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1.
J Perinatol ; 40(5): 790-797, 2020 05.
Article in English | MEDLINE | ID: mdl-32203182

ABSTRACT

OBJECTIVE: Neonatal neurodevelopmental follow-up clinic provides continued surveillance and assessment of high-risk premature infants. We hypothesized that attrition is associated with race and social factors. STUDY DESIGN: We performed a retrospective cohort study of neonates born at 26-32 weeks gestation who were admitted to a level IV neonatal intensive care unit. Maternal and neonatal characteristics and follow-up attendance were collected. Statistical analysis was performed with significance set at p value < 0.05. RESULTS: In total, 237 neonates met study criteria. There was a 62% loss to follow-up over 2 years. Factors associated with loss to follow-up included older gestational age, African American race, and maternal cigarette smoking. Protective factors included older maternal age, a neonatal diagnosis of bronchopulmonary dysplasia, and longer hospital length of stay. CONCLUSIONS: Social disparities negatively impact neonatal follow-up clinic attendance. Efforts to identify and target high-risk populations must be started during initial hospitalization before infants are lost to follow-up.


Subject(s)
Intensive Care Units, Neonatal , Patient Discharge , Female , Follow-Up Studies , Gestational Age , Humans , Infant , Infant, Newborn , Infant, Premature , Retrospective Studies
2.
Clin Perinatol ; 47(1): 105-121, 2020 03.
Article in English | MEDLINE | ID: mdl-32000919

ABSTRACT

Nonimmune hydrops fetalis (NIHF) historically has been considered a lethal fetal condition. Understanding NIHF to be a symptom or an end-stage status of a variety of fetal conditions, along with improved fetal diagnostics and interventions, has changed the landscape for at least some fetuses. Understanding the pathophysiologic mechanisms has led to the development of diagnostic algorithms, improved understanding of cause, and therefore fetal or neonatal treatments. Multidisciplinary counseling and shared decision making are critical to supporting families through pregnancy decisions, potential fetal therapeutic interventions, neonatal management decisions, and at times accepting or transitioning to palliative care.


Subject(s)
Hydrops Fetalis/diagnosis , Hydrops Fetalis/therapy , Rare Diseases/diagnosis , Rare Diseases/therapy , Counseling , Decision Making , Diagnosis, Differential , Female , Humans , Hydrops Fetalis/mortality , Hydrops Fetalis/physiopathology , Infant, Newborn , Pregnancy , Prenatal Diagnosis , Prognosis , Rare Diseases/mortality , Rare Diseases/physiopathology
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