High-risk Infant Follow-up Research Articles

Neurodevelopmental outcome of late-preterm infants: A pragmatic review

The number of late-preterm births (34^{0/7} to 36^{6/7} weeks of gestation at birth) has steadily increased over recent years. Recent reports suggest that late-preterm infants are at an increased risk of developing neurodevelopmental abnormalities, compared with full-term infants. The aim of this paper is to carry out a pragmatic review of the current evidence regarding the neurodevelopmental risks of speech delay, cerebral palsy, cognitive delay, autism spectrum disorder and attention deficit hyperactivity disorder in late-preterm infants. Evidence from cohort studies indicates that late-preterm infants have a higher risk of speech delay in the first two years, and cognitive delay and attention problems in early childhood, compared with infants born at term. However, the results are inconsistent. Some reports indicate ‘catch up’ development with speech and cognition. Developmental surveillance through regular follow-up of high-risk late-preterm infants is necessary to identify risks at the earliest.

Neurodevelopmental outcome of late-preterm infants: A pragmatic review

The number of late-preterm births (34^{0/7} to 36^{6/7} weeks of gestation at birth) has steadily increased over recent years. Recent reports suggest that late-preterm infants are at an increased risk of developing neurodevelopmental abnormalities, compared with full-term infants.The aim of this paper is to carry out a pragmatic review of the current evidence regarding the neurodevelopmental risks of speech delay, cerebral palsy, cognitive delay, autism spectrum disorder and attention deficit hyperactivity disorder in late-preterm infants.Evidence from cohort studies indicates that late-preterm infants have a higher risk of speech delay in the first two years, and cognitive delay and attention problems in early childhood, compared with infants born at term. However, the results are inconsistent. Some reports indicate ‘catch up’ development with speech and cognition. Developmental surveillance through regular follow-up of high-risk late-preterm infants is necessary to identify risks at the earliest.

Audiological follow-up in a risk-based newborn hearing screening programme: An exploratory study of the influencing factors.

BackgroundFollow-up return rate in Early Hearing Detection and Intervention (EHDI) programmes is of specific importance as it ensures that benchmarks are met and that no child with suspected hearing loss is left unidentified.ObjectivesThe aim of this study was to determine the factors influencing audiological follow-up of high-risk infants in a risk-based newborn hearing screening programme.MethodA non-experimental, exploratory, qualitative research design was employed. Purposive sampling was used. The study was conducted at a secondary level hospital in the public health care sector in South Africa. Participants comprised 10 caregivers (age range 26–40 years) of infants who had been enrolled in a risk-based newborn hearing screening programme, and returned for follow-up appointments. Data were collected using semi-structured interviews. Responses were recorded by the researcher and a colleague to ensure rigour and trustworthiness of findings. Data were analysed using thematic analysis for open-ended questions and descriptive statistics for the closed-ended questions.ResultsThe most common positive contributors that facilitated participants’ attendance at follow-up appointments were: having friendly audiologists; a clear line of communication between caregiver and audiologist and a reminder of the appointment. The most significant perceived challenge that participants described in returning for the follow-up appointment was living in far proximity from the hospital.ConclusionFindings of the study revealed that influencing factors on follow-up return rate are demographic, socio-economic, and interpersonal in nature and further suggested the need for an all-inclusive appointment day. It may be of importance to not only look at what is being done to improve the follow-up return rate but also how it should be done in terms of professional-to-patient communication and interactions.

NICU Graduates: The Role of the Allied Health Team in Follow-Up.

Infants who graduate from the neonatal intensive care unit, including those infants born preterm and/or with brain injury, are at increased risk of long-term neurodevelopmental impairments. The developmental allied health team, consisting of physical therapy, occupational therapy, and speech pathology, is crucial in early evaluation of gross motor, fine motor, feeding, and language development. Surveillance of neurodevelopment in the first year of life is essential to ensure early detection of specific developmental delays and impairments, and to ensure timely referral for early intervention. Early intervention is not only important in optimizing long-term outcomes for the child, but it also plays an important role in enhancing the parent-child relationship and parental well-being. In this review, we discuss the role of the developmental allied health team in the follow-up of high-risk infants, identify key assessment tools used in early neurodevelopmental surveillance, and provide recommendations regarding referral to intervention programs to optimize child and family outcomes. [Pediatr Ann. 2018;47(4):e165-e171.].

