Resource utilization after discharge for very low birthweight (vlbw) infants

ABSTRACT 1382 OBJECTIVE: To describe VLBW outcomes at 2-4 years in 4 domains: health, development, resource utilization, and family supports. METHODS: Parents of all VLBW infants born

between 6/94 and 6/96 were asked to complete a comprehensive telephone survey. RESULTS: Of the 228 infants eligible for the study, 86 (38%) families completed the interview. The mean

gestational age and birthweight for our sample were 28±2.6 wks and 1062±264 gms. The study sample was similