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Peyton C, Frazier M, Aaby D, Millman R, Rodriguez S, Boswell L, Msall ME, Spittle A, de Regnier RA, Barbosa VM, Sukal-Moulton T. Assessing Neonatal Intensive Care Unit (NICU) Graduates Across Varied Settings: A Study on the Feasibility of the Baby Moves App. J Pediatr 2024; 269:113979. [PMID: 38387754 PMCID: PMC11096057 DOI: 10.1016/j.jpeds.2024.113979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/15/2024] [Accepted: 02/16/2024] [Indexed: 02/24/2024]
Abstract
We assessed the feasibility of obtaining parent-collected General Movement Assessment videos using the Baby Moves app. Among 261 participants from 4 Chicago NICUs, 70% submitted videos. Families living in higher areas of childhood opportunity used the app more than those from areas of lower opportunity.
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Affiliation(s)
- Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago IL; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Mech Frazier
- Department of Research Services, Northwestern University Libraries, Chicago, IL
| | - David Aaby
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Ryan Millman
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago IL
| | - Sarah Rodriguez
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL
| | - Lynn Boswell
- Ann and Robert H Lurie Children's Hospital, Chicago IL
| | - Michael E Msall
- Department of Pediatrics, University of Chicago, Chicago, IL
| | - Alicia Spittle
- Victorian Infant Brain Studies (VIBeS), Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Raye-Ann de Regnier
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL; Ann and Robert H Lurie Children's Hospital, Chicago IL
| | | | - Theresa Sukal-Moulton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago IL; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Carlton K, Adams S, Fischer E, Foy A, Heffelfinger A, Jozwik J, Kim I, Koop J, Miller L, Stibb S, Cohen S. HOPE and DREAM: A Two-Clinic NICU Follow-up Model. Am J Perinatol 2024; 41:e1570-e1574. [PMID: 36918156 DOI: 10.1055/a-2053-7513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE The natural extension of inpatient-focused neonatal neurocritical care (NNCC) programs is the evaluation of long-term neurodevelopmental outcomes in the same patient population. CLINICAL DESIGN A dedicated and collaborative team of neonatologists, neonatal neurologists, neuropsychologists, neurosurgeons, physical medicine and rehabilitation physicians, and psychologists are necessary to provide personalized medicine, developmental assessments, and parental education for NNCC graduates. To achieve this goal, we devised a two-clinic follow-up model at Children's Wisconsin: HOPE (Healthy Outcomes Post-ICU Engagement) and DREAM: Developmentally Ready: Engagement for Achievement of Milestones) clinics. Those infants with significant neurologic diagnoses attend DREAM clinic, while all other high-risk neonatal intensive care unit (NICU) infants are seen in the HOPE clinic. CONCLUSION These clinic models allow for a targeted approach to post-NICU care, which has improved family engagement and perceptions of value. KEY POINTS · Infants with neurologic compromise are a specialized population with increasing survival.. · Interdisciplinary NICU follow-up brings together previously separated outpatient service lines.. · Our novel clinic model allows for specialized developmental assessments..
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Affiliation(s)
- Katherine Carlton
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Samuel Adams
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Elizabeth Fischer
- Division of Pediatric Psychology and Developmental Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrew Foy
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amy Heffelfinger
- Division of Neuropsychology, Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jenna Jozwik
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Irene Kim
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jennifer Koop
- Division of Neuropsychology, Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lauren Miller
- Division of Neuropsychology, Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Stacy Stibb
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Susan Cohen
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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Sebastian T, Gu W, Iurcotta T, Brachio SS. Improving access to neurodevelopmental resources for NICU graduates. J Perinatol 2024; 44:578-580. [PMID: 37919513 DOI: 10.1038/s41372-023-01819-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/10/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Theiju Sebastian
- Department of Pediatrics, Division of Neonatology, University of Chicago Medical Center, Chicago, IL, USA.