Programmatic and Administrative Barriers to High-Risk Infant Follow-Up Care.

This article characterizes programmatic features of a population-based network of high-risk infant follow-up programs and identifies potential challenges associated with attendance from the providers' perspective. A web-based survey of high-risk infant follow-up program directors, coordinators, and providers of a statewide high-risk infant follow-up system. Frequencies and percentages were used to describe the survey responses. Of the 68 high-risk infant follow-up programs in California, 56 (82%) responded to the survey. The first visit no-show rate between 10 and 30% was estimated by 44% of programs with higher no-show rates for subsequent visits. Common strategies to remind families of appointments were phone calls and mailings. Most programs (54%) did not have a strategy to help families who lived distant to the high-risk infant follow-up clinic. High-risk infant follow-up programs may lack resources and effective strategies to enhance follow-up, particularly for those living at a distance.

Clinical Outcomes of High-Risk Infant Follow-Up Program in a Tertiary Care Centre.

Background:High-risk infant follow-up (HRIF) program is necessary for early detection, timely intervention, and promotion of health outcomes in vulnerable infants, ethically. The present study was carried out to assess the clinical outcomes of the HRIF Program in Alzahra hospital as a tertiary care centre, in Iran.Materials and Methods:In this cohort study, 5840 neonates were born at Alzahra hospital, from June 1, 2011 to 30th February 2012. Among those who were admitted to neonatal intensive care unit (NICU), 253 infants were recruited by census according to HRIs criteria. After doing necessary measurements and family education, information was recorded in HRI health certificate and then entered in the access database for analysis.Results:From 253 eligible HRIs registered, 241 (95%) infants attended the follow-up clinic after discharge. A total of180 cases were recalled for further visits, 110 of which attended the clinic. Anthropometric indices had an increasing trend in the first 6 months of life. There was no significant relation between ages and stages questionnaire (ASQ) results and infant birth weight, height, and head circumference. The ratios of intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP) were 8.7% and 3.1%, respectively. The incidence of congenital hypothyroidism was 2:341 in HRIs.Conclusions:Although some outcomes, such as ROP, improved in our study compared to similar studies, the findings indicate an impairment of the current follow-up processes and highlight the necessity to modify the current HRIF program. Ethically, we insist on integrating HRIF program in child health services to promote early childhood development.

Implementation of the Hammersmith Infant Neurological Examination in a High-Risk Infant Follow-Up Program

BackgroundHigh-risk infant follow-up programs provide early identification and referral for treatment of neurodevelopmental delays and impairments. In these programs, a standardized neurological examination is a critical component of evaluation for clinical and research purposes. MethodsTo address primary challenges of provider educational diversity and standardized documentation, we designed an approach to training and implementation of the Hammersmith Infant Neurological Examination with precourse materials, a workshop model, and adaptation of the electronic medical record. ConclusionsProvider completion and documentation of a neurological examination were evaluated before and after Hammersmith Infant Neurological Examination training. Standardized training and implementation of the Hammersmith Infant Neurological Examination in a large high-risk infant follow-up is feasible and effective and allows for quantitative evaluation of neurological findings and developmental trajectories.

Five-Year Follow-Up of High-Risk Infants with Family History of Allergy Who Were Exclusively Breast-Fed or Fed Partial Whey Hydrolysate, Soy, and Conventional Cow's Milk Formulas: Expression of Serious Concern.

Five-Year Follow-Up of High-Risk Infants with Family History of Allergy Who Were Exclusively Breast-Fed or Fed Partial Whey Hydrolysate, Soy, and Conventional Cow's Milk Formulas: Expression of Serious Concern.

Part C Early Intervention Enrollment in Low Birth Weight Infants At-Risk for Developmental Delays.

