Presence of neonatal intensive care services at birth hospital and early intervention enrollment in infants ≤1500 g.

Objectives To determine whether the receipt of therapeutic services of very-low-birth-weight (VLBW; ≤1500 g) neonates inadvertently delivered at community Level 2 and 3 neonatal intensive care units (NICUs) compared with those born at a well-baby nursery (WBN; Level 1) differed. Methods This is a retrospective study of neonates who were born at Level 1 (WBN), 2, 3, and 4 NICUs and discharged from a Level 4 hospital (n = 529). All infants were evaluated at the Regional Neonatal Follow-up Program at 12 ± 1 months corrected gestational age (CA) and assessed for use of therapeutic services including: early intervention (EI), occupational therapy (OT), physical therapy (PT), speech therapy (ST), and special education (SE). Results Compared to infants born at community Level 2 and 3 NICU hospitals, those outborn at a community Level 1 WBN had significantly higher utilization of EI (90% vs. 62%) and PT (83% vs. 61%) at 12 months CA. This association persisted when controlling for covariates. Infants who required EI had significantly lower Bayley-III cognitive scores at 3 years of age. Conclusion VLBW infants outborn at WBN (Level 1) hospitals required more outpatient therapeutic services than those born at hospitals with NICU facilities. These results suggest that delivering at the appropriate community hospital level of care might be advantageous for long-term outcomes.

Morbidity and neurodevelopmental outcomes at 2 years in preterm infants undergoing percutaneous transcatheter closure vs. surgical ligation of the PDA.

OBJECTIVE: Review a cohort of preterm infants ≤29 weeks of gestation at birth and compare morbidities and neurodevelopmental outcomes based on PDA status and type of PDA closure. STUDY DESIGN: Single center observational retrospective-prospective case control study of premature infants who had no hsPDA, underwent surgical ligation or percutaneous transcatheter closure of the PDA. Neurodevelopmental testing was done using the Bayley Scales of Infant Development 3rd ed. RESULTS: The percutaneous transcatheter closure group had an older post menstrual age and greater weight at the time of procedure, and started enteral feeds and achieved room air status at an earlier post procedure day. Infants in the surgical ligation group were more likely to experience vocal cord paralysis. There was no difference in neurodevelopmental outcomes between groups. CONCLUSION: Waiting for infants to achieve the appropriate size for percutaneous transcatheter closure of the PDA may lead to reduced short-term complications without increasing the risk of neurodevelopmental impairment.

Comparison of Goal Achievement When Transitioning from In-Person Therapy to Teletherapy in Westchester County Early Intervention Program Due to the COVID-19 Pandemic.

The sudden transition to virtual therapeutic services during the COVID-19 pandemic provided a unique opportunity to explore telehealth as a platform for delivering early intervention (EI) services. Through retrospective chart review of 93 children, we collected the following data: demographics, diagnosed conditions, therapy type, service format, and provider-reported participant goal achievement (1=no progress, 2=little progress, 3=moderate progress, 4=great deal of progress, 5=outcome achieved) over a six-month period before and after transitioning to telehealth. Pre- and post-transition progress scores were compared using the Wilcoxon signed-rank test. Results demonstrated maintained progress among children who transitioned from in-person to virtual services for similar therapy types. Children receiving speech therapy in-person and virtually demonstrated increased achievement (3.00 vs 3.33; p=0.032). Participants receiving a particular therapy post-transition but not in-person attained similar achievement as those who received the same therapy only in-person. Our research suggests that teletherapy may be a viable option for delivering EI services.

Low-Grade Intraventricular Hemorrhage and Neurodevelopmental Outcomes at 24-42 Months of Age.

Infants with high-grade (III-IV) intraventricular hemorrhage have been reported to have worse neurodevelopmental outcomes than those without, but outcomes of infants with low-grade (I-II) intraventricular hemorrhage are mixed. We sought to compare neurodevelopmental outcomes of infants with low-grade intraventricular hemorrhage to those with no intraventricular hemorrhage. This is a retrospective cohort study of very preterm (≤32 weeks' gestation) infants evaluated between 24 and 42 months chronologic age using the Bayley Scales of Infant Development, 3rd edition, to determine neurodevelopmental outcomes. Linear regression was used to control for potential confounders. There was no difference in outcome scores between groups when controlling for confounding variables. Infants with low-grade intraventricular hemorrhage, however, had higher rates of enrollment in early intervention services (64% vs 49%, P = .023). Low-grade intraventricular hemorrhage itself may not significantly increase the risk of neurodevelopmental impairment through the first 3 years of life considering other conditions of prematurity.

Neurodevelopmental Outcome of Extremely Low Birth Weight Infants Fed an Exclusive Human Milk Diet Is Not Affected by Growth Velocity.

