm children were more likely to be enrolled in therapies than their late-preterm counterparts. However, when adjusting for neonatal comorbidities of prematurity, there was no difference in enrollment in early intervention services between the very preterm and late-preterm infants. CONCLUSIONS: After controlling for comorbidities of prematurity, we found that late-preterm infants requiring admission to the neonatal unit have the same risk as very preterm infants of requiring interventional therapies. This would indicate that it is not only the degree of prematurity but also the morbidities experienced in the neonatal period in conjunction with the period of rapid brain growth that have a profound influence on neurodevelopmental outcomes. This should be considered when planning their hospital discharge and follow-up.
Subject(s)
Developmental Disabilities/rehabilitation , Infant, Premature, Diseases/rehabilitation , Infant, Very Low Birth Weight , Cohort Studies , Comorbidity , Developmental Disabilities/epidemiology , Early Intervention, Educational , Education, Special/statistics & numerical data , Female , Gestational Age , Health Services Needs and Demand/statistics & numerical data , Humans , Infant , Infant, Newborn , Infant, Premature, Diseases/epidemiology , Male , New York , Occupational Therapy/statistics & numerical data , Physical Therapy Modalities/statistics & numerical data , Retrospective Studies , Speech Therapy/statistics & numerical dataABSTRACT
AIMS: To identify associations between reactive airway disease (RAD), eczema, and gastroesophageal reflux (GERD) and antenatal/neonatal variables. METHODS: This is a retrospective observational cohort analysis of former preterm (PT) infants evaluated at the Regional Neonatal Follow-up Program in the Lower Hudson Valley Region of New York. Subjects <2 years evaluated between January 2005 and December 2007 were included. Patient demographics, antenatal factors and co-morbidities of prematurity were correlated with each medical condition. RESULTS: A total of 727 subjects were analyzed: 12.8% had RAD, 10.5% had eczema; and 26.7% had GERD. RAD and GERD correlated inversely with gestational age. RAD was more prevalent in singletons and African Americans; GERD in Caucasians; and eczema in singletons and males. Respiratory disease in the newborn period increased the incidence of RAD and GERD. Toddlers who had RAD were likely to have eczema or GERD; no association between GERD and eczema existed. CONCLUSIONS: These three medical conditions were strongly associated. Their association may be the result of a common element developing each condition, or due to one condition exacerbating another. Respiratory problems in the newborn were strong predictors of GERD and RAD.