Objectives To investigate enrollment patterns in Part C Early Intervention (EI) for low birth weight (LBW) infants (≤2500g). A secondary aim is to characterize LBW infants that are not enrolled in EI, but would qualify by meeting criteria for a condition associated with a "high-probability" for developmental delays (i.e., Intraventricular Hemorrhage grade III or higher, Apgar score of ≤5 at 5min, and/or birth weight of ≤1200g). Methods Data were gathered from 165 LBW infants participating in a high-risk infant follow-up program. Developmental assessment was completed. Basic demographic information and data regarding enrollment in EI were collected via parent questionnaire. Medical variables were extracted from each infant's electronic medical record. Results 71.5% of LBW infants were not enrolled in EI. Factors influencing probability of EI enrollment included birth weight, gestational age, developmental test scores, and insurance status. Of the 107 infants living in Oregon who were not enrolled in EI, 42.1% would qualify for services due to an early medical condition identified in Oregon as a condition associated with a "high-probability" for developmental delays. Conclusions Less than one third of LBW infants were enrolled in EI by their first visit to a high-risk infant follow-up program. Those infants demonstrating developmental delays and public insurance were more likely to be enrolled. The majority of infants who have readily identifiable medical risk factors that qualify them for EI were not enrolled. This study was limited by the constraints implicated by using a clinical sample.

Referral of Very Low Birth Weight Infants to High-Risk Follow-Up at Neonatal Intensive Care Unit Discharge Varies Widely across California

To determine rates and factors associated with referral to the California Children's Services high-risk infant follow-up (HRIF) program among very low birth weight (BW) infants in the California Perinatal Quality of Care Collaborative. Using multivariable logistic regression, we examined independent associations of demographic and clinical variables, neonatal intensive care unit (NICU) volume and level, and California region with HRIF referral. In 2010-2011, 8071 very low BW infants were discharged home; 6424 (80%) were referred to HRIF. Higher odds for HRIF referral were associated with lower BW (OR 1.9, 95% CI 1.5-2.4; ≤ 750 g vs 1251-1499g), higher NICU volume (OR 1.6, 1.2-2.1; highest vs lowest quartile), and California Children's Services Regional level (OR 3.1, 2.3-4.3, vs intermediate); and lower odds with small for gestational age (OR 0.79, 0.68-0.92), and maternal race African American (OR 0.58, 0.47-0.71) and Hispanic (OR 0.65, 0.55-0.76) vs white. There was wide variability in referral among regions (8%-98%) and NICUs (<5%-100%), which remained after risk adjustment. There are considerable disparities in HRIF referral, some of which may indicate regional and individual NICU resource challenges and barriers. Understanding demographic and clinical factors associated with failure to refer present opportunities for targeted quality improvement initiatives.

Challenges of integrating patient-centered data into clinical workflow for care of high-risk infants

In this paper, we outline the challenges to integrating patient-centered data into clinical workflow that were encountered during the deployment of a research prototype mobile system, Estrellita, designed to support collection of data about preterm infants and their parents. The data sources for our analysis come from approximately 4 years of collaboration, beginning in March of 2008, between an academic research team and various clinical partners specializing in high-risk infant care. Specifically, we draw from interviews with parents, pediatric health specialists, community pediatricians, and clinicians at a high-risk infant follow-up program; our collaborative experience throughout the project; and observations of one clinician as she integrated patient-generated data into her workflow over an 8-month period. We identified three major challenges to integrating patient-generated data into the clinical workflow: (1) finding an appropriate clinical partner, (2) designing for the unique workflow of the HRIF program, and (3) designing to minimize clinician liability. We further present workflow analysis from one clinician who monitored the patient-generated data. We discuss lessons learned and opportunities for design.

Parental preference and ability to participate in web-based developmental screening and surveillance: preliminary evidence for preterm infants after NICU discharge.

The objectives of this article were (a) to describe prevalence of Internet and email access among parents of preterm infants attending high-risk follow-up, (b) to describe parent preference for completing developmental questionnaires online versus on paper, and (c) to examine predictors of access and preference. We surveyed 270 parents of preterm infants attending a high-risk follow-up clinic about Internet and email access, preference for completing a developmental questionnaire online versus on paper. Median (interquartile range) gestational age was 28 (26, 30) weeks, and birth weight was 970 (765, 1230) grams. Ninety-five percent of parents had Internet and email access, and 71% preferred completing a developmental questionnaire online versus on paper or were indifferent. Less maternal education, lower family income, and Hispanic ethnicity were associated with less Internet and email access. Most families attending a high-risk preterm infant follow-up clinic had Internet and email access and preferred completing developmental questionnaires online to on paper or were indifferent.

