Neonatal-Perinatal Medicine Fellow Emory University School of Medicine Atlanta, Georgia, United States
Background: High-risk infant follow-up (HRIF) programs provide multidisciplinary care and developmental surveillance for infants at risk for delays and impairments after Neonatal Intensive Care Unit (NICU) discharge. Early engagement with HRIF is critical, because timely evaluation promotes early identification of concerns and facilitates provision of early intervention services to improve outcomes. Despite this, HRIF participation is an ongoing challenge. The largest proportion of patients withdraw between NICU discharge and the first visit. Published studies aiming to improve early follow-up have variably assumed that either parent education, organizational, or socioeconomic barriers are root causes of poor attendance to this first visit. We proposed a systematic analysis of factors impacting attendance of high-risk infants based on the International Classification of Health and Disability, to identify high-yield intervention targets. Objective: Determine infant clinical characteristics and family personal or environmental factors associated with timely first visit attendance at HRIF among referred infants discharged from a large referral NICU, serving a high proportion of families with adverse psychosocial determinants of health. Design/Methods: This is a retrospective and prospective study of 153 infants and families who were referred to HRIF in 2022-2023. Infants were < 32 weeks gestational age, < 1500 grams at birth, or had select risk factors for neurodevelopmental impairment. We determined attendance rates at the first HRIF visit and whether attendance was delayed beyond the recommended 3-4 months corrected age. We will compare infant and family factors that are associated with timely HRIF participation. Univariate analyses will be used to compare outcomes with a p-value < 0.05 considered significant. Finally, we will complement our study with a mixed methods analysis of NICU parent interviews, social determinants of health, and adverse childhood experiences. This study was approved by the university IRB. Data collection is in process with analysis to be completed by April.
