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King TL, Cristea AI, Slaven JE, Niehaus JZ. Risk Factors for Foster Care Placement in Patients with Bronchopulmonary Dysplasia. Am J Perinatol 2024; 41:764-770. [PMID: 35436799 DOI: 10.1055/s-0042-1744509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Bronchopulmonary dysplasia (BPD) is a major cause of morbidity in neonates and can be associated with long hospitalization and high health care utilization. This extremely stressful situation can be difficult for many families and caregivers. The high-risk situation combined with increased medical complexity can result in involvement of Department of Child Services (DCS) and even foster care placement. This study seeks to define risk factors for DCS involvement and foster care placement in children with BPD. STUDY DESIGN A retrospective study of children born at less than 32 weeks of gestation born between 2010 and 2016, on oxygen at 28 days of life and discharged home from a tertiary care center. RESULTS A total of 246 patients were identified. DCS was involved in 49 patients with 13 requiring foster care placement. The most common correlated risk factors that were identified for DCS involvement were maternal THC (tetrahydrocannabinol) positivity, hospital policy violations, maternal mental health diagnosis, and home insecurity. Home insecurity (p < 0.005) and amphetamine use (p < 0.005) were associated with foster care placement. CONCLUSION There are numerous risk factors for both DCS and foster care placement. The identification of these risk factors is important to help establish services to help families and identify potential biases to avoid. KEY POINTS · There were both substance-related and non-substance-related risk factors for DCS involvement.. · Home insecurity and maternal amphetamine use were risk factors associated with foster care placement.. · This study fills the knowledge gap of risk factors for DCS and foster care placement in BPD..
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Affiliation(s)
- Tyler L King
- Division of Newborn Medicine, Washington University School of Medicine in St. Louis, St Louis, Missouri
| | - A Ioana Cristea
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jason Z Niehaus
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Kilbride HW, Vohr BR, McGowan EM, Peralta-Carcelen M, Stringer K, Das A, Archer SW, Hintz SR. Early neurodevelopmental follow-up in the NICHD neonatal research network: Advancing neonatal care and outcomes, opportunities for the future. Semin Perinatol 2022; 46:151642. [PMID: 35842320 PMCID: PMC11068160 DOI: 10.1016/j.semperi.2022.151642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
At the inception of the Eunice Kennedy Shriver National Institute of Child Health and Development Neonatal Research Network (NRN), provision of care for extremely preterm (EPT) infants was considered experimental. The NRN Follow-up Study Group, initiated in 1993, developed infrastructure with certification processes and standards, allowing the NRN to assess 2-year outcomes for EPT and to provide important metrics for randomized clinical trials. This chapter will review the NRN Follow-up Study Group's contributions to understanding factors related to improved neurodevelopmental, behavioral, and social-emotional outcomes of EPT infants. We will also discuss follow up challenges, including reassessing which outcomes are most meaningful for parents and investigators. Finally, we will explore how outcome studies have informed clinical decisions and ethical considerations, given limitations of prediction of complex later childhood outcomes from early neurodevelopmental findings.
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Affiliation(s)
- Howard W Kilbride
- Department of Pediatrics, Children's Mercy-Kansas City and the University of Missouri-Kansas City, 2401 Gillham Road, 3rd Floor Annex, Kansas City, MO.
| | - Betty R Vohr
- Department of Pediatrics, Women and Infants Hospital of Rhode Island and Brown University, Providence, RI
| | - Elisabeth M McGowan
- Department of Pediatrics, Women and Infants Hospital of Rhode Island and Brown University, Providence, RI
| | | | - Kimberlly Stringer
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL
| | - Abhik Das
- Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, MD
| | - Stephanie Wilson Archer
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Susan R Hintz
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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3
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Adams WA, Malcolm W, Goldstein R, Lemmon ME, Mago-Shah D, Cotten M, Peterson J, Fisher K, Younge N. Longitudinal medical needs for periviable NICU survivors. Early Hum Dev 2022; 169:105580. [PMID: 35569179 PMCID: PMC9627457 DOI: 10.1016/j.earlhumdev.2022.105580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the technologies required, medications needed, and early intervention services utilized from discharge to 12 months post-discharge for periviable infants (22 0/7 to 24 6/7 weeks gestational age) followed in a comprehensive NICU follow-up clinic. STUDY DESIGN Information regarding medication use, technology requirement, and early intervention services was collected prospectively at one, six, and twelve months after discharge. Neurodevelopmental assessment was completed at 12 months corrected age. RESULT 69 periviable infants were actively treated and survived to discharge during the study period. 54 infants were enrolled and followed in the comprehensive NICU follow-up clinic. Use of technology and prescribed medications decreased with a 46% reduction of infants requiring ≥1 technology device (74.1% vs. 40.4%, p < 0.01) and 64% reduction in infants requiring ≥1 medication (88.9% vs 31.9%, p < 0.01) 12 months post discharge. There was an increase in early intervention services with 83% of infants receiving services by 12 months post discharge. CONCLUSION Technology and medication requirements were high at discharge but notably decreased in the first year after discharge concurrent with increased enrollment in early interventional services. Many periviable infants survive without severe short-term developmental delays.
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Affiliation(s)
- W. Aaron Adams
- Duke University School of Medicine, Department of Pediatrics, Division of Neonatology, 2400 Pratt Street, 8 Floor, Durham, NC 27705, United States of America,Corresponding author. (W.A. Adams)
| | - William Malcolm
- Duke University School of Medicine, Department of Pediatrics, Division of Neonatology, 2400 Pratt Street, 8 Floor, Durham, NC 27705, United States of America
| | - Ricki Goldstein
- University of Kentucky, School of Medicine, Department of Pediatrics, Division of Neonatology, 1000 South Limestone, Lexington, KY 40536, United States of America
| | - Monica E. Lemmon
- Duke University School of Medicine, Department of Pediatrics, Division of Neurology and Neurodevelopmental Medicine, Department of Population Health Sciences, T0913 Children's Health Center, DUMC Box 3936, Durham, NC 27710, United States of America
| | - Deesha Mago-Shah
- Duke University School of Medicine, Department of Pediatrics, Division of Neonatology, 2400 Pratt Street, 8 Floor, Durham, NC 27705, United States of America
| | - Michael Cotten
- Duke University School of Medicine, Department of Pediatrics, Division of Neonatology, 2400 Pratt Street, 8 Floor, Durham, NC 27705, United States of America
| | - Jennifer Peterson
- Duke University School of Medicine, Department of Pediatrics, Division of Neonatology, 2400 Pratt Street, 8 Floor, Durham, NC 27705, United States of America
| | - Kimberley Fisher
- Duke University School of Medicine, Department of Pediatrics, Division of Neonatology, 2400 Pratt Street, 8 Floor, Durham, NC 27705, United States of America
| | - Noelle Younge
- Duke University School of Medicine, Department of Pediatrics, Division of Neonatology, 2400 Pratt Street, 8 Floor, Durham, NC 27705, United States of America
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McKenzie K, Lynch E, Msall ME. Scaffolding Parenting and Health Development for Preterm Flourishing Across the Life Course. Pediatrics 2022; 149:186921. [PMID: 35503323 PMCID: PMC9847416 DOI: 10.1542/peds.2021-053509k] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 01/21/2023] Open
Abstract
Advances in obstetrics and neonatal medicine have resulted in improved survival rates for preterm infants. Remarkably, >75% extremely (<28 weeks) preterm infants who leave the NICU do not experience major neurodevelopmental disabilities, although >50% experience more minor challenges in communication, perception, cognition, attention, regulatory, and executive function that can adversely impact educational and social function resulting in physical, behavioral, and social health issues in adulthood. Even late premature (32-36 weeks) infants have more neurodevelopmental challenges than term infants. Although early intervention and educational programs can mitigate risks of prematurity for children's developmental trajectories, restrictive eligibility requirement and limitations on frequency and intensity mean that many premature infants must "fail first" to trigger services. Social challenges, including lack of family resources, unsafe neighborhoods, structural racism, and parental substance use, may compound biological vulnerabilities, yet existing services are ill-equipped to respond. An intervention system for premature infants designed according to Life Course Health Development principles would instead focus on health optimization from the start; support emerging developmental capabilities such as self-regulation and formation of reciprocal secure early relationships; be tailored to each child's unique neurodevelopmental profile and social circumstances; and be vertically, horizontally, and longitudinally integrated across levels (individual, family, community), domains (health, education), and time. Recognizing the increased demands placed on parents, it would include parental mental health supports and provision of trauma-informed care. This developmental scaffolding would incorporate parenting, health, and developmental interventions, with the aim of improved health trajectories across the whole of the life course.
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Affiliation(s)
- Kamryn McKenzie
- University of Chicago Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, Chicago, Illinois
| | - Emma Lynch
- University of Chicago Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, Chicago, Illinois
| | - Michael E. Msall
- Address correspondence to Address correspondence to: Michael E. Msall, MD, Section of Developmental and Behavioral Pediatrics, University of Chicago Kennedy Research Center and Comer Children's Hospital, 936 East 61 St Street, Room 207, Chicago, IL 60637. E-mail:
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Johnson TJ, Patel AL, Schoeny ME, Meier PP. Cost Savings of Mother's Own Milk for Very Low Birth Weight Infants in the Neonatal Intensive Care Unit. PHARMACOECONOMICS - OPEN 2022; 6:451-460. [PMID: 35147912 PMCID: PMC8831687 DOI: 10.1007/s41669-022-00324-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 05/09/2023]
Abstract
OBJECTIVE The study aim was to determine the relationship between hospitalization costs and mother's own milk (MOM) dose for very low birth weight (VLBW; < 1500 g) infants during the initial neonatal intensive care unit (NICU) stay. Additionally, because MOM intake during the NICU hospitalization is associated with a reduction in the risk of late-onset sepsis, necrotizing enterocolitis (NEC), and bronchopulmonary dysplasia (BPD), we aimed to quantify the incremental cost of these potentially preventable complications of prematurity. METHODS The study included 430 VLBW infants enrolled in the Longitudinal Outcomes of Very Low Birthweight Infants Exposed to Mothers' Own Milk prospective cohort study between 2008 and 2012 at Rush University Medical Center in Chicago, IL, USA. NICU hospitalization costs included hospital, feeding, and physician costs. The average marginal effect of MOM dose and prematurity-related complications known to be reduced by MOM intake on NICU hospitalization costs were estimated using generalized linear regression. RESULTS The mean NICU hospitalization cost was $190,586 (standard deviation $119,235). The marginal cost of sepsis was $27,890 (95% confidence interval [CI] $2934-$52,646), of NEC was $46,103 (95% CI $16,829-$75,377), and of BPD was $41,976 (95% CI $24,660-59,292). The cumulative proportion of MOM during the NICU hospitalization was not significantly associated with cost. CONCLUSIONS A reduction in the incidence of complications that are potentially preventable with MOM intake has significant cost implications. Hospitals should prioritize investments in initiatives to support MOM feedings in the NICU.