Who Is at Risk? High-Risk Infant Follow-up

Plans for discharge home from the neonatal intensive care unit (NICU) should begin with identification of which infants are at-risk for developing disability or early demise. As much as possible, this article serves as an evidenced-based review for identifying vulnerable infants in the NICU who are at higher risk for morbidity or early mortality. This article draws on the American Association of Pediatrics recommendations that highlight the responsibilities of the NICU team to recognize risk, plan discharge, and assist with transitioning care post discharge. Nurses, as professional team members, are ideal for identifying at-risk status, devising individualized discharge plans, and assuring referrals to high-risk infant follow-up (HRIF). HRIF programs bridge care pre and post NICU discharge to assure that infants with complex issues and special needs reach optimal health and developmental levels.

Long‐term cognitive outcomes of extremely low‐birth‐weight infants: the influence of the maternal educational background

The purpose of the present contribution is to analyse the relationships between perinatal risk factors, social parameters and neurodevelopmental outcomes in extremely low-birth-weight (ELBW) children up to the age of 10-13 years. Of 200 live-born ELBW infants, 148 were enrolled in the high-risk infant follow-up programme. Each follow-up visit included a neurodevelopmental examination and an interview with the infant's parents. Multivariate analyses using SPSS (version 17.0, Chicago, IL, USA) were conducted, and a p-value of <0.05 indicated a statistically significant result. The results of the logistic regression analysis of the biological and sociodemographic risk factors illustrated that a low maternal educational background is the most important factor (OR, 21.9) associated with a decreased composite intelligence quotient (IQ) in children between 10 and 13 years old. A Grade III or Grade IV intraventricular haemorrhage (IVH) or periventricular leukomalacia (PVL) were also associated with decreased IQ at the age of 10-13 years (OR, 6.9). These results were confirmed by ANOVAs with repeated measurements. Maternal educational background is the strongest predictor of long-term neurodevelopment in ELBW children. The findings emphasize the need for special support and follow-up care services for poorly educated parents.

Current state of high-risk infant follow-up care in the United States: results of a national survey of academic follow-up programs

High-risk infant follow-up programs have the potential to act as multipurpose clinics by providing continuity of clinical care, education of health care trainees and facilitating outcome data research. Currently there are no nationally representative data on high-risk infant follow-up practices in the United States. The objective of this study is to collect information about the composition of high-risk infant follow-up programs associated with academic centers in the United States, with respect to their structure, function, funding resources and developmental assessment practices, and to identify the barriers to establishment of such programs. Staff neonatologists, follow-up program directors and division directors of 170 Neonatal Intensive Care Units (NICU) associated with pediatric residency programs were invited to participate in an anonymous online survey from October 2009 to January 2010. The overall response rate was 84%. Ninety three percent of the respondents have a follow-up program associated with their NICU. Birth weight, gestational age and critical illness in the NICU were the major criteria for follow-up care. Management of nutrition and neurodevelopmental assessments was the most common service provided. Over 70% have health care trainees in the clinic. About 75% of the respondents have the neurodevelopmental outcome data available. Most of the respondents reported multiple funding sources. Lack of personnel and funding were the most common causes for not having a follow-up program. High-risk infant follow-up programs associated with academic centers in the United States are functioning as multidisciplinary programs providing clinical care, trainee education and facilitating outcomes research.

Outpatient Early Intervention and Therapeutic Services (OEITS) Utilized by Infants in High Risk Infant Follow-Up (HRIF) Programs in California: Initial Results of a Quality Improvement and Research Network

Journal of Developmental & Behavioral Pediatrics (JDBP) is a leading resource for clinicians, teachers, and researchers involved in pediatric healthcare and child development. This important journal covers some of the most challenging issues affecting child development and behavior, including: ADHD Autism Depression Anxiety Disorders Internalizing & Externalizing Behaviors Behavioral Aspects of Chronic Illness Psychosocial Determinants of Child Health Developmental/Behavioral Health Disparities Stress & Adversity Neurodevelopmental Disabilities Learning Disabilities/Differences Parenting & Family Factors Gene-Environment Interactions Clinical Screening and Assessment Official Journal of the Society for Developmental and Behavioral Pediatrics.