| | - Wendi Gu
- Department of Pediatrics, Division of Neonatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Toni Iurcotta
- Department of Pediatrics, Division of Neonatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Sandhya S Brachio
- Department of Pediatrics, Division of Neonatology, Columbia University Irving Medical Center, New York, NY, USA
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Cassidy AR, Neumann AA. [Formula: see text] Optimizing neurodevelopmental outcomes following fetal diagnosis of congenital heart disease: a call for primary prevention neuropsychology. Child Neuropsychol 2023; 29:1155-1177. [PMID: 36942716 DOI: 10.1080/09297049.2023.2190966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
Critical congenital heart disease (CHD) presents a lasting threat to quality of life through its adverse impact on neurodevelopmental and psychosocial outcomes. As recognition of this threat has increased, so too has an appreciation for the role of pediatric neuropsychologists in supporting families affected by CHD. But there is more to offer these families than traditional neuropsychological services, which tend to focus on secondary/tertiary forms of prevention. Now that many children with CHD are diagnosed prenatally, it may be possible to begin mitigating CHD-related risks and promoting positive outcomes earlier than ever before. Through primary prevention-oriented fetal neuropsychological consultation, as well as close collaboration with allied specialists, pediatric neuropsychology has an opportunity to re-envision its typical borders and more familiar practice models; to forge early and enduring partnerships with families; and to help promote the best possible neurodevelopmental trajectories, beginning before children are even born. In this conceptual review, we survey and integrate evidence from developmental science, developmental origins of health and disease, maternal-fetal medicine, and cardiac neurodevelopmental literatures, along with current practice norms, arriving ultimately at two central conclusions: 1) there is an important role to fill on multidisciplinary teams for the pediatric neuropsychologist in fetal cardiac care and 2) role expansion (e.g., through valuing broader-based training, flexing more generalist skills) can likely improve neuropsychological outcomes earlier than has been standard for pediatric neuropsychologists. Such a reimagining of our practice may be considered primary prevention neuropsychology. Implications for care in various settings and pragmatic barriers to implementation are discussed.
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Affiliation(s)
- Adam R Cassidy
- Departments of Psychiatry & Psychology and Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alyssa A Neumann
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
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Davis JW, Seeber CE, Nathan EA, Strunk T, Gill A, Sharp M. Outcomes to 5 years of outborn versus inborn infants <32 weeks in Western Australia: a cohort study of infants born between 2005 and 2018. Arch Dis Child Fetal Neonatal Ed 2023; 108:499-504. [PMID: 36804194 DOI: 10.1136/archdischild-2022-324749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/30/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE We compared mortality and morbidity of inborn versus outborn very preterm infants <32 weeks' gestation in Western Australia (WA) between 2005 and 2018. DESIGN Retrospective cohort study. PATIENTS Infants <32 weeks' gestation who were born in WA. MAIN OUTCOME MEASURES Mortality was assessed as death before discharge home from the tertiary neonatal intensive care unit. Short-term morbidities included combined brain injury (intracranial haemorrhage grade ≥3 and cystic periventricular leukomalacia) and other major neonatal outcomes. Developmental assessments at age 2, 3 and 5 years were evaluated. We performed multivariable logistic regression analysis of outborn status on outcomes, controlling for gestational age, birth weight z-score, sex and multiple birth. RESULTS A total of 4974 infants were born in WA between 22 and 32 weeks' gestation between 2005 and 2018 of which 4237 (89.6%) were inborn and 443 (10.4%) were outborn. Overall mortality to discharge was higher in outborn infants (20.5% (91/443) vs 7.4% (314/4237); adjusted OR (aOR) 2.44, 95% CI 1.60 to 3.70, p<0.001). Outborn infants had higher rates of combined brain injury than those inborn (10.7% (41/384) vs 6.0% (246/4115); aOR 1.98, 95% CI 1.37 to 2.86), p<0.001). No difference in up to 5-year developmental measures was detected. Follow-up data were available for 65% of outborn and 79% of inborn infants. CONCLUSIONS Outborn preterm infants <32 weeks in WA had increased odds of mortality and combined brain injury than those inborn. Developmental outcomes up to 5 years were similar between groups. Loss to follow-up may have impacted the long-term comparison.