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Affiliation(s)
- Tricia J Johnson
- Department of Health Systems Management, Rush University, 1700 West Van Buren Street, TOB Suite 126B, Chicago, IL, 60612, USA.
| | - Aloka L Patel
- Department of Pediatrics, Rush University Children's Hospital, Chicago, IL, USA
| | | | - Paula P Meier
- College of Nursing, Rush University, Chicago, IL, USA
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6
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Nobile S, Di Sipio Morgia C, Vento G. Perinatal Origins of Adult Disease and Opportunities for Health Promotion: A Narrative Review. J Pers Med 2022; 12:jpm12020157. [PMID: 35207646 PMCID: PMC8877993 DOI: 10.3390/jpm12020157] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 01/27/2023] Open
Abstract
The “developmental origins of health and disease” (DOHaD) hypothesis refers to the influence of early developmental exposures and fetal growth on the risk of chronic diseases in later periods. During fetal and early postnatal life, cell differentiation and tissue formation are influenced by several factors. The interaction between genes and environment in prenatal and early postnatal periods appears to be critical for the onset of multiple diseases in adulthood. Important factors influencing this interaction include genetic predisposition, regulation of gene expression, and changes in microbiota. Premature birth and intrauterine growth restriction (IUGR) are other important factors considered by the DOHaD hypothesis. Preterm birth is associated with impaired or arrested structural or functional development of key organs/systems, making preterm infants vulnerable to cardiovascular, respiratory, and chronic renal diseases during adulthood. Growth restriction, defined as impaired fetal growth compared to expected biological potential in utero, is an additional negative factor increasing the risk of subsequent diseases. Environmental factors implicated in the developmental programming of diseases include exposure to pollution, stress, drugs, toxic agents, nutrition, and exercise. The DOHaD may explain numerous conditions, including cardiovascular, metabolic, respiratory, neuropsychiatric, and renal diseases. Potential antenatal and postnatal preventive measures, interventions, and future directions are discussed.
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7
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Banihani R, Seesahai J, Asztalos E, Terrien Church P. Neuroimaging at Term Equivalent Age: Is There Value for the Preterm Infant? A Narrative Summary. CHILDREN (BASEL, SWITZERLAND) 2021; 8:227. [PMID: 33809745 PMCID: PMC8002329 DOI: 10.3390/children8030227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022]
Abstract
Advances in neuroimaging of the preterm infant have enhanced the ability to detect brain injury. This added information has been a blessing and a curse. Neuroimaging, particularly with magnetic resonance imaging, has provided greater insight into the patterns of injury and specific vulnerabilities. It has also provided a better understanding of the microscopic and functional impacts of subtle and significant injuries. While the ability to detect injury is important and irresistible, the evidence for how these injuries link to specific long-term outcomes is less clear. In addition, the impact on parents can be profound. This narrative summary will review the history and current state of brain imaging, focusing on magnetic resonance imaging in the preterm population and the current state of the evidence for how these patterns relate to long-term outcomes.
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Affiliation(s)
- Rudaina Banihani
- Newborn & Developmental Paediatrics, Sunnybrook Health Science Centre, 2075 Bayview Ave, The University of Toronto, Toronto, ON M4N 3M5, Canada; (J.S.); (E.A.); (P.T.C.)
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8
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Arnold C, Davis AS. Increasing Length of Stay in the NICU for Premature Newborns: Good or Bad? Pediatrics 2021; 147:peds.2020-032748. [PMID: 33510033 DOI: 10.1542/peds.2020-032748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Cody Arnold
- Division of Neonatology, Department of Pediatrics, The University of Texas Health Sciences Center at Houston McGovern Medical School, Houston, Texas; and
| | - Alexis S Davis
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Rysavy MA, Colaizy TT, Bann CM, DeMauro SB, Duncan AF, Brumbaugh JE, Peralta-Carcelen M, Harmon HM, Johnson KJ, Hintz SR, Vohr BR, Bell EF. The relationship of neurodevelopmental impairment to concurrent early childhood outcomes of extremely preterm infants. J Perinatol 2021; 41:2270-2278. [PMID: 33758389 PMCID: PMC7985590 DOI: 10.1038/s41372-021-00999-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/19/2021] [Accepted: 02/04/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Determine how neurodevelopmental impairment (NDI) relates to concurrent outcomes for children born extremely preterm. STUDY DESIGN Retrospective cohort study children born 22 0/7-26 6/7 weeks' gestation at NICHD Neonatal Research Network hospitals. Outcomes were ascertained at 18-22 months' corrected age. RESULT Of 6562 children, 2618 (40%) died and 441 (7%) had no follow-up. Among the remaining 3483 children, 825 (24%), 1576 (45%), 657 (19%), and 425 (12%) had no, potential/mild, moderate, and severe NDI, respectively. Rehospitalization, respiratory medications, surgery, and medical support services were associated with greater NDI severity but affected >10% of children without NDI. Rehospitalization occurred in 40% of children with no NDI (mean (SD): 1.7 (1.3) episodes). CONCLUSION Medical, functional, and social outcomes at 18-22 months' corrected age were associated with NDI; however, many children without NDI were affected. These data should contribute to counseling families and the design of studies for childhood outcomes beyond NDI.
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Affiliation(s)
- Matthew A. Rysavy
- grid.214572.70000 0004 1936 8294Stead Family Department of Pediatrics, University of Iowa, Iowa, IA USA
| | - Tarah T. Colaizy
- grid.214572.70000 0004 1936 8294Stead Family Department of Pediatrics, University of Iowa, Iowa, IA USA
| | - Carla M. Bann
- grid.62562.350000000100301493Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC USA
| | - Sara B. DeMauro
- grid.25879.310000 0004 1936 8972Department of Pediatrics, University of Pennsylvania, Philadelphia, PA USA
| | - Andrea F. Duncan
- grid.25879.310000 0004 1936 8972Department of Pediatrics, University of Pennsylvania, Philadelphia, PA USA
| | - Jane E. Brumbaugh
- grid.66875.3a0000 0004 0459 167XDepartment of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN USA
| | - Myriam Peralta-Carcelen
- grid.265892.20000000106344187Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL USA
| | - Heidi M. Harmon
- grid.214572.70000 0004 1936 8294Stead Family Department of Pediatrics, University of Iowa, Iowa, IA USA
| | - Karen J. Johnson
- grid.214572.70000 0004 1936 8294Stead Family Department of Pediatrics, University of Iowa, Iowa, IA USA
| | - Susan R. Hintz
- grid.168010.e0000000419368956Department of Pediatrics, Stanford University, Palo Alto, CA USA
| | - Betty R. Vohr
- grid.40263.330000 0004 1936 9094Department of Pediatrics, Brown University, Providence, RI USA
| | - Edward F. Bell
- grid.214572.70000 0004 1936 8294Stead Family Department of Pediatrics, University of Iowa, Iowa, IA USA
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Litt JS, Mercier CE, Edwards EM, Morrow K, Soll R. Follow-through care for high-risk infants during the COVID-19 pandemic: lessons learned from the Vermont Oxford Network. J Perinatol 2021; 41:2625-2630. [PMID: 34315972 PMCID: PMC8314022 DOI: 10.1038/s41372-021-01158-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 06/07/2021] [Accepted: 06/14/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has altered the delivery of follow-up care for high-risk infants. We performed an audit to characterize programmatic responses in a quality improvement network. STUDY DESIGN We audited 43 North American-based follow-up programs of the Vermont Oxford Network Extremely Low Birth Weight Follow-up Study Group in October, 2020. Our electronic survey included yes/no, agree/disagree, and free text response items. RESULT The response rate was 67.4%. Most programs altered capacity and the timing, frequency, or content of clinical assessments. Most perceived practice changes compromised their ability to ascertain infants' medical and developmental needs. There was a rapid uptake of telemedicine services. Despite challenges with implementation, many endorsed improved connectedness with families. CONCLUSION Programs adapted rapidly to meet the needs of high-risk infants during the pandemic. Clinical operations, assessment procedures, and quality metrics will also need to evolve. Quality improvement study group collaboratives are well-positioned to coordinate such work.