Role of establishing the perinatal system management of high-risk infants

Objective To explore role of establishing the perinatal system management of high-risk infants.Methods A retrospective survey was done from the gradual establishment of perinatal high-risk infants since the system management mode( 1995-2008 ),all hospitalized in our hospital and related neonatal birth information, analysis response after high-risk children quality of life in the management of key indicators, such as perinatal mortality rate, the incidence of asphyxia, low birth weight infants and extremely low birth weight infant survival, the occurrence of central coordination disorder of perinatal factors, intervention effects and high-risk infant follow-up.Results Delivery from 1995 to 2008, the number of year-on-year increase in the number of high-risk pregnancy, but the perinatal mortality rate showed a clear downward trend, asphyxia rate dropped to very low.The survival rate of very-low-birth-weight and extremely-low-birth-weight infants continue to improve; central coordination disorder occurred in a variety of risk factors, followed by fetal distress ( 30.5% ), mother of the history of early infection ( 28.5% ), ges-tational diabetes mothers( 27.8% ), full-term small for gestational age( 26.7% ), premature infants ( 25. 8%), neonatal asphyxia (25.0%), neonatal hypoxic-ischemic encephalopathy (23.1%), history of vaginal bleeding during early pregnancy ( 20.5% ), hyperbilirubinemia ( 15.9% ); and systems management in high-risk infants in the control group than the out-patient center coordination disorder found in children with early, short course, a good effect.Perinatal high-risk infants a year follow-up rate of 85% of them were premature and full-term small for gestational age.Conclusions Perinatal management of high-risk infants in the establishment of systems that can effectively improve the quality of perinatal life. Key words: Perinatal; High-risk infant; Model of system management

Sonographic diagnosis of the central nervous system in the neonate and infant--pathomorphology, indications and value

Standardized cerebral sonography permits early diagnosis of intracranial abnormalities and follow-up of high-risk neonates and infants during the first year of life. In the last three years 782 neonates and infants were examined using a real-time sector scanners (3,5--7,5 MHz). Echogenicity of parenchymal structures as well as the ventricular system, the subarachnoid space and the choroid plexus were routinely investigated. Based on morphological criteria a stage classification of brain haemorrhage into five degrees of severity has been developed. The sonographic pattern of normal anatomy, various types of hydrocephalus, intracranial infectious pathology, brain tumor and meningomyelocele is described. Sonographic monitoring facilitates the decision on conservative or neurosurgical treatment of hydrocephalus.

Physiologically Redefining Bronchopulmonary Dysplasia

To the Editor .— I was initially excited after reading the multicenter study published in the November 2004 issue of Pediatrics by Walsh et al, “Impact of a Physiologic Definition on Bronchopulmonary Dysplasia Rates.”1 After more careful thought, I wished to express my concerns about the limitations of the authors' proposed “physiologic definition” of bronchopulmonary dysplasia (BPD) and the potential implications on infant morbidity and mortality. The general pediatrician and the pediatric pulmonologist are the physicians who are most frequently responsible for the follow-up and long-term care of high-risk postneonatal infants who have BPD and respiratory control disorders. After leaving the security of the NICU or “step-down” unit, in which they are closely monitored and observed, they are often discharged to high-risk home environments. Their morbidity and mortality rates, in at least the first year of life, remain high. Some succumb to episodes of acute cardiorespiratory failure, while others may die, suddenly and unexpectedly, in homes or in day care centers in which they may be poorly supervised and/or exposed to stresses such as viral infections or continued tobacco smoke or are left sleeping on unsafe surfaces and positions. I am afraid that limiting the definition of BPD to those infants who can maintain …

Longitudinal multicenter follow-up of high-risk infants: why, who, when, and what to assess

This article reviews experience with longitudinal follow-up of high-risk infants in the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network. In 1993, the Network initiated a research protocol to provide longitudinal follow-up of infants with birth weight less than 1001 g and infants with higher birth weights who participated in certain Network randomized trials. Infants are assessed at 18 to 22 months corrected age (corrected for degree of prematurity) using measures of the infant’s health, growth, neuromotor, and early cognitive functioning, language, behavior, and family resources. Data from these assessments have been used to investigate potentially modifiable risk factors for cerebral palsy and delayed early cognitive functioning and to evaluate the risks and benefits of interventions assessed in randomized trials. The Network’s experience thus far suggests that longitudinal follow-up can provide valuable information about treatments given to fetuses and neonates.