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Affiliation(s)
- Jonathan W Davis
- Newborn Emergency Transport Service of Western Australia, Perth Children's Hospital, Nedlands, Western Australia, Australia
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - C E Seeber
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Elizabeth A Nathan
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Tobias Strunk
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Andy Gill
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Mary Sharp
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
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Pattnaik P, Nafday S, Angert R. Neonatal Intensive Care Unit to Home Discharge Communication: A Quality Improvement Project. Pediatr Qual Saf 2023; 8:e669. [PMID: 37434592 PMCID: PMC10332829 DOI: 10.1097/pq9.0000000000000669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 06/06/2023] [Indexed: 07/13/2023] Open
Abstract
Neonatal intensive care unit (NICU) graduates require complex services after discharge. The NICU discharge process at Children's Hospital at Montefiore-Weiler, Bronx, NY (CHAM-Weiler) lacked a system for routine primary care provider (PCP) notification. Here, we describe a quality improvement project to improve communication with PCPs to ensure communication of critical information and plans. Methods We assembled a multidisciplinary team and collected baseline data on discharge communication frequency and quality. We used quality improvement tools to implement a higher-quality system. The outcome measure was the successful delivery of a standardized notification and discharge summary to a PCP. We collected qualitative data through multidisciplinary meetings and direct feedback. The balancing measures comprised additional time spent during the discharge process and relaying erroneous information. We used a run chart to track progress and drive change. Results Baseline data indicated that 67% of PCPs did not receive notifications before discharge, and when PCPs did receive notifications, the discharge plans were unclear. PCP feedback led to proactive electronic communication and a standardized notification. The key driver diagram allowed the team to design interventions that led to sustainable change. After multiple Plan-Do-Study-Act cycles, delivery of electronic PCP notifications occurred more than 90% of the time. Surveys of pediatricians who received notifications indicated that the notifications were highly valued and aided in the transition of care for these at-risk patients. Conclusion A multidisciplinary team, including community pediatricians, was key to improving the rate of PCP notification of NICU discharge to more than 90% and transmitting higher-quality information.
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Affiliation(s)
- Priyam Pattnaik
- From the Department of Pediatrics, Division of Neonatology, Connecticut Children’s Medical Center, Hartford, Conn
| | - Suhas Nafday
- Department of Pediatrics, Division of Neonatology, The Children’s Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, N.Y
| | - Robert Angert
- Department of Pediatrics, Division of Neonatology, New York University Langone Medical Center, New York, N.Y
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Litt JS, Campbell DE. High-Risk Infant Follow-Up After NICU Discharge: Current Care Models and Future Considerations. Clin Perinatol 2023; 50:225-238. [PMID: 36868707 DOI: 10.1016/j.clp.2022.11.004] [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: 03/05/2023]
Abstract
Preterm infants are at heightened risk for chronic health problems and developmental delays compared with term-born peers. High-risk infant follow-up programs provide surveillance and support for problems that may emerge during infancy and early childhood. Although considered standard of care, program structure, content, and timing are highly variable. Families face challenges accessing recommended follow-up services. Here, the authors review common models of high-risk infant follow-up, describe novel approaches, and outline considerations for improving the quality, value, and equity of follow-up care.
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Affiliation(s)
- Jonathan S Litt
- Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA; Department of Pediatrics, Harvard Medical School; Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health.
