Our Responsibility to Follow Through for NICU Infants and Their Families.

Abstract

* Abbreviations: PBP — : potentially better practice QI — : quality improvement In America, health and well-being are, to a large extent, determined by a person’s race, ethnicity, income, immigration status, and neighborhood of residence. Racism, segregation, and inequality of income, opportunity, and wealth cause disparities in health outcomes across the life course.1 The effects are particularly pronounced for infants requiring neonatal intensive care and their families because of the already significant risk for neurodevelopmental disabilities and need for specialized services. As health professionals, pediatricians, and neonatal health care providers, we have the responsibility to address these social determinants of health. We must learn to practice social as well as technical medicine2 and follow-through, accepting that our responsibility to the infants and families we serve extends beyond the hospital or clinic walls. Although in this article we focus on follow-through in the neonatal intensive care setting, the ideas for practicing social medicine we present have wider application in pediatrics, obstetrics, and beyond. We have proposed the term “follow-through” to distinguish our proposal from the more typical neonatal practice of “follow-up” in which the services and staffing of clinics are focused, primarily, on medical conditions and assessment of neurodevelopment after discharge from the NICU. Only 70% of follow-up clinics provide any social services, for example, and <10% provide legal services.3 We propose a more comprehensive approach that begins before birth and continues into childhood, involving health professionals, families, and communities as partners to meet the social as well … Address correspondence to Erika M. Edwards, PhD, MPH, Data Science, Vermont Oxford Network, 33 Kilburn St, Burlington, VT 05401. E-mail: eedwards{at}vtoxford.org