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Affiliation(s)
- Jonathan S. Litt
- grid.239395.70000 0000 9011 8547Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Charles E. Mercier
- grid.414924.e0000 0004 0382 585XUniversity of Vermont Medical Center, Burlington, VT USA ,grid.492967.7Vermont Oxford Network, Burlington, VT USA
| | - Erika M. Edwards
- grid.414924.e0000 0004 0382 585XUniversity of Vermont Medical Center, Burlington, VT USA ,grid.492967.7Vermont Oxford Network, Burlington, VT USA
| | - Kate Morrow
- grid.492967.7Vermont Oxford Network, Burlington, VT USA
| | - Roger Soll
- grid.414924.e0000 0004 0382 585XUniversity of Vermont Medical Center, Burlington, VT USA ,grid.492967.7Vermont Oxford Network, Burlington, VT USA
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Cha JH, Choi N, Kim YJ, Lee HJ, Kim CR, Park HK. Developmental Outcome of Very-Low-Birth-Weight Infants without Major Brain Injuries Based on Data from the Korean Neonatal Network: A Nationwide Cohort Study. NEONATAL MEDICINE 2020. [DOI: 10.5385/nm.2020.27.4.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
OBJECTIVES The objectives of this study are to determine whether abnormalities on neonatal cranial ultrasound (CUS) are associated with minor motor abnormalities at 2 years' corrected age (CA) and to assess functional outcomes and resource utilization among children with minor motor abnormalities. METHODS Infants born at <27 weeks in the National Institute of Child Health and Human Development Neonatal Research Network between January 1, 2010, and December 31, 2014, who underwent neuroimaging with CUS at both <28 days and ≥28 days and were evaluated at 18 to 26 months' CA, were included. Follow-up included Bayley-3, neuromotor examination, Gross Motor Function Classification System (GMFCS) level, and parent questionnaires about special services and resource needs. Children were classified by the most severe motor abnormality at 18 to 26 months' CA as follows: none, minor, or major motor function abnormality. Minor motor abnormalities were defined as any of the following: (1) Bayley-3 motor composite, fine motor score, or gross motor score 1 to 2 SDs below the test normative means; (2) mild abnormalities of axial or extremity motor skills on standardized neuromotor examination; or (3) GMFCS level 1. RESULTS A total of 809 (35%) of 2306 children had minor motor function abnormalities alone. This did not increase substantially with CUS findings (no intraventricular hemorrhage [IVH]: 37%, grade I IVH: 32%, grade II IVH: 38%, grade III/IV IVH: 30%, isolated ventriculomegaly: 33%, and cystic periventricular leukomalacia: 24%). The adjusted odds of minor axial and upper extremity function abnormalities and GMFCS level 1 were significantly higher in children with more severe CUS findings. Children with minor motor abnormalities had increased resource utilization and evidence of functional impairment compared with those without motor function abnormalities. CONCLUSION Minor motor abnormalities at 2 years' CA are common and cannot be predicted by neonatal CUS abnormalities alone. Minor motor abnormalities are associated with higher resource utilization and evidence of functional impairment. These findings have important implications for early counseling and follow-up planning for extremely preterm infants.
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Prematurity as an Independent Risk Factor for the Development of Pulmonary Disease. J Pediatr 2019; 213:110-114. [PMID: 31262531 DOI: 10.1016/j.jpeds.2019.05.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/03/2019] [Accepted: 05/29/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To determine if premature infants without bronchopulmonary dysplasia (BPD) are at similar risk for developing pulmonary morbidity as compared with those with BPD and if there are differences in management of care. STUDY DESIGN We retrospectively abstracted information from our electronic medical record from January 1, 2006, to December 31, 2015, for primary care patients born at <30 weeks of gestation (n = 811). Multivariate models determined the impact of BPD on a diagnosis of respiratory disease, respiratory medications, subspecialty visits, and emergency department use or hospitalizations after adjusting for gestational age, sex, insurance type, and race. RESULTS Infants with BPD were more likely to be diagnosed with asthma than those without BPD (75% vs 60%; OR, 1.8; 95% CI, 1.27-2.54), but not all respiratory conditions (OR, 1.56; 95% CI, 0.7-3.51), and were more likely to be referred to a pulmonologist (relative risk, 5.98; 95% CI, 4.1-8.74). Infants with BPD were more likely to be hospitalized for respiratory conditions than those without BPD (50% vs 30%; relative risk, 2.44; 95% CI, 1.73-3.45). CONCLUSIONS Although infants with BPD were more likely to have a diagnosis of asthma and be readmitted for respiratory conditions, 60% of infants without BPD were also diagnosed with asthma and 30% were readmitted. There were significant differences in the management of patients, including time to pulmonary referral and prescription rates for inhaled corticosteroids. Practitioners should consider all patients born prematurely at high risk for respiratory morbidity.
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NICU human milk dose and health care use after NICU discharge in very low birth weight infants. J Perinatol 2019; 39:120-128. [PMID: 30341399 PMCID: PMC6298834 DOI: 10.1038/s41372-018-0246-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the association between human milk (HM) dose and health care utilization at one and 2 years of life in very low birth weight (birth weight < 1500 g; VLBW) infants. STUDY DESIGN This study included 345 VLBW infants enrolled in a prospective observational cohort study (2008-2012) who completed a neonatal high-risk follow-up clinic visit. Subsequent health care utilization included hospitalizations, emergency department visits, pediatric subspecialists, and specialized therapies. RESULTS Each 10 mL/kg/day increase in HM in the first 14 days of life was associated with 0.26 fewer hospitalizations (p = 0.04) at 1 year and 0.21 fewer pediatric subspecialist types (p = 0.04) and 0.20 fewer specialized therapy types (p = 0.04) at 2 years. CONCLUSION HM dose in early life for VLBW infants was an independent predictor of the number of hospitalizations at 1 year and types of pediatric subspecialists and specialized therapies at 2 years of life.
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Kim NH, Youn YA, Cho SJ, Hwang JH, Kim EK, Kim EAR, Lee SM. The predictors for the non-compliance to follow-up among very low birth weight infants in the Korean neonatal network. PLoS One 2018; 13:e0204421. [PMID: 30273357 PMCID: PMC6166943 DOI: 10.1371/journal.pone.0204421] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/09/2018] [Indexed: 12/02/2022] Open
Abstract
The critical need to emphasize preterm infant follow-up after neonatal intensive care unit (NICU) discharge assures early identification of and intervention for neurodevelopmental disability. The aims of this study were to observe the follow-up rates in high-risk follow-up clinics, and analyze factors associated with non-compliance to follow-up among very low birth weight (VLBW) infants. The data was prospectively collected for 3063 VLBW infants between January 2013 and December 2014 from 57 Korean neonatal network (KNN) centers at a corrected age of 18–24 months. Correlations among demographic data, clinical variables, and neonatal intensive care unit (NICU) volume (divided into 4 quartiles) with the occurrence of non-compliance were analyzed. The overall follow-up rate at the corrected age of 18–24 month was 65.4%. The follow-up rates were inversely related to birth weight and gestational age. Apgar score, hospital stay, maternal age, and maternal education were significantly different between the compliance and non-compliance groups. The follow-up rate was higher for mothers with chorioamnionitis, abnormal amniotic fluid, multiple pregnancy, and in vitro fertilization. Infants with respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus ligation, periventricular leukomalacia, and retinopathy of prematurity were more common in the compliance group. Follow-up rates showed significant differences according to NICU volume. Using multivariate logistic regression, high birth weight, low NICU volume, siblings, foreign maternal nationality and high 5 min APGAR scores were significant independent factors associated with the non-compliance of VLBW infants for follow-up at 18–24 months of age. This is the first nation-wide analysis of follow-up for VLBW infants in Korea. Understanding factors associated with failure of compliance could help improve the long-term follow-up rates and neurodevelopmental outcomes through early intervention.
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Affiliation(s)
- Nam Hyo Kim
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Young Ah Youn
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University, Seoul, Korea
| | - Su Jin Cho
- Department of Pediatrics, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Jong-Hee Hwang
- Department of Pediatrics, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Ee-Kyung Kim
- Departmemt of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Ellen Ai-Rhan Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Soon Min Lee
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Weber A, Harrison TM, Steward D, Ludington-Hoe S. Paid Family Leave to Enhance the Health Outcomes of Preterm Infants. Policy Polit Nurs Pract 2018; 19:11-28. [PMID: 30134774 DOI: 10.1177/1527154418791821] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prematurity is the largest contributor to perinatal morbidity and mortality. Preterm infants and their families are a significant vulnerable population burdened with limited resources, numerous health risks, and poor health outcomes. The social determinants of health greatly shape the economic and psychosocial resources that families possess to promote optimal outcomes for their preterm infants. The purposes of this article are to analyze the resource availability, relative risks, and health outcomes of preterm infants and their families and to discuss why universal paid family leave could be one potential public policy that would promote optimal outcomes for this infant population. First, we discuss the history of family leave in the United States and draw comparisons with other countries around the world. We use the vulnerable populations conceptual model as a framework to discuss why universal paid family leave is needed and to review how disparities in resource availability are driving the health status of preterm infants. We conclude with implications for research, nursing practice, and public policy. Although health care providers, policy makers, and other key stakeholders have paid considerable attention to and allocated resources for preventing and treating prematurity, this attention is geared toward individual-based health strategies for promoting preconception health, preventing a preterm birth, and improving individual infant outcomes. Our view is that public policies addressing the social determinants of health (e.g., universal paid family leave) would have a much greater impact on the health outcomes of preterm infants and their families than current strategies.
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Affiliation(s)
- Ashley Weber
- 1 University of Cincinnati College of Nursing, Cincinnati, OH, USA
| | - Tondi M Harrison
- 2 The Ohio State University College of Nursing, Columbus, OH, USA
| | - Deborah Steward
- 2 The Ohio State University College of Nursing, Columbus, OH, USA
| | - Susan Ludington-Hoe
- 3 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Pauline Voie M, Tunby J, Strømsvik N. Collaboration challenges faced by nurses when premature infants are discharged. Nurs Child Young People 2018. [PMID: 29512964 DOI: 10.7748/ncyp.2018.e960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIM To explore the collaboration challenges faced by neonatal intensive care unit (NICU) nurses and public health nurses when preparing premature infants for transition home and to explore the culture of cooperation between the two professional groups. METHOD Qualitative individual interviews were undertaken with two NICU nurses and two public health nurses. A qualitative content analysis was used to analyse the data. FINDINGS Three main themes were identified: different expectations and lack of communication between NICU nurses and public health nurses; responsibilities and interactions between the two professional groups were not clearly defined; and the public health nurses' competence was not recognised by the NICU nurses and parents. CONCLUSION There is a need of clear guidelines about the discharge process from the NICU. This issue must be given further attention.
