What Will It Take to Improve Very Low Birth Weight Follow-up Care?

Abstract

The study by Wang et al1 in this issue of Pediatrics highlights the lack of quality indicators for the neurodevelopmental follow-up of very low birth weight (VLBW) survivors. It is an excellent example of the effort required to develop explicit process criteria to evaluate the quality of VLBW follow-up care. The authors systematically reviewed 437 articles on clinical predictors, screening, and treatment for VLBW children by searching the PubMed database, screening articles by prominent authors in the field and articles cited in the Agency for Healthcare Research and Quality evidence report Criteria for Determining Disability in Infants and Children: Low Birth Weight ,2 and reviewing the clinical practice guidelines for follow-up care of VLBW infants. They drafted a set of 96 potential quality-of-care indicators in 5 content areas (general care; physical health; vision, hearing, speech, and language; developmental behavioral assessment; and psychosocial assessment), which a panel of 10 experts rated for validity, feasibility, and quality of evidence. Validity and feasibility were rated on a 9-point scale (1, low; 9, high). The quality of evidence was rated by using the Canadian Task Force on Periodic Health Examination system,3 which ranks quality of evidence from data generated from randomized, controlled trials as level I, data from cohort or case-control studies and nonrandomized, controlled trials … Address correspondence to Linda L. Wright, MD, Center for Research for Mothers and Children, National Institute of Child Health and Human Development, National Institutes of Health, Building 6100, Room 4B05J, Bethesda, MD 20815. E-mail: wrightl{at}mail.nih.gov