This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Neurology  • Pediatric Neurology  • Neurology, Other  • Child Development  • Neonatology and Infant Care  • Pediatrics, Other  • Rehabilitation Medicine  • Alert me on articles by topic  Social Bookmarking   What's this?

Special Outpatient Services in Early Childhood

Susan R. Hintz, MD, MSEpi; Douglas E. Kendrick, MStat; Betty R. Vohr, MD; W. Kenneth Poole, PhD; Rosemary D. Higgins, MD; for the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network

Arch Pediatr Adolesc Med. 2008;162(8):748-755.

Objective  To determine special outpatient services (SOS) use, need, associated factors, and neurodevelopmental and functional outcomes among extremely preterm infants at 18 to 22 months' corrected age.

Design  Retrospective analysis.

Setting  National Institute of Child Health and Human Development (NICHD) Neonatal Research Network.

Participants  Infants younger than 28 weeks' gestational age who had been born weighing less than 1000 g at an NICHD Neonatal Research Network center from January 1, 1997, to December 31, 2000, and who were receiving follow-up at 18 to 22 months' corrected age.

Interventions  Questionnaires were administered at the 18- to 22-month follow-up visit regarding SOS use since hospital discharge and the current need for SOS (social work, visiting nurse, medical specialty, early intervention, speech and language services, occupational therapy and physical therapy, and neurodevelopmental and behavioral services).

Main Outcome Measures  The use of and need for SOS were analyzed by gestational age. Logistic regression analysis identified factors independently associated with the use of more than 5 services and with the need for any services.

Results  Of 2315 infants, 54.7% used more than 3 SOS by 18 to 22 months, and 19.1% used 6 to 7 SOS. The need for any SOS was reported by approximately 37%. The following variables that were commonly associated with adverse neurodevelopmental outcomes were also associated with the use of more than 5 SOS: sepsis, birth weight, postnatal corticosteroid use, bronchopulmonary dysplasia, and cystic periventricular leukomalacia or grade 3 or 4 intraventricular hemorrhage. Male sex was associated with the need for any SOS. Although high SOS use was more likely among children with adverse neurodevelopmental outcomes, a reported need for SOS was common even among those with mild developmental impairment (39.7%) and mild cerebral palsy (42.2%).

Conclusions  High SOS use is common, has identifiable neonatal risk factors, and is associated with neurodevelopmental impairment. Extremely preterm survivors have substantial need for community supports regardless of their impairment level. Efforts to improve comprehensive delivery of family-centered community-based services are urgently needed.

Author Affiliations: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California (Dr Hintz); RTI International, Research Triangle Park, North Carolina (Mr Kendrick and Dr Poole); Neonatal Follow-up Clinic, Women & Infants Hospital, and Department of Pediatrics, Brown University School of Medicine, Providence, Rhode Island (Dr Vohr); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland (Dr Higgins).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

This Month in Archives of Pediatrics & Adolescent Medicine
Arch Pediatr Adolesc Med. 2008;162(8):711.
FULL TEXT