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.
Highlights
Improvement of survival rates for very low birth weight (VLBW) and extremely preterm infants resulted in advances in perinatal and neonatal care [1,2,3]
Data were prospectively collected for 3522 VLBW infants born between January 2013 and December 2014 from 57 Korean Neonatal Network (KNN) centers by local staff using a standardized electronic case report form [16,17]
neonatal intensive care unit (NICU) volume, as calculated according to the number of VLBW infants per institution enrolled in KNN, showed significant differences in follow-up rates
Summary
Improvement of survival rates for very low birth weight (VLBW) and extremely preterm infants resulted in advances in perinatal and neonatal care [1,2,3]. Preterm infants are at a high risk for neurologic and developmental sequelae [4,5,6] and require significant outpatient services [7]. The need to link high-risk infant tracking after discharge from the neonatal intensive care unit (NICU) has been emphasized to assure early identification and intervention [8]. Successful visits for outpatient services in recent studies are not guaranteed, with compliance rates between 70% to 100% with variations, even if neonates were identified as highrisk infants and careful follow-ups are required [9,10]. In a population-based study, there was wide variability in referral among regions (8–98%) and NICUs (< 5–100%) [11]
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