Background: An exclusive human milk (EHM) diet in extremely low birth weight (ELBW) infants (birth weight ≤1,000 g) is linked to an increased likelihood of extrauterine growth restriction (EUGR, weight <10% at discharge). Past studies associated EUGR with worse neurodevelopmental (ND) outcomes; however, its impact when an EHM diet is used is unknown. Objective: Determine whether EUGR adversely affects 2-year ND outcomes of ELBW infants fed an EHM diet. Secondary aims were to compare short-term morbidities and growth through 2 years corrected age (CA). Materials and Methods: Prospective cohort study of ELBW infants fed an EHM diet until 34 weeks corrected gestational age and assessed at 2 years CA. ND outcomes between EUGR and non-EUGR infants were compared using the Bayley Scales of Infant Development 3rd Ed (BSID-III). Results: Eighty-one ELBW infants survived, 44 were seen for follow-up, and 16 (36%) were EUGR. Baseline characteristics and Neonatal Intensive Care Unit (NICU) morbidities were similar. There were no statistically significant differences (median [25-75%]) between EUGR and non-EUGR groups in cognition, (90 [80-99] versus 95 [90-104]), language (84 [68-105] versus 89 [75-100]), or motor composite scores (87 [74-96] versus 91 [88-96]). Weight z-scores during NICU stay dropped in both groups, more pronounced for the EUGR infants. There was no difference in linear or head growth. Conclusion: In our institution, ND outcomes at 2 years CA for ELBW infants fed an EHM diet were similar regardless of EUGR status. This suggests a neuroprotective effect of EHM diet in the ELBW population, despite weight gain velocity during NICU stay.

Indicators of compliance for developmental follow-up of infants discharged from a regional NICU.

AIM: To identify factors associated with compliance of scheduled outpatient developmental follow-up appointments in an effort to better ensure future care. METHODS: This retrospective observational cohort study looked at patients born between January 7(th) 2006 and June 30(th) 2007 and discharged from a regional neonatal intensive care unit (RNICU). Discharge summaries were reviewed to attain information regarding 16 patient descriptives and 12 patient morbidities. Data were recorded and analyzed utilizing the statistical software SPSS 11.5. RESULTS: Children of older mothers were more likely to attend follow-up (compliant: 30 years vs. non-compliant: 27 years). Factors which significantly improved compliance with follow-up care were patient contact after discharge (compliant: 65% vs. non-compliant: 35%) and early intervention referral (compliant: 64% vs. non-compliant: 36%). Factors which significantly hindered compliance were maternal drug use during pregnancy (compliant: 11.8% vs. non-compliant: 88%), and patient transfer to outside NICUs [(transferred out: compliant: 3 (10.3%), non-compliant 25 (89.3%)]. CONCLUSIONS: Several factors associated with compliance have been identified. Direct patient contact after discharge positively correlated with improved follow-up attendance. The severity of patient disease in the NICU did not impact follow-up rates. As a result close attention needs to be paid to factors which influence compliance with outpatient follow-up for developmental screening.

Habilitation of very preterm infants at a Post Acute Care Inpatient Rehabilitation (PACIR) center after neonatal intensive care unit (NICU) discharge.

OBJECTIVE: To investigate whether Post-Acute Care Inpatient Rehabilitation (PACIR) admission after NICU stay affects the total length of stay (LOS) of very preterm (VPT: ≤30 weeks of gestation) infants. METHODS: A retrospective case control study of VPT infants d/c'd from the NICU at Maria Fareri Children's Hospital (MFCH) to either a PACIR (Blythedale Children's Hospital: BH) for convalescent care (cases) or directly home (controls). RESULTS: 35 cases and 70 controls. Total LOS (MFCH + BH) was longer for cases [196 vs. 97 days]. At the time of d/c from MFCH, Special Health Care Needs (SHCN) amongst cases were greater than controls, however, became similar at the time of home d/c. The majority of cases achieved habilitation goals at the PACIR. CONCLUSIONS: Although LOS was longer for patients transferred to a PACIR, habilitation at BH Hospital reduced the SHCN at the time of home d/c amongst cases.

Thyroid hormone supplementation in preterm infants born before 28 weeks gestational age and neurodevelopmental outcome at age 36 months.

BACKGROUND: Thyroid hormones are required for normal brain maturation, and neonatal plasma thyroid hormone concentrations are low in infants less than 28 weeks gestation. It is not known whether treatment of such infants with thyroid hormone improves neurodevelopmental outcome. METHODS: At three years corrected age, mental, motor, and neurological development was assessed in infants born at less than 28 weeks gestational age who had participated in a phase 1 trial of differing doses and modes of administration of thyroid hormone. The trial's endpoints were thyroid hormone (thyroxine, T4) and thyotropin plasma concentrations in eight study arms: six treated with T4 [4, 8, and 16 µg/(kg · day)], bolus or continuous], one treated with iodine only, and one treated with placebo. Follow-up at three years was not part of the original study goals. Developmental index scores, rates of cerebral palsy (CP), and rates of adverse outcome (death or moderate to severe delay in development and/or disabling CP) were compared between the eight study groups and between groups combined by dosage level, and between infants with and without T4 supplementation. RESULTS: Of 166 randomized infants, 32 (19%) died in the neonatal period. Of the 134 survivors, follow-up results were available for 89 children (66%). Mental and motor development and rates of cerebral palsy did not differ in any of the comparisons made. CONCLUSION: In this study, no differences in neurodevelopment were found in relation to thyroid hormone treatment, but power was insufficient to detect any but very large differences.