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Affiliation(s)
- Mona Pauline Voie
- Department of pediatrics, division of child and adolescent health, University Hospital of North Norway, Tromsø, Norway
| | - Jorunn Tunby
- Division of child and adolescent health, University Hospital of North Norway, Tromsø
| | - Nina Strømsvik
- Department of medical genetics, division of child and adolescent health, University Hospital of North Norway, Tromsø
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Li M, Pan B, Shi Y, Fu J, Xue X. Increased expression of CHOP and LC3B in newborn rats with bronchopulmonary dysplasia. Int J Mol Med 2018; 42:1653-1665. [PMID: 29901175 DOI: 10.3892/ijmm.2018.3724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 05/09/2018] [Indexed: 11/06/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) seriously affects the health and prognosis of children, but the efficacy of treatments is poor. The present study aimed to examine the effects of C/EBP homologous protein (CHOP), activating transcription factor 4 (ATF4) and microtubule‑associated protein light chain 3β (LC3B), and the interaction between CHOP and LC3B, in newborn rats with BPD. At 1, 7, 14 and 21 days, the rats in the model [fraction of inspired oxygen (FiO2)=80‑85%] and control groups (FiO2=21%) were randomly sacrificed, and lung samples were collected. Alveolar development was evaluated according to the radial alveolar count (RAC) and alveolar septum thickness. Ultrastructural changes were observed by transmission electron microscopy (TEM), the expression levels of CHOP, ATF4 and LC3B were determined by immunohistochemistry, and western blot and reverse transcription‑quantitative polymerase chain reaction analyses. The co‑localization of CHOP and LC3B in lung tissues was determined by immunofluorescence. The results showed that, compared with the control group, alveolarization arrest was present in the model group. The TEM observations revealed that, at 14 days, type II alveolar epithelial cell (AECII) lamellar bodies were damaged, with an apparent dilation of the endoplasmic reticulum (ER) and autophagy in cells within the model group. Between days 7 and 14, the protein levels of ATF4, CHOP and LC3B were significantly increased in the model group. The mRNA levels of CHOP and LC3B were lower at days 7‑21. CHOP and LC3B were co‑localized in the cells of the lung tissues at day 14 in the model group. Pearson's correlation analysis showed that the protein levels of CHOP and LC3B‑II were positively correlated in the model groups. As in previous studies, the present study demonstrated that BPD damaged the AECII cells, which exhibited detached and sparse microvilli and the vacuolization of lamellar bodies. In addition, it was found that the ER was dilated, with autophagosomes containing ER and other organelles in AECII cells; the expression levels of CHOP and LC3B‑II were upregulated. CHOP and LC3B‑II may have joint involvement in the occurrence and development of BPD.
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Affiliation(s)
- Mengyun Li
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Bingting Pan
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Yongyan Shi
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Jianhua Fu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Xindong Xue
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
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Klin A, Jones W. An agenda for 21st century neurodevelopmental medicine: lessons from autism. Rev Neurol 2018; 66:S3-S15. [PMID: 29516447 PMCID: PMC6606044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
The future of neurodevelopmental medicine has the potential of situating child neurology at the forefront of a broad-based public health effort to optimize neurodevelopmental outcomes of children born with high-prevalence and diverse genetic, pre- and peri-natal, and environmental burdens compromising early brain development and leading to lifetime disabilities. Building on advancements in developmental social neuroscience and in implementation science, this shift is already occurring in the case of emblematic neurodevelopmental disorders such as autism. Capitalizing on early neuroplasticity and on quantification of trajectories of social-communicative development, new technologies are emerging for high-throughput and cost-effective diagnosis and for community-viable delivery of powerful treatments, in seamless integration across previously fragmented systems of healthcare delivery. These solutions could be deployed in the case of other groups of children at greater risk for autism and communication delays, such as those born extremely premature or with congenital heart disease. The galvanizing concept in this aspirational future is a public health focus on promoting optimal conditions for early brain development, not unlike current campaigns promoting pre-natal care, nutrition or vaccination.
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Affiliation(s)
- A Klin
- Children's Healthcare of Atlanta and Emory University School of Medicine. Atlanta, Georgia, EE.UU
| | - W Jones
- Children's Healthcare of Atlanta and Emory University School of Medicine. Atlanta, Georgia, EE.UU
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20
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Casey PH, Irby C, Withers S, Dorsey S, Li J, Rettiganti M. Home Visiting and the Health of Preterm Infants. Clin Pediatr (Phila) 2017; 56:828-837. [PMID: 28720035 DOI: 10.1177/0009922817715949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The results of home visiting programs which target medically fragile low-birth-weight preterm infants (LBWPT) have been inconsistent. We provided nurse/social worker home visits to families of LBWPT infants on a regular schedule. Teams were trained in approaches to improve the health and development of the infants. The completion of immunization series was sigmificantly higher and the infant mortality rates of the home visits childen were significanly lower compared to national and state rates. We used state Medicaid data and examined frequency of hospitalization, emergency department visits, routine and nonscheduled visits to primary care physician, and pharmacy use of the home-visited subjects compared with a propensity-matched group. The home-visited group had more routine and nonscheduled visits but no more hospitalizations or E.D. visits. Home visiting teams improved important markers of child health, including completed immunizations and mortality rate, perhaps by the careful monitoring of health status and assuring health care when needed.
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Affiliation(s)
- Patrick H Casey
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA.,2 Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Carmen Irby
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sandra Withers
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Susan Dorsey
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jingyun Li
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA.,2 Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Malik Rettiganti
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA.,2 Arkansas Children's Research Institute, Little Rock, AR, USA
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21
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Darling R, Atav AS. Measuring birth outcomes in New York State using a multidimensional approach. Nurs Forum 2017; 53:122-128. [PMID: 28662303 DOI: 10.1111/nuf.12224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Poorer birth outcomes in the United States and New York State (NYS) remain a significant public health concern. The objectives of this study were to assess the effect of common and unique demographic, socioeconomic, and health services predictors on low birth weight (LBW), moderately LBW, very low birth weight (VLBW), and extremely low birth weight (ELBW) in NYS counties and to recommend policies that address unique differences at the county level. METHODS Secondary data were collected for each of the 62 counties in NYS. Using a multidimensional approach, common and unique factors for LBW, moderately LBW, VLBW, and ELBW among NYS counties were evaluated. Correlations and multiple regression analyses were conducted for each of the outcome variables. RESULTS Late prenatal care was the only significant predictor across all measures of poorer birth outcomes in NYS counties. Out-of-wedlock births, Medicaid Obstetrical Maternal Service providers, rural location, early prenatal care, advanced maternal age, and teen pregnancy rate were significant predictors, but not for all measures. CONCLUSIONS Findings highlight the need to move beyond the number of providers when analyzing birth outcomes at the county level. Programs that support teens and women of all ages and marital status need to be expanded to curb poorer birth outcomes that take a heavy human and financial toll in NYS.
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Affiliation(s)
- Rosa Darling
- Binghamton University Decker School of Nursing, Binghamton, NY
| | - A Serdar Atav
- Binghamton University Decker School of Nursing, Binghamton, NY
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22
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Hsieh RL, Hsieh WH, Lee WC. Short-term family-centered workshop for children with developmental delays enhances family functioning and satisfaction: A prospective clinical trial. Medicine (Baltimore) 2016; 95:e4200. [PMID: 27495025 PMCID: PMC4979779 DOI: 10.1097/md.0000000000004200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We investigated the clinical efficacy on family functioning and parental satisfaction of a short-term family-centered workshop for children with developmental delays.A total of 32 children with developmental delays and their parents participated in 2-hour weekly group therapy sessions over 6 weeks. The workshop was conducted by rehabilitation professionals and teachers using a family-centered multidisciplinary approach. Both before and after the 6-week workshop, the parents were administered the Pediatric Quality of Life Inventory (PedsQL) Family Impact Module, the PedsQL Healthcare Satisfaction Module, the Hospital Anxiety and Depression Scale, and the World Health Organization Quality of Life brief assessment instrument. Overall satisfaction with the workshop was also evaluated.Significant improvements were noted in physical aspect (P = 0.03), communication (P = 0.002), and daily activities (P = 0.04) in the PedsQL Family Impact Module, and in communication (P = 0.03) and technical skills (P = 0.05) in the PedsQL Healthcare Satisfaction Module. Overall satisfaction with the workshop was rated as very high. There was no significant effect on psychological distress or quality of life.Short-term family-centered workshops for children with developmental delays improved family functioning and the parental perception of satisfaction, including health care satisfaction.
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Affiliation(s)
- Ru-Lan Hsieh
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University
- Correspondence: Ru-Lan Hsieh, Department of Physical Medicine and Rehabilitation, Shin-Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Rd, Shih Lin District, Taipei 11101, Taiwan (e-mail: )
| | - Wen-Huei Hsieh
- Department of Child Care and Education and Research Center for Industry of Human Ecology, College of Human Ecology, Chang Gung University of Science and Technology
| | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Mousavi SS, Chaman R, Khosravi A, Mohagheghi P, Mousavi SA, Keramat A. The Needs of Parents of Preterm Infants in Iran and a Comparison With Those in Other Countries: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PEDIATRICS 2016; 26:e4396. [PMID: 28203326 PMCID: PMC5294933 DOI: 10.5812/ijp.4396] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 03/06/2016] [Accepted: 03/27/2016] [Indexed: 11/24/2022]
Abstract
Context Proper accountability to needs of preterm infants’ parents requires recognition of these needs and how they change in different conditions. The aim of this study was to assess the needs of parents of preterm infants in Iran, as compared to those in other regions in the world. Evidence Acquisition A search of Iranian databases (Iran Medex, Magiran, and SID) and international resources (PubMed, Scopus, and Google Scholar) was conducted, with no time limitations, to 5 October 2014. Using standard tools, all quantitative studies that considering the parental needs of preterm infants and parental support were extracted. The STROBE checklist was used for the evaluation of the studies. Thirty-one studies were extracted in the qualitative evaluation, of which 17 were included in the meta-analysis. The variance between the studies was analyzed using tau-squared (Tau2) and review manager 5 software. Results The results obtained using the nurse-parent support tool (NPST) showed that mothers considered that all the fields of support were of great importance. The parental needs in Iran were similar to those of parents in other regions worldwide. However, the mean score for Iranian parents’ assessment of the support they received was 2.20 ± 0.06, whereas it was 3.84 ± 0.72 for other countries. The mean scores for parents’ assessment of the provision of emotional, informational appraisal, and instrumental support in Iran were 1.73 ± 0.06, 2.1 ± 0.06, 1.54 ± 0.6, and 3.44 ± 0.04, respectively, compared to 3.18 ± 1.34, 4.11 ± 0.5, 4.26 ± 0.18, and 4.51 ± 0.14, respectively, in other countries. Conclusions Parents always prefer the priorities of their babies to their individual needs. Given the lower scores for the parental assessment of received support in Iran, it is important to focus on these specific items in providing interventions to meet the needs of Iranian parents.
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Affiliation(s)
| | - Reza Chaman
- Associate Professor, Epidemiology, Department of Community Medicine, Yasuj University Of Medical Sciences, Yasuj, IR Iran
| | - Ahmad Khosravi
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, IR Iran
| | - Parisa Mohagheghi
- Associate Professor, Iran University of Medical Sciences, Tehran, IR Iran
| | - Seyed Abbas Mousavi
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, IR Iran
| | - Afsaneh Keramat
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, IR Iran
- Corresponding author: Afsaneh Keramat, Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, IR Iran. Tel: +98-2332395054, Fax: +98-2332394800, E-mail:
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Guerra E, Downey E, O'Mahony JA, Caboni MF, O'Shea C, Ryan AC, Kelly AL. Influence of duration of gestation on fatty acid profiles of human milk. EUR J LIPID SCI TECH 2016. [DOI: 10.1002/ejlt.201500396] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Elena Guerra
- Department of Agricultural and Food Science (DISTAL)Alma Mater Studiorum – University of BolognaCesena (FC)Italy
| | - Eimear Downey
- School of Food and Nutritional SciencesUniversity College CorkCorkIreland
| | - James A. O'Mahony
- School of Food and Nutritional SciencesUniversity College CorkCorkIreland
| | - Maria Fiorenza Caboni
- Department of Agricultural and Food Science (DISTAL)Alma Mater Studiorum – University of BolognaCesena (FC)Italy
| | - Carol‐Anne O'Shea
- Department of Paediatrics and Child HealthUniversity College CorkCorkIreland
| | - Anthony C. Ryan
- Department of Paediatrics and Child HealthUniversity College CorkCorkIreland
| | - Alan L. Kelly
- School of Food and Nutritional SciencesUniversity College CorkCorkIreland
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Peres H, Glazer Y, Landau D, Marks K, Abokaf H, Belmaker I, Cohen A, Shoham-Vardi I. Understanding utilization of outpatient clinics for children with special health care needs in southern Israel. Matern Child Health J 2015; 18:1831-45. [PMID: 24414986 DOI: 10.1007/s10995-013-1427-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To understand the pattern of utilization of ambulatory care by parents of children with special health care needs (CSHCN) and to explore parental challenges in coping with health maintenance of their infants after discharge from a neonatal intensive care unit (NICU). CSHCN require frequent utilization of outpatient ambulatory clinics especially in their first years of life. Multiple barriers are faced by families in disadvantaged populations which might affect adherence to medical referrals. Our study attempts to go beyond quantitative assessment of adherence rates, and capture the influence of parental agency as a critical factor ensuring optimal utilization of healthcare for CSHCN. A prospective, mixed-methods, cohort study followed 158 Jewish and Bedouin-Arab infants in the first year post discharge from NICU in southern Israel. Rates of utilization of ambulatory clinics were obtained from medical records, and quantitative assessment of factors affecting it was based on structured interviews with parents at baseline. Qualitative analysis was based on home visits or telephone in-depth interviews conducted about 1 year post-discharge, to obtain a rich, multilayered, experiential perspectives and explained perceptions by parents. Adherence to post-discharge referrals was generally good, but environmental, cultural, and financial obstacles to healthcare, magnified by communication barriers, forced parents with limited resources to make difficult choices affecting utilization of healthcare services. Improving concordance between primary caregivers and health care providers is crucial, and further development of supportive healthcare for CSHCN in concordance with parental limitations and preferences is needed.
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Affiliation(s)
- Hagit Peres
- Department of Anthropology and Sociology, Ashkelon Academic College, 12 Ben-Zvi Ave, 78211, Ashkelon, Israel,
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Rodrigues AN, Bajuk B, Oei J, Lui K, Abdel-Latif ME. Neurodevelopmental outcome of extremely preterm infants born to rural and urban residents' mothers in Australia. Early Hum Dev 2015; 91:437-43. [PMID: 26025333 DOI: 10.1016/j.earlhumdev.2015.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 04/05/2015] [Accepted: 04/26/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rural and remote residents in Australia have long experienced unfavourable health outcomes compared to their urban counterparts. AIMS To study neurodevelopmental outcome at 2-3 years of age, corrected for prematurity of extremely preterm infants admitted to a regional neonatal Australian network from rural and urban regions (based on usual location of maternal residence). METHODS A multicenter population-based cohort study in which surviving urban and rural infants <29 weeks of gestation born between 1998 and 2004 underwent neurodevelopmental assessment at 2-3 years of age, corrected for prematurity by a developmental assessment team. Moderate/severe functional disability was defined as developmental delay (GQ or MDI>2 SD below the mean), cerebral palsy (aided for walking), sensorineural or conductive deafness (requiring amplification), and bilateral blindness (visual acuity <6/60 in the better eye). RESULTS Of the 1970 infants alive at 2-3 years of age, 268 (63.8%) rural and 1205 (77.7%) urban infants were evaluated. Infants lost to follow-up were of slightly higher gestational age and birth weight. Both rural and urban assessed groups were comparable in gestation and birth weight percentile. In comparison to their urban counterparts, the rural group had more outborn infants (19.8% vs. 4.6%, p<0.001). They, however, did not have an increased risk of moderate/severe functional disability (OR 0.77, 95% CI 0.52-1.23, p=0.176). This finding was not significantly altered by limiting the analysis to different gestational ages. CONCLUSION Extremely premature surviving young children from rural areas of residence do not seem to have an increased risk for moderate/severe functional disability.
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Affiliation(s)
| | - Barbara Bajuk
- Neonatal Intensive Care Units' (NICUS) Data Collection, NSW Pregnancy and Newborn Services Network (PSN), Sydney Children's Hospitals Network, NSW, Australia
| | - Julee Oei
- Department of Newborn Care, Royal Hospital for Women, NSW, Australia; School of Women's and Children's Heath, University of New South Wales, NSW, Australia
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women, NSW, Australia; School of Women's and Children's Heath, University of New South Wales, NSW, Australia
| | - Mohamed E Abdel-Latif
- The Clinical School, Australian National University, ACT, Australia; Department of Neonatology, Centenary Hospital for Women and Children, ACT, Australia.
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Landsem IP, Handegård BH, Ulvund SE, Kaaresen PI, Rønning JA. Early intervention influences positively quality of life as reported by prematurely born children at age nine and their parents; a randomized clinical trial. Health Qual Life Outcomes 2015; 13:25. [PMID: 25888838 PMCID: PMC4343051 DOI: 10.1186/s12955-015-0221-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 02/06/2015] [Indexed: 01/25/2023] Open
Abstract
Background The Tromsø Intervention Study on Preterms evaluates an early, sensitizing intervention given to parents of prematurely born children (birth-weight < 2000 g). The current study investigated the potential influence of the intervention on children’s self-reported and parental proxy-reported quality of life (QoL) at children’s age of nine. Methods Participants were randomized to either intervention (PI, n = 72) or preterm control (PC, n = 74) in the neonatal care unit, while healthy term-born infants were recruited to a term reference group (TR, n = 75). The intervention was a modified version of the Mother-Infant Transaction Program, and comprised eight one-hour sessions during the last week before discharge and four home visits at 1, 2, 4 and 12 weeks post-discharge. The two control groups received care in accordance with written guidelines drawn up at the hospital. Participants and parents reported QoL independently on the Kinder Lebensqualität Fragebogen (KINDL) questionnaire. Differences between groups were analyzed by SPSS; Linear Mixed Models and parent–child agreement were analyzed and compared by intra-class correlations within each group. Results On average, children in all groups reported high levels of well-being. The PI children reported better physical well-being than the PC children (p = 0.002). In all other aspects of QoL both the PI and the PC children reported at similar levels as the term reference group. PI parents reported better emotional wellbeing (p = 0.05) and a higher level of contentment in school (p = 0.003) compared with PC parents. Parent–child agreement was significantly weaker in the PI group than in the PC group on dimensions such as emotional well-being and relationships with friends (p < 0.05). PI parents reported QoL similar to parents of terms on all aspects except the subscale self-esteem, while PC parents generally reported moderately lower QoL than TR parents. Conclusions This early intervention appears to have generated long-lasting positive effects, improving perceived physical well-being among prematurely born children and parent’s perception of these children’s QoL in middle childhood. Trial registration Clinical Trials Gov NCT00222456.