| | - Deborah E Campbell
- Division of Neonatology, Children's Hospital at Montefiore, Weiler Einstein Campus, 1601 Tenbroeck Avenue, Bronx, NY 10461, USA; Department of Pediatrics, Albert Einstein College of Medicine
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8
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Chuo J, Olson C. Telemedicine: Progress Toward Optimizing Care Delivery (Let's Not Regress). Hosp Pediatr 2023; 13:e17-e19. [PMID: 36504283 DOI: 10.1542/hpeds.2022-007002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- John Chuo
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christina Olson
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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9
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Watson L, Woods CW, Cutler A, DiPalazzo J, Craig AK. Telemedicine Improves Rate of Successful First Visit to NICU Follow-up Clinic. Hosp Pediatr 2023; 13:3-8. [PMID: 36503988 DOI: 10.1542/hpeds.2022-006874] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES NICU graduates require ongoing surveillance in follow-up clinics because of the risk of lower cognitive, motor, and academic performance. We hypothesized that multiple programmatic changes, including availability of telemedicine consultation before hospital discharge, would improve NICU follow-up clinic attendance rates. METHODS In this retrospective study, we included infants who survived and were premature (≤29 6/7 weeks/<1500 g) or had brain injury (grade III/IV intraventricular hemorrhage, stroke or seizure, hypoxic ischemic encephalopathy). We compared rates of follow-up for the early cohort (January 2018-June 2019; no telemedicine) with the late cohort (May 2020-May 2021; telemedicine available); and performed a mediation analysis to assess other programmatic changes for the late cohort including improved documentation to parents and primary care provider regarding NICU follow-up. RESULTS The rate of successful 12-month follow-up improved from 26% (early cohort) to 61% (late cohort) (P < .001). After controlling for maternal insurance, the odds of attending a 12-month follow-up visit were 3.7 times higher for infants in the late cohort, for whom telemedicine was available (confidence interval, 1.8-7.9). Approximately 37% of this effect was mediated by including information for NICU follow-up in the discharge documentation for parents (P < .001). CONCLUSIONS Telemedicine consultation before NICU discharge, in addition to improving communication regarding the timing and importance of NICU follow-up, was effective at improving the rate of attendance to NICU follow-up clinics.
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Affiliation(s)
- Lilly Watson
- Department of Pediatrics, Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Christopher W Woods
- Division of Neonatology, Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Anya Cutler
- MaineHealth Institute for Research, Portland, Maine
| | | | - Alexa K Craig
- Division of Pediatric Neurology, Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
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Lakshmanan A, Rogers EE, Lu T, Gray E, Vernon L, Briscoe H, Profit J, Jocson MAL, Hintz SR. Disparities and Early Engagement Associated with the 18- to 36-Month High-Risk Infant Follow-Up Visit among Very Low Birthweight Infants in California. J Pediatr 2022; 248:30-38.e3. [PMID: 35597303 DOI: 10.1016/j.jpeds.2022.05.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/14/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine follow-up rates for the high-risk infant follow-up (HRIF) visit at 18-36 months among infants with very low birthweights and identify factors associated with completion. STUDY DESIGN We completed a retrospective cohort study using linked California Perinatal Quality of Care Collaborative neonatal intensive care unit, California Perinatal Quality of Care Collaborative California Children's Services HRIF, and Vital Statistics Birth Cohort databases. We identified maternal, sociodemographic, neonatal, clinical, and HRIF program level factors associated with the 18- to 36-month follow-up using multivariable Poisson regression. RESULTS From 2010 to 2015, among 19 284 infants with very low birthweight expected to attend at least 1 visit at 18-36 months, 10 249 (53%) attended. On multivariable analysis, factors independently associated with attendance at an 18- to 36-month visit included estimated gestational age (relative risk [RR], 1.21; 95% CI, 1.15-1.26; <26 weeks vs ≥31 weeks), maternal education (RR, 1.09; 95% CI, 1.06-1.12; college degree or more vs high school), distance from clinic (RR, 0.92; 95% CI, 0.89-0.97; fourth quartile vs first quartile), and Black non-Hispanic race vs White race (RR, 0.88; 95% CI, 0.84-0.92). However, completion of an initial HRIF visit within the first 12 months was the factor most strongly associated with completion of an 18- to 36-month visit (RR, 6.47; 95% CI, 5.91-7.08). CONCLUSIONS In a California very low birthweight cohort, maternal education, race, and distance from the clinic were associated with sustained HRIF participation, but attendance at a visit by 12 months was the most significantly associated factor. These findings highlight the importance of early engagement with all families to ensure equitable follow-through for children born preterm.