Risks for common medical conditions experienced by former preterm infants during toddler years.

AIMS: To identify associations between reactive airway disease (RAD), eczema, and gastroesophageal reflux (GERD) and antenatal/neonatal variables. METHODS: This is a retrospective observational cohort analysis of former preterm (PT) infants evaluated at the Regional Neonatal Follow-up Program in the Lower Hudson Valley Region of New York. Subjects <2 years evaluated between January 2005 and December 2007 were included. Patient demographics, antenatal factors and co-morbidities of prematurity were correlated with each medical condition. RESULTS: A total of 727 subjects were analyzed: 12.8% had RAD, 10.5% had eczema; and 26.7% had GERD. RAD and GERD correlated inversely with gestational age. RAD was more prevalent in singletons and African Americans; GERD in Caucasians; and eczema in singletons and males. Respiratory disease in the newborn period increased the incidence of RAD and GERD. Toddlers who had RAD were likely to have eczema or GERD; no association between GERD and eczema existed. CONCLUSIONS: These three medical conditions were strongly associated. Their association may be the result of a common element developing each condition, or due to one condition exacerbating another. Respiratory problems in the newborn were strong predictors of GERD and RAD.

Comparison of enrollment in interventional therapies between late-preterm and very preterm infants at 12 months' corrected age.

OBJECTIVE: To determine the requirement for therapeutic services of late-preterm infants (34 to 36 weeks' gestation) and morbidities associated with their developmental delays compared with their very preterm (<32 weeks' gestation) counterparts. METHODS: We used a retrospective cohort study of former preterm children admitted to the neonatal unit who were evaluated at the Regional Neonatal Follow-up Program of Westchester Medical Center in New York at 12 +/- 2 months' corrected age from January 2005 through October 2006. Logistic regression was used to compare odds ratios between late-preterm and very preterm children who qualified for early intervention services. Antenatal, demographic, and neonatal factors were compared between subgroups. RESULTS: Of the 497 preterm infants evaluated at the Regional Neonatal Follow-up Program, 127 met inclusion criteria (77 very preterm and 50 late-preterm infants). Of the late-preterm infants, 30% qualified for and received early intervention services, 28% physical therapy, 16% occupational therapy, 10% speech therapy, and 6% special education. In the very preterm subgroup, 70% qualified for and received early intervention services, 66% physical therapy, 32% occupational therapy, 32% speech therapy, and 21% special education. Very preterm children were more likely to be enrolled in therapies than their late-preterm counterparts. However, when adjusting for neonatal comorbidities of prematurity, there was no difference in enrollment in early intervention services between the very preterm and late-preterm infants. CONCLUSIONS: After controlling for comorbidities of prematurity, we found that late-preterm infants requiring admission to the neonatal unit have the same risk as very preterm infants of requiring interventional therapies. This would indicate that it is not only the degree of prematurity but also the morbidities experienced in the neonatal period in conjunction with the period of rapid brain growth that have a profound influence on neurodevelopmental outcomes. This should be considered when planning their hospital discharge and follow-up.

The relationship between congenital malformations and preterm birth.

AIMS: To investigate how congenital malformations (CM) are associated with preterm (PT) births. METHODS: A population cohort study analyzed data from the New York State Congenital Malformations Registry to look at live births from the Lower Hudson Valley Region from 2000-2003. ICD9 codes identified all cases and types of CM in addition to cases with multiple malformations. Subjects were categorized into one of three gestational age (GA) groups. Only cases with a known GA at birth were included. Poisson regression analysis established a risk ratio for children born with a CM of being born preterm. RESULTS: The PT birth rate was 11.2% and the CM rate 3%. Children with a CM were more likely to be born PT (RR: 2.20; CI: 2.01-2.40), moderately preterm (RR: 1.95; CI: 1.76-2.15), and very preterm (RR: 3.45; CI: 2.95-4.04) than term. This relationship was maintained for most organ systems and malformation types evaluated when checked individually. Being born with more than one CM increased the likelihood of being born PT (OR: 1.72; CI: 1.37-2.15). CONCLUSIONS: Congenital malformations in children have a significant impact upon the likelihood of being born PT, and contribute significantly to the degree of prematurity.