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Affiliation(s)
- Inger Pauline Landsem
- Child and Adolescent Department, University Hospital of Northern Norway, Tromsø, Norway. .,UiT, Health Faculty, The Arctic University of Norway, Tromsø, Norway.
| | | | - Stein Erik Ulvund
- UiT, RKBU Nord, The Arctic University of Norway, Tromsø, Norway. .,Department of Education, University of Oslo, Oslo, Norway.
| | - Per Ivar Kaaresen
- Child and Adolescent Department, University Hospital of Northern Norway, Tromsø, Norway. .,UiT, Health Faculty, The Arctic University of Norway, Tromsø, Norway.
| | - John A Rønning
- Child and Adolescent Department, University Hospital of Northern Norway, Tromsø, Norway. .,UiT, Health Faculty, The Arctic University of Norway, Tromsø, Norway.
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Referral of very low birth weight infants to high-risk follow-up at neonatal intensive care unit discharge varies widely across California. J Pediatr 2015; 166:289-95. [PMID: 25454311 DOI: 10.1016/j.jpeds.2014.10.038] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/08/2014] [Accepted: 10/16/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To determine rates and factors associated with referral to the California Children's Services high-risk infant follow-up (HRIF) program among very low birth weight (BW) infants in the California Perinatal Quality of Care Collaborative. STUDY DESIGN Using multivariable logistic regression, we examined independent associations of demographic and clinical variables, neonatal intensive care unit (NICU) volume and level, and California region with HRIF referral. RESULTS In 2010-2011, 8071 very low BW infants were discharged home; 6424 (80%) were referred to HRIF. Higher odds for HRIF referral were associated with lower BW (OR 1.9, 95% CI 1.5-2.4; ≤ 750 g vs 1251-1499 g), higher NICU volume (OR 1.6, 1.2-2.1; highest vs lowest quartile), and California Children's Services Regional level (OR 3.1, 2.3-4.3, vs intermediate); and lower odds with small for gestational age (OR 0.79, 0.68-0.92), and maternal race African American (OR 0.58, 0.47-0.71) and Hispanic (OR 0.65, 0.55-0.76) vs white. There was wide variability in referral among regions (8%-98%) and NICUs (<5%-100%), which remained after risk adjustment. CONCLUSIONS There are considerable disparities in HRIF referral, some of which may indicate regional and individual NICU resource challenges and barriers. Understanding demographic and clinical factors associated with failure to refer present opportunities for targeted quality improvement initiatives.
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Abstract
We present the case of a 4-year-old with multiple congenital anomalies. These included complete tracheal rings with agenesis of the right lung and missing right ribs. He was hospitalized from birth until he was age 3 years and 6 months. At age 4 years and 4 months he had yet to move to a family home or experience his first day of school because he was in a transitional care facility. The intensity of his care was initially high, slowly declined over time, and eventually entered the range where he would be potentially manageable in a home environment. Despite the countless medical teams treating him, he did not receive a referral either to the early intervention or educational services that he had a right to under the Individuals with Disabilities Education Act. While his case is extreme, there is a disconnect between the United States health care and educational systems, which negatively impacts both the health and development of children with chronic conditions who require frequent and prolonged hospitalizations.
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Abstract
Speech and language impairments of both simple and complex language functions are common among former preterm infants. Risk factors include lower gestational age and increasing illness severity including severe brain injury. Even in the absence of brain injury, however, altered brain maturation and vulnerability imposed by premature entrance to the extrauterine environment is associated with brain structural and microstructural changes. These alterations are associated with language impairments with lasting effects in childhood and adolescence and increased needs for speech therapy and education supports. Studies are needed to investigate language interventions which begin in the neonatal intensive care unit.
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Affiliation(s)
- Betty Vohr
- Department of Pediatrics, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA.
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Adams-Chapman I, Bann CM, Vaucher YE, Stoll BJ. Association between feeding difficulties and language delay in preterm infants using Bayley Scales of Infant Development-Third Edition. J Pediatr 2013; 163:680-5.e1-3. [PMID: 23582139 PMCID: PMC3755022 DOI: 10.1016/j.jpeds.2013.03.006] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 01/14/2013] [Accepted: 03/06/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the relationship between abnormal feeding patterns and language performance on the Bayley Scales of Infant Development-Third Edition at 18-22 months adjusted age among a cohort of extremely premature infants. STUDY DESIGN This is a descriptive analysis of 1477 preterm infants born ≤ 26 weeks gestation or enrolled in a clinical trial between January 1, 2006 and March 18, 2008 at a National Institute of Child Health and Human Development Neonatal Research Network center who completed the 18-month neurodevelopmental follow-up assessment. At 18-22 months adjusted age, a comprehensive neurodevelopmental evaluation was performed by certified examiners including the Receptive and Expressive Language Subscales of the Bayley Scales of Infant Development-Third Edition and a standardized adjusted age feeding behaviors and nutritional intake. Data were analyzed using bivariate and multilevel linear and logistic regression modeling. RESULTS Abnormal feeding behaviors were reported in 193 (13%) of these infants at 18-22 months adjusted age. Abnormal feeding patterns, days of mechanical ventilation, hearing impairment, and Gross Motor Functional Classification System level ≥ 2 each independently predicted lower composite language scores. CONCLUSIONS At 18 months adjusted age, premature infants with a history of feeding difficulties are more likely to have language delay. Neuromotor impairment and days of mechanical ventilation are both important risk factors associated with these outcomes.
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Affiliation(s)
- Ira Adams-Chapman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30303, USA.
| | - Carla M. Bann
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Yvonne E Vaucher
- Pediatrics, University of California at San Diego, San Diego, CA
| | - Barbara J Stoll
- Pediatrics, Emory University School of Medicine, Atlanta, GA
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Caskey M, Vohr B. Assessing language and language environment of high-risk infants and children: a new approach. Acta Paediatr 2013; 102:451-61. [PMID: 23397889 DOI: 10.1111/apa.12195] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 02/02/2013] [Accepted: 02/05/2013] [Indexed: 12/01/2022]
Abstract
UNLABELLED Language delays are common among premature infants and children with hearing loss. There are multiple tools and reports for assessing language in young children. Assessing early language and providing intervention is key to improving outcomes. CONCLUSION We conclude that utilization of a new tool, Language Environment Analysis digital language processor (LENA™), to assess the natural language environment of high-risk infants and children in a variety of settings including the neonatal intensive care unit and home, provides the opportunity to access and identify key features of the early language environment.
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Affiliation(s)
- Melinda Caskey
- Department of Pediatrics; Women & Infants Hospital; Providence; RI; USA
| | - Betty Vohr
- Department of Pediatrics; Women & Infants Hospital; Providence; RI; USA
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Instituting parent education practices in the neonatal intensive care unit: an administrative case report of practice evaluation and statewide action. Phys Ther 2012; 92:967-75. [PMID: 22466024 PMCID: PMC3386515 DOI: 10.2522/ptj.20110360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Infants born preterm are at high risk of developmental disabilities and benefit from early developmental intervention programs. Physical therapists with neonatal expertise are ideally suited to educate parents about ways to support their infant's development in the first months of life. However, administrative policies are needed to support the therapist in providing adequate parent education in the neonatal intensive care unit (NICU). This administrative case report describes the process used by a team of neonatal therapists to evaluate clinical practice, determine the need for change, and develop and implement a new parent education program in the NICU. CASE DESCRIPTION Physical therapy parent education practices were evaluated in an academic medical center with a 36-bed, level-3 NICU. Physical therapists with neonatal expertise covered multiple units within the hospital each day. A series of focus groups, a small descriptive study, and staff discussion were used to evaluate parent education practices in this academic medical center. A new parent education program was developed based on data collected and literature to improve clinical care. OUTCOMES The new parent education model was implemented over the course of several months using overlapping initiatives. Administrative support for the change was developed through collaboration, open communication, and presentation of clinical data. In addition, this hospital-based program contributed to the development of a statewide initiative to educate parents of preterm infants about the importance of supporting development in the first months of life. DISCUSSION A collaborative and data-driven approach to evaluating parent education practices supported the development of a new parent education practice while acknowledging the need to meet staff productivity standards and provide excellent care throughout the hospital.
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Factors associated with rehospitalizations of very low birthweight infants: impact of a transition home support and education program. Early Hum Dev 2012; 88:455-60. [PMID: 22104626 DOI: 10.1016/j.earlhumdev.2011.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 10/06/2011] [Accepted: 10/30/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the effects of a transition-home education and support program, BPD, and health insurance type on VLBW infant rehospitalizations at 3 and 7 months corrected age. It was hypothesized that the transition-home program would be associated with decreased rehospitalizations between Phase 1 and 2, and public health insurance and BPD would be associated with increased rehospitalizations. METHODS 274 infants with birth weight <1500 g were enrolled in two successive years of a transition-home program (Phase 1-start-up) and (Phase 2-full implementation) and followed to 7 months CA. RESULTS The Phase 2 rehospitalization rates were lower but not statistically significant at both 3 months (20% and 15%; p=0.246), and 7 months (24% and 17%; p=0.171). Infants with public insurance had twice as many rehospitalizations by 3 months (28% versus 11%; p=0.018) in Phase 1. In regression analyses the intervention effects did not achieve significance for the cohort at 3 months (OR=0.63; CI=0.33 to 1.20) or 7 months (OR=0.61; CI=0.33 to 1.13). BPD and public insurance did not reach significance in the models whereas siblings were significantly associated with increased odds of rehospitalization. In subgroup analyses for infants on pubic health insurance the intervention significantly decreased the odds of rehospitalization between Phase 1 and 2(OR=0.43; CI=0.19 to 0.96) at 3 months. CONCLUSIONS Our findings suggest that a transition-home program may be beneficial to reduce the rehospitalization rate for VLBW infants, and infants on public insurance may derive greater benefit.
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Tang BG, Feldman HM, Huffman LC, Kagawa KJ, Gould JB. Missed opportunities in the referral of high-risk infants to early intervention. Pediatrics 2012; 129:1027-34. [PMID: 22614772 PMCID: PMC4074653 DOI: 10.1542/peds.2011-2720] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Using a statewide population-based data source, we describe current neonatal follow-up referral practices for high-risk infants with developmental delays throughout California. METHODS From a cohort analysis of quality improvement data from 66 neonatal follow-up programs in the California Children's Services and California Perinatal Quality Care Collaborative High-Risk Infant Follow-Up Quality of Care Initiative, 5129 high-risk infants were evaluated at the first visit between 4 and 8 months of age in neonatal follow-up. A total of 1737 high-risk infants were evaluated at the second visit between 12 and 16 months of age. We calculated referral rates in relation to developmental status (high versus low concern) based on standardized developmental testing or screening. RESULTS Among infants with low concerns (standard score >70 or passed screen) at the first visit, 6% were referred to early intervention; among infants with high concerns, 28% of infants were referred to early intervention. Even after including referrals to other (private) therapies, 34% infants with high concerns did not receive any referrals. These rates were similar for the second visit. CONCLUSIONS In spite of the specialization of neonatal follow-up programs to identify high-risk infants with developmental delays, a large proportion of potentially eligible infants were not referred to early intervention.
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Affiliation(s)
- Brian G. Tang
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California; and
| | - Heidi M. Feldman
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California; and
| | - Lynne C. Huffman
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California; and
| | - Kimie J. Kagawa
- State of California, Department of Health Care Services, Systems of Care Division, Children's Medical Services, Program Development Section, Sacramento, California
| | - Jeffrey B. Gould
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California; and
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Abstract
OBJECTIVE To examine the prevalence of behavior disorders in a 2001-2003 birth cohort of extremely preterm/extremely low birth weight (EPT/ELBW, <28 weeks gestational age or <1000 g) children in kindergarten. METHOD We compared 148 EPT/ELBW children with 111 term-born normal birth weight classmate controls on reports of psychiatric symptoms obtained from parent interview (Children's Interview for Psychiatric Syndromes-Parent Form [P-ChIPS]), parent and teacher ratings of behavior (Child Behavior Checklist, Teacher's Report Form, and Behavior Rating Inventory of Executive Function), and teacher ratings of social functioning (School Social Behavior Scales, second edition). Associations of behavior disorders with global cognitive ability and tests of executive function were also examined within the EPT/ELBW group. RESULTS Rates of attention-deficit/hyperactivity disorder combined on psychiatric interview were about twice as high for the EPT/ELBW group than for the normal birth weight group, odds ratio (95% confidence interval) = 2.50 (1.34, 4.68), p = .004. The EPT/ELBW group also had much higher rates of teacher-identified disorders in attention, behavior self-regulation, and social functioning, with odds ratios (95% confidence intervals) ranging from 3.35 (1.64, 6.83) to 18.03 (4.12, 78.94), all p values <.01. Attention-deficit/hyperactivity disorder and impaired behavior self-regulation were associated with deficits on tests of executive function but not with global cognitive impairment. CONCLUSIONS The findings document increased rates of disorders in attention, behavior self-regulation, and socialization in EPT/ELBW children and suggest that deficits on tests of executive function are associated with some of these disorders. Early identification and intervention for these disorders are needed to promote early adjustment to school and facilitate learning progress.
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Definition and outpatient management of the very low-birth-weight infant with bronchopulmonary dysplasia. Adv Ther 2012; 29:297-311. [PMID: 22529025 DOI: 10.1007/s12325-012-0015-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Indexed: 12/28/2022]
Abstract
Bronchopulmonary dysplasia (BPD), also known as chronic lung disease of prematurity, is the major cause of pulmonary disease in infants. The pathophysiology and management of BPD have evolved over the past four decades as improved neonatal intensive care unit (NICU) modalities have increased survival rates. The likelihood for developing BPD increases with the degree of prematurity and reaches 25-35% in very low-birth-weight and extremely low-birth-weight infants. BPD affects many organ systems, and infants with BPD are at increased risk for rehospitalization and numerous complications following NICU discharge. The management of BPD and medically related problems, particularly during the first 2 years of life, remains a continuing challenge for parents and healthcare providers. It is important that a multidisciplinary team consisting of the neonatologist/attending physician, primary care physician, and other specialized support staff work in concert and meet regularly to provide continuity of care and accurate patient assessments.
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Taylor HG, Klein N, Anselmo MG, Minich N, Espy KA, Hack M. Learning problems in kindergarten students with extremely preterm birth. ACTA ACUST UNITED AC 2011; 165:819-25. [PMID: 21893648 DOI: 10.1001/archpediatrics.2011.137] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To assess learning problems among kindergarten students with extremely preterm birth and to identify risk factors. DESIGN Cohort study. SETTING Children's hospital. PARTICIPANTS A cohort of 148 children born between January 1, 2001, and December 31, 2003, with extremely preterm birth, defined as less than 28 weeks' gestation or having a birth weight of less than 1000 g, and 111 classmate control individuals born at term with normal birth weight. INTERVENTIONS The children were enrolled in the study during their first year in kindergarten and were assessed on measures of learning progress. MAIN OUTCOME MEASURES Achievement testing, teacher ratings of learning progress, and individual educational assistance. RESULTS Children with extremely preterm birth had lower mean standard scores than controls on achievement tests of spelling (8.52; 95% confidence interval, 4.58-12.46) and applied mathematics (11.02; 6.76-15.28). They had higher rates of substandard learning progress by teacher report in written language (odds ratio, 4.23; 95% CI, 2.32-7.73) and mathematics (7.08; 2.79-17.95). Group differences in mathematics achievement and in teacher ratings of learning progress were statistically significant even in children without neurosensory deficits or low global cognitive ability. Neonatal risk factors, early childhood neurodevelopmental impairment, and socioeconomic status predicted learning problems in children with extremely preterm birth; however, many children with problems were not enrolled in a special education program. CONCLUSIONS Learning problems in children with extremely preterm birth are evident in kindergarten and are associated with neonatal and early childhood risk factors. Our findings support efforts to provide more extensive monitoring and interventions before and during the first year of school.
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Affiliation(s)
- H Gerry Taylor
- Department of Pediatrics, Case Western Reserve University, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH 44106-6038, USA.
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Larroque B, Ancel PY, Marchand-Martin L, Cambonie G, Fresson J, Pierrat V, Rozé JC, Marpeau L, Thiriez G, Alberge C, Bréart G, Kaminski M, Marret S. Special care and school difficulties in 8-year-old very preterm children: the Epipage cohort study. PLoS One 2011; 6:e21361. [PMID: 21760892 PMCID: PMC3132214 DOI: 10.1371/journal.pone.0021361] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 05/26/2011] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate school difficulties, special care and behavioral problems in 8 year-old very preterm (VPT) children. PATIENT AND METHODS Longitudinal population-based cohort in nine regions of France of VPT children and a reference group born at 39-40 weeks of gestation (WG). The main outcome measures were information about school, special care and behavioral problems using Strengths and Difficulties Questionnaire from a questionnaire to parents. RESULTS Among the 1439 VPT children, 5% (75/1439) were in a specialised school or class, 18% (259/1439) had repeated a grade in a mainstream class and 77% (1105/1439) were in the appropriate grade-level in mainstream class; these figures were 1% (3/327) , 5% (16/327) and 94% (308/327) , respectively, for the reference group. Also, 15% (221/1435) of VPT children in a mainstream class received support at school versus 5% (16/326) of reference group. More VPT children between the ages of five and eight years received special care (55% (794/1436)) than children born at term (38% (124/325)); more VPT children (21% (292/1387)) had behavioral difficulties than the reference group (11% (35/319)). School difficulties, support at school, special care and behavioral difficulties in VPT children without neuromotor or sensory deficits varied with gestational age, socioeconomic status, and cognitive score at the age of five. CONCLUSIONS Most 8-year-old VPT children are in mainstream schools. However, they have a high risk of difficulty in school, with more than half requiring additional support at school and/or special care. Referral to special services has increased between the ages of 5 and 8 years, but remained insufficient for those with borderline cognitive scores.
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Affiliation(s)
- Beatrice Larroque
- INSERM, UMR S953, IFR 69, Epidemiological Research on Perinatal Health and Women's and Children's Health, Paris, France
- UPMC Univ Paris 06, UMR S953, Paris, France
- * E-mail:
| | - Pierre-Yves Ancel
- INSERM, UMR S953, IFR 69, Epidemiological Research on Perinatal Health and Women's and Children's Health, Paris, France
- UPMC Univ Paris 06, UMR S953, Paris, France
| | - Laetitia Marchand-Martin
- INSERM, UMR S953, IFR 69, Epidemiological Research on Perinatal Health and Women's and Children's Health, Paris, France
- UPMC Univ Paris 06, UMR S953, Paris, France
| | - Gilles Cambonie
- Department of Neonatology, Arnaud de Villeneuve Hospital, Montpellier, France
| | | | - Véronique Pierrat
- Department of Neonatology, Jeanne de Flandres Hospital, Lille, France
| | | | - Loic Marpeau
- Department of Gynaecology and Obstetrics, Rouen University Hospital, Rouen and EA 4309 Perinatal Neurological Handicap, Institute of Biomedical Research and Innovation, Rouen University, Rouen, France
| | - Gerard Thiriez
- Paediatric intensive Care unit, Saint Jacques Hospital, Besançon, France
| | | | - Gérard Bréart
- INSERM, UMR S953, IFR 69, Epidemiological Research on Perinatal Health and Women's and Children's Health, Paris, France
- UPMC Univ Paris 06, UMR S953, Paris, France
| | - Monique Kaminski
- INSERM, UMR S953, IFR 69, Epidemiological Research on Perinatal Health and Women's and Children's Health, Paris, France
- UPMC Univ Paris 06, UMR S953, Paris, France
| | - Stéphane Marret
- Department of Neonatal Medicine, Rouen University Hospital, Rouen and EA 4309 Perinatal Neurological Handicap, Institute of Biomedical Research and Innovation, Rouen University, Rouen, France
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Abstract
In the late-1980s and early-1990s, much attention in America was focused on cocaine abuse. In particular, the effects of prenatal cocaine use on mothers and infants were in the news spotlight. Risks of adverse effects prompted funding for novel treatment programs. More recently, media attention has shifted elsewhere, and specialized treatment resources have grown scarce. This redirection of funding is unfortunate, as social stigma and fear of legal consequences continue to encourage cocaine-abusing pregnant women to hide drug use and avoid prenatal care. The purpose of this article is to summarize the most prominent adverse maternal and fetal/infant effects associated with prenatal cocaine use; review treatment options, focusing on comprehensive care programs of the 1990s as well as recent research on evidence-based practices and their applicability to pregnant women; and highlight the population of prenatal cocaine-abusing women uninterested in treatment, with a focus on promising strategies to promote drug abstinence and other positive health behaviors.
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Messinger D, Lambert B, Bauer CR, Bann CM, Hamlin-Smith K, Das A. The Relationship between Behavior Ratings and Concurrent and Subsequent Mental and Motor Performance in Toddlers Born at Extremely Low Birth Weight. JOURNAL OF EARLY INTERVENTION 2010; 32:214-233. [PMID: 20948978 PMCID: PMC2952951 DOI: 10.1177/1053815110380917] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
When predicting child developmental outcomes, reliance on children's scores on measures of developmental functioning alone might mask more subtle behavioral difficulties especially in children with developmental risk factors. The current study examined predictors and stability of examiner behavior ratings and their association with concurrent and subsequent mental and motor performance in toddlers born at extremely low birth weight. Toddlers were evaluated using the Behavior Rating scale (BRS) and the mental and psychomotor indexes of the Bayley-II at 18 and 30 months corrected age. BRS total and factor scores showed moderate stability between 18 and 30 months. These scores also predicted 30-month Mental Scale and Psychomotor Scale scores above and beyond prior mental and motor performance. Our findings suggest that early behavior ratings are associated with child mental and motor performance; therefore, behavior ratings might be useful in identifying toddlers at developmental risk and who might benefit from early intervention.
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Stephens BE, Tucker R, Vohr BR. Special health care needs of infants born at the limits of viability. Pediatrics 2010; 125:1152-8. [PMID: 20439603 DOI: 10.1542/peds.2009-1922] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare rates of survival and special health care needs (SHCN) from discharge to 18 months' corrected age between infants who were born between 22 and 24 weeks and 25 and 27 weeks and to determine predictors and persistence of SHCN. METHODS Data were collected on 508 infants who were born between 22 and 27 weeks from January 1, 1998, to December 31, 2002 at Women and Infants Hospital. SHCN was defined as need for home oxygen, medication, monitor, gastrostomy tube, or ventriculoperitoneal shunt. chi(2) was used to compare rates of survival and SHCN between groups. Regression analyses explored predictors of SHCN and their persistence. RESULTS Survival at 22 to 24 weeks was 53% vs 90% at 25 to 27 weeks. There were no 22-week survivors. Survivors at 23 to 24 weeks were more likely to be discharged on oxygen, a monitor, or medications; remain on oxygen or a monitor or require tube feeds at 18 months; and have a SHCN at any time than survivors who were born at 25 to 27 weeks. The strongest predictor of SHCN at discharge was chronic lung disease and at 18 months was public health insurance. CONCLUSIONS Rates of SHCN were high for infants who were born at the limits of viability. Although rates decreased with increasing age, 40% had persistent SCHN at 18 months. The association of public health insurance with persistent SHCN indicates a need for comprehensive health care and support services for infants with combined biological and environmental risks.
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Affiliation(s)
- Bonnie E Stephens
- Department of Pediatrics and Neonatology, Women and Infants Hospital, 101 Dudley St, Providence, RI 02905, USA.
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Vederhus BJ, Markestad T, Eide GE, Graue M, Halvorsen T. Health related quality of life after extremely preterm birth: a matched controlled cohort study. Health Qual Life Outcomes 2010; 8:53. [PMID: 20492724 PMCID: PMC2894784 DOI: 10.1186/1477-7525-8-53] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 05/23/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The majority of infants born before the last trimester now grow up. However, knowledge on subsequent health related quality of life (HRQoL) is scarce. We therefore aimed to compare HRQoL in children born extremely preterm with control children born at term. Furthermore, we assessed HRQoL in relation to perinatal and neonatal morbidity and to current clinical and sociodemographic characteristics. METHOD The Child Health Questionnaire (CHQ-PF50) and a general questionnaire were applied in a population based cohort of 10 year old children born at gestational age < or = 28 weeks or with birth weight < or = 1000 grams in Western Norway in 1991-92 and in term-born controls, individually matched for gender and time of birth. The McNemar test and paired t-tests were used to explore group differences between preterms and matched controls. Paired regression models and analyses of interaction (SPSS mixed linear model) were used to explore potential effects of sociodemographic and clinical characteristics on HRQoL in the two groups. RESULTS All 35 eligible preterm children participated. None had major impairments. Learning and/or attention problems were present in 71% of preterms and 20% of controls (odds ratio (OR): 7.0; 95% confidence interval (CI): 2.2 to 27.6). Insufficient professional support was described by 36% of preterm vs. 3% of control parents (OR: infinite; CI: 2.7 to infinite). Preterms scored lower on eight CHQ-PF50 sub-scales and the two summary scores, boys accounting for most of the deficits in areas of behavior, psychosocial functioning and parental burden. HRQoL was associated with learning and/or attention problems in both preterm and control children, significantly more so in preterms in areas related to health and parental burden. Within the preterm group, HRQoL was mostly unrelated to perinatal and neonatal morbidity. CONCLUSIONS HRQoL for children born extremely preterm, and particularly for boys, was described by parents to be inferior to that of children born at term, and sufficiently poor to affect the daily life of the children and their families. Learning and/or attention problems were reported for a majority of preterms, strongly influencing their HRQoL.
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Affiliation(s)
- Bente J Vederhus
- Department of Paediatrics, Haukeland University Hospital, Bergen, Norway.
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Marret S, Ancel PY, Marchand L, Charollais A, Larroque B, Thiriez G, Alberge C, Pierrat V, Rozé JC, Fresson J, Bréart G, Kaminski M. [Special outpatient services at 5 and 8 years in very-preterm children in the EPIPAGE study]. Arch Pediatr 2010; 16 Suppl 1:S17-27. [PMID: 19836664 DOI: 10.1016/s0929-693x(09)75297-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED The immature brain is highly susceptible to the consequences of very preterm birth with a high rate of long-term neurodisabilities in survivors and high use of specific outpatient services to limit the functional effects of the disabilities. To assess the economic burden for the social and health care system, it is necessary to inventory the community supports and need for special education or rehabilitation used by preterm children. Such studies are few and were done only in extremely low-birthweight or extremely preterm newborns in the United States. OBJECTIVE To study the rates of specific outpatient services and special education at 5 years of age and between 5 and 8 years of age in a geographically-defined population of children born very preterm. DESIGN, SETTING AND PATIENTS 2901 liveborn children before 33 weeks'gestation (WG) and one control group of 666 liveborn children at 39-40WG were included in nine regions of France in 1997 corresponding to more than one third of all births. At five years, these children had a medical examination and were evaluated by a psychologist at local centres organised for the study in every region. Cognitive function was assessed by the mental processing composite scale (PMC) of the Kauffmann Assessement Battery for Children test, which is considered to be equivalent to intelligence quotient and behavioral difficulties using the Strength and Difficulties questionnaire completed by the parents. Data for dependence or compensatory aids, i.e. occupational therapy or physical therapy, speech therapy, psychologist or psychiatrist visits, orthoptic therapy, wearing glasses, wearing hearing aid, specific equipment to walk (walker, wheelchair...), orthopaedic treatment or anti-epileptic treatment were collected from parents. At eight years, a postal questionnaire was sent to the parents to collect data on specific outpatient services and special treatments at home and school. Stata software was used (version 9.0). Main outcome measures. Parent Questionnaire for identifying children with chronic conditions and specific health care needs at 5 and 8 years and categorization of developmental neurodisabilities based on examination of children and psychometric evaluation at 5 years. RESULTS At 5 years data were obtained for respectively 1817 and 396 children born before 33WG or at 39-40WG, which represent 80% of the very preterm children and 71% of the at term children. At 8 years we obtained data for 63% of the very preterm children and 59% of the at term children. At 5 years, care in a rehabilitation center and/or specific outpatient services were required for 41% of children born between 24 and 28WG, 32% of children born between 24 and 32WG and 15% of those born at 39-40WG. Between 5 and 8 years, these figures were respectively 61%, 50% and 36%. In the very preterm group, rates of specific outpatient services were higher than 80% if the child had a motor and/or a neurosensory deficit. In case of cognitive deficiencies (PMC < 85), rates of specific outpatient services were low at 37% at 5 years and increases at 63% between 5 and 8 years. CONCLUSION Compared to the children born at term, the very preterm children have considerable educational needs, which are inversely related to gestational age at birth and to age of the children at the time of reporting. Despite economic burden, efforts to improve access to services are necessary, in particular in case of cognitive impairment.
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Affiliation(s)
- S Marret
- Service de Pédiatrie néonatale et réanimation, Centre d'Education fonctionnelle de l'Enfant, Hôpital Universitaire de Rouen, Université de Rouen, Rouen, France.
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