Differential Effects of the Single-Family Room Neonatal Intensive Care Unit on 18- to 24-Month Bayley Scores of Preterm Infants.

OBJECTIVES: To determine the effects of human milk and social/environmental disparities on developmental outcomes of infants born preterm cared for in a single-family room (SFR) neonatal intensive care unit (NICU). STUDY DESIGN: Outcomes were compared between infants weighing ?1250 g cared for in an open-bay NICU (1/2007-8/2009) (n?=?394) and an SFR NICU (1/2010-12/2011) (n?=?297). Human milk provision at 1 week, 4 weeks and discharge, and 4 week volume (mL/kg/day) were analyzed. At 18-24 months of age, the Bayley III was administered. Group differences were evaluated and multiple linear regression analyses were run. RESULTS: Infants cared for in the SFR NICU had higher Bayley III cognitive and language scores, higher rates of human milk provision at 1 and 4 weeks, and higher human milk volume at 4 weeks. In adjusted regression models, the SFR NICU was associated with a 2.55-point increase in Bayley cognitive scores and 3.70-point increase in language scores. Every 10?mL/kg/day increase of human milk at 4 weeks was independently associated with increases in Bayley cognitive, language, and motor scores (0.29, 0.34, and 0.24, respectively). Medicaid was associated with decreased cognitive (?4.11) and language (?3.26) scores, and low maternal education and non-white race with decreased language scores (?4.7 and ?5.8, respectively). Separate models by insurance status suggest there are differential benefits from SFR NICU and human milk between infants with Medicaid and private insurance. CONCLUSIONS: Infants born preterm cared for in the SFR NICU have higher Bayley language and cognitive scores and receive more human milk. Independent effects on outcomes were derived from SFR NICU, provision of human milk, and social and environmental factors.

Impact of a Transition Home Program on Rehospitalization Rates of Preterm Infants.

OBJECTIVES: To evaluate the effects of a transition home program on 90-day rehospitalization rates of preterm (PT) infants born at <37 weeks gestational age implemented over 3 years for infants with Medicaid and private insurance, and to identify the impact of social/environmental and medical risk factors on rehospitalization. STUDY DESIGN: In this prospective cohort study of 954 early, moderate, and late PT infants, all families received comprehensive transition home services provided by social workers and family resource specialists (trained peers) working with the medical team. Rehospitalization data were obtained from a statewide database and parent reports. Group comparisons were made by insurance type. Regression models were run to identify factors associated with rehospitalization and duration of rehospitalization. RESULTS: In bivariable analyses, Medicaid was associated with more infants hospitalized, more than 1 hospitalization, and more days of hospitalization. Early PT infants had more rehospitalizations by 90 days than moderate (P = .05) or late PT infants (P = .01). In regression modeling, year 3 of the transition home program vs year 1 was associated with a lower risk for rehospitalization by 90 days (OR, 0.57; 95% CI, 0.36-0.93; P = .03). Medicaid (P = .04), non-English-speaking (P = .02), multiple pregnancies (P = .05), and bronchopulmonary dysplasia (P = .001) were associated with increased risk. Both bronchopulmonary dysplasia and Medicaid were associated with increased days of rehospitalization in adjusted analyses. The major cause of rehospitalization was respiratory illness (61%). CONCLUSIONS: Transition home prevention strategies must be directed at both social/environmental and medical risk factors to decrease the risk of rehospitalization.

Factors associated with rehospitalizations of very low birthweight infants: impact of a transition home support and education program.

OBJECTIVE: To determine the effects of a transition-home education and support program, BPD, and health insurance type on VLBW infant rehospitalizations at 3 and 7 months corrected age. It was hypothesized that the transition-home program would be associated with decreased rehospitalizations between Phase 1 and 2, and public health insurance and BPD would be associated with increased rehospitalizations. METHODS: 274 infants with birth weight <1500 g were enrolled in two successive years of a transition-home program (Phase 1-start-up) and (Phase 2-full implementation) and followed to 7 months CA. RESULTS: The Phase 2 rehospitalization rates were lower but not statistically significant at both 3 months (20% and 15%; p=0.246), and 7 months (24% and 17%; p=0.171). Infants with public insurance had twice as many rehospitalizations by 3 months (28% versus 11%; p=0.018) in Phase 1. In regression analyses the intervention effects did not achieve significance for the cohort at 3 months (OR=0.63; CI=0.33 to 1.20) or 7 months (OR=0.61; CI=0.33 to 1.13). BPD and public insurance did not reach significance in the models whereas siblings were significantly associated with increased odds of rehospitalization. In subgroup analyses for infants on pubic health insurance the intervention significantly decreased the odds of rehospitalization between Phase 1 and 2(OR=0.43; CI=0.19 to 0.96) at 3 months. CONCLUSIONS: Our findings suggest that a transition-home program may be beneficial to reduce the rehospitalization rate for VLBW infants, and infants on public insurance may derive greater benefit.

Impact of very low birth weight infants on the family at 3 months corrected age.

BACKGROUND: Very low birth weight infants (VLBW, <1500 g) have increased impact on families compared to term infants. However, there is limited research examining this impact in the first months post-discharge. AIM: To determine maternal, neonatal, and infant characteristics associated with greater impact on the family at 3 months corrected age in VLBW infants. It was hypothesized that social/environmental and medical risk factors would be associated with higher impact. STUDY DESIGN: Maternal, neonatal, and infant data were collected prospectively. Parents completed the Impact on Family, Family Support, and Family Resource Scales. Associations between characteristics and impact scores were analyzed by t-test and Pearson's correlation. Regression models for each impact score identified significant risk factors for impact. SUBJECTS: 152 VLBW infants born February 28, 2007 to September 5, 2008 who had a follow-up evaluation at 3 months corrected age. OUTCOME MEASURE: Impact on family. RESULTS: Siblings in the home, neonatal medical risk factors, longer hospitalization, more days on ventilator or oxygen, lower gestational age, lower social support, and poorer family resources were associated with increased impact. Multivariate analyses identified siblings in the home, poorer family resources, lower gestational age, and oxygen requirement at 3 months as the most important predictors of impact. CONCLUSIONS: Social/environmental and medical risk factors contribute to impact on family. Families with identified risk factors should receive support services to assist them in coping with the burden of caring for a VLBW infant.