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Affiliation(s)
- Ashwini Lakshmanan
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA.
| | | | - Tianyao Lu
- California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Erika Gray
- California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Lelis Vernon
- Florida Perinatal Quality Collaborative (PQC), Tampa, FL; Stanford University School of Medicine Department of Pediatrics, Division of Neonatal and Developmental Medicine, Palo Alto, CA
| | | | - Jochen Profit
- California Perinatal Quality Care Collaborative, Palo Alto, CA; Florida Perinatal Quality Collaborative (PQC), Tampa, FL
| | - Maria A L Jocson
- California Department of Health Care Services, California Children's Services, Sacramento, CA
| | - Susan R Hintz
- California Perinatal Quality Care Collaborative, Palo Alto, CA; Florida Perinatal Quality Collaborative (PQC), Tampa, FL
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11
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Sobotka SA, Lynch EJ, Dholakia AV, Mayampurath A, Pinto NP. PICU Survivorship: Factors Affecting Feasibility and Cohort Retention in a Long-Term Outcomes Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1041. [PMID: 35884025 PMCID: PMC9317147 DOI: 10.3390/children9071041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
Our understanding of longitudinal outcomes of Pediatric Intensive Care Unit (PICU) survivors is limited by the heterogeneity of follow-up intervals, populations, and outcomes assessed. We sought to demonstrate (1) the feasibility of longitudinal multidimensional outcome assessment and (2) methods to promote cohort retention. The objective of this presented study was to provide details of follow-up methodology in a PICU survivor cohort and not to present the outcomes at long-term follow-up for this cohort. We enrolled 152 children aged 0 to 17 years admitted to the PICU in a prospective longitudinal cohort study. We examined resource utilization, family impact of critical illness, and neurodevelopment using the PICU Outcomes Portfolio (POP) Survey which included a study-specific survey and validated tools: 1. Functional Status Scale, 2. Pediatric Evaluation of Disability Inventory Computer Adaptive Test, 3. Pediatric Quality of Life Inventory, 4. Strengths and Difficulties Questionnaire, and 5. Vanderbilt Assessment Scales for Attention Deficit-Hyperactivity Disorder. POP Survey completion rates were 89%, 78%, and 84% at 1, 3, and 6 months. Follow-up rates at 1, 2, and 3 years were 80%, 55%, and 43%. Implementing a longitudinal multidimensional outcome portfolio for PICU survivors is feasible within an urban, tertiary-care, academic hospital. Our attrition after one year demonstrates the long-term follow-up challenges in this population. Our findings inform ongoing efforts to implement core outcome sets after pediatric critical illness.
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Affiliation(s)
- Sarah A. Sobotka
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, 950 East 61st Street, Suite 207, Chicago, IL 60637, USA;
| | - Emma J. Lynch
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, 950 East 61st Street, Suite 207, Chicago, IL 60637, USA;
| | - Ayesha V. Dholakia
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA;
| | - Anoop Mayampurath
- Department of Biostatistics & Medical Informatics, The University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Neethi P. Pinto
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
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12
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Suir I, Oosterhaven J, Boonzaaijer M, Nuysink J, Jongmans M. The AIMS home-video method: parental experiences and appraisal for use in neonatal follow-up clinics. BMC Pediatr 2022; 22:338. [PMID: 35690764 PMCID: PMC9187888 DOI: 10.1186/s12887-022-03398-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background In The Netherlands, prematurely born infants and their parents are offered regular developmental check-ups in a hospital setting. In line with providing healthcare at distance, the use of video footage showing the infant’s behavior and movements, taken by parents at home and assessed by professionals online, might be a fruitful future practice. The focus of this study was to gain insight into parental experiences with the Alberta Infant Motor Scale home-video method and their appraisal of its applicability for use in an outpatient neonatal follow-up clinic. Method A qualitative descriptive study among parents of healthy extremely or very premature infants (GA 26.2–31.5 weeks) participating in a longitudinal study of motor development between 3–18 months corrected age. Ten semi-structured interviews were conducted and transcribed verbatim. Data was analyzed independently. Inductive content analysis was performed following the process of the AIMS home-video method. Results Parents appraised the AIMS home-video method as manageable and fun to do. Instructions, instruction film, and checklists were clear. Transferring the video footage from their phone to their computer and uploading it to the web portal was sometimes time-consuming. Parents gained a better awareness of their infant’s motor development and found the provided feedback a confirmation of what they already thought about their infant’s development and was reassuring that their child was doing well. First-time parents seemed more uncertain and had a greater need for information about (motor) development, but on the other hand, also had confidence in their child. All parents thought that home-videos can be an addition to follow-up visits, but cannot replace (all) visits. It may be an opportunity to reduce the frequency of hospital visits, while still having their infant monitored. Conclusion Parents appraised the AIMS home-video method positively and are of the opinion that home-videos can be of added value in monitoring infants at risk in neonatal follow-up additional to hospital visits. In future research a user-friendly application and/or platform to exchange video footage safely between parents and professionals should be developed with all possible stakeholders involved and implementation should be explored. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03398-9.
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Affiliation(s)
- I Suir
- Research Group Lifestyle and Health, Research Centre Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, The Netherlands. .,Faculty of Social and Behavioural Sciences, Department of Pedagogical and Educational Sciences, Utrecht University, Utrecht, The Netherlands.
| | - J Oosterhaven
- Research Group Lifestyle and Health, Research Centre Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, The Netherlands
| | - M Boonzaaijer
- Research Group Lifestyle and Health, Research Centre Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, The Netherlands.,Faculty of Social and Behavioural Sciences, Department of Pedagogical and Educational Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Neonatology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - J Nuysink
- Research Group Lifestyle and Health, Research Centre Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, The Netherlands
| | - M Jongmans
- Faculty of Social and Behavioural Sciences, Department of Pedagogical and Educational Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Neonatology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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13
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Lakshmanan A, Sunshine I, Escobar CM, Kipke M, Vanderbilt D, Friedlich PS, Mirzaian CB. Connecting to Early Intervention Services After Neonatal Intensive Care Unit Discharge in a Medicaid Sample. Acad Pediatr 2022; 22:253-262. [PMID: 34757023 PMCID: PMC8901461 DOI: 10.1016/j.acap.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe caregiver perspectives regarding connecting to early intervention (EI) services after neonatal intensive care unit discharge in a Medicaid sample. METHODS Open-ended semistructured interviews and focus groups were conducted with English- or Spanish-speaking families enrolled in Medicaid in an urban high-risk infant follow-up clinic at a safety-net center, which serves preterm and high-risk term infants. We generated salient themes using inductive-deductive thematic analysis. RESULTS Thirty-two participants completed the study. The infant's median (interquartile range) birth weight was 1365 (969, 2800) grams; 50% were Hispanic; 31% reported living in a neighborhood with fourth quartile economic hardship. Eighty-one percent were classified as having chronic complex disease per the Pediatric Medical Complexity Algorithm and 63% had a diagnosis of developmental delay. A conceptual model was constructed and the analysis revealed major themes describing families' challenges and ideas to facilitate connection to EI. We identified subthemes related to the person in environment: health care environment/support and socio-economic resources, parent perspectives and built environment; provider level factors such as appointment scheduling, staff limitations, and parent suggestions to improve health care and service navigation, which included improved information sharing, the importance of patient advocates, video resources, early referrals to EI facilitated by the discharging hospital and system workarounds. CONCLUSIONS The results from this study may provide a granular roadmap for providers to help facilitate referrals to EI services. We identified several ideas such as using advocates and providing transitional resources, including online media, that might improve the connection to EI services.
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Affiliation(s)
- Ashwini Lakshmanan
- Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California (A Lakshmanam), Los Angeles, Calif; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (A Lakshmanam), Los Angeles, Calif.
| | - Isabel Sunshine
- Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif
| | - Cindy M Escobar
- Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif
| | - Michele Kipke
- Division of Research on Children, Youth and Families, Children's Hospital, Keck School of Medicine, University of Southern California (M Kipke), Los Angeles, Calif; Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California (M Kipke), Los Angeles, Calif
| | - Douglas Vanderbilt
- Section of Developmental-Behavioral Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California (D Vanderbilt), Los Angeles, Calif
| | - Philippe S Friedlich
- Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif
| | - Christine B Mirzaian
- Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California (CB Mirzaian), Los Angeles, Calif
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Haffner DN, Bartram LR, Coury DL, Rice CE, Steingass KJ, Moore-Clingenpeel M, Maitre NL. The Autism Detection in Early Childhood Tool: Level 2 autism spectrum disorder screening in a NICU Follow-up program. Infant Behav Dev 2021; 65:101650. [PMID: 34653736 DOI: 10.1016/j.infbeh.2021.101650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 09/16/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Children born preterm are at increased risk for autism spectrum disorder (ASD). However, early diagnosis of ASD is challenging because conventional screening Level 1 tools are less reliable in this population. We sought to determine whether the Autism Detection in Early Childhood (ADEC) and Child Behavior Checklist (CBCL) could accurately identify children at risk for ASD in a NICU Follow-up setting and thus facilitate referral for formal ASD evaluation. METHOD Children aged 18-36 months were recruited from a NICU Follow-up program. All children received presumptive diagnoses based on DSM-5 criteria and were screened for ASD risk with the ADEC and CBCL. Children scoring in the "at risk" range on either tool were referred for a full diagnostic ASD evaluation. RESULTS Sixty-nine patients (median birth weight 1140 g; median gestational age 28 weeks) were included with 18 designated "at risk" for ASD. Nine (13 %) scored "at risk" on the ADEC and 12 (17 %) on the CBCL. Thirteen children underwent diagnostic ASD evaluation with 9 receiving a formal diagnosis of ASD. The ADEC demonstrated the best performance (sensitivity 89 %, specificity 98 %). The CBCL was less sensitive (sensitivity 50 %, specificity 90 %). Requiring elevated scores on both the CBCL and ADEC was specific but not sensitive (sensitivity 33 %, specificity 100 %). CONCLUSION The ADEC performed well in identifying children at risk for ASD within this high-risk NICU cohort, adding benefit as an autism-specific screening tool over the CBCL alone.
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Affiliation(s)
- Darrah N Haffner
- Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, Columbus, OH, USA; Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Lindsay R Bartram
- Department of Pediatrics, Division of Developmental Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daniel L Coury
- Department of Pediatrics, Division of Developmental Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Courtney E Rice
- Department of Psychiatry and Behavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Katherine J Steingass
- Department of Pediatrics, Division of Developmental Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Melissa Moore-Clingenpeel
- Biostatistics Core, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Nathalie L Maitre
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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15
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Parker MG, Hwang SS. Quality improvement approaches to reduce racial/ethnic disparities in the neonatal intensive care unit. Semin Perinatol 2021; 45:151412. [PMID: 33865628 DOI: 10.1016/j.semperi.2021.151412] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Inequities in neonatal care quality and outcomes persist. Current models of neonatal quality improvement (QI) typically involve implementation of standardized approaches to clinical care that seek to provide consistent care to all infants and their families, which may neglect to account for the unique needs of diverse patient populations. Current approaches often fail to track outcome and process measures by important social disparity metrics, such as race/ethnicity and primary language. Despite these shortcomings, use of a QI structure has tremendous potential to address disparities in neonatal care. Crucial components of a QI approach to achieve health equity include: (1) Identifying equity goals from the inception of a project; (2) Inclusion of diverse family members on multidisciplinary teams; (3) Tracking outcome and process measures according to disparity metrics; and (4) Conducting interventions that preferentially address barriers of high-risk social groups. Hospital-system commitment to diversity and inclusion in the healthcare work force, recognition of the impact of unconscious provider bias and advocacy in the greater public health setting are needed to address underlying social inequities that impact neonatal care quality.
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Affiliation(s)
- Margaret G Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, 88 E Newton St, Vose Hall, 3rd Floor, Boston, MA 02118, United States.
| | - Sunah S Hwang
- Department of Pediatrics, Colorado Children's Hospital, University of Colorado School of Medicine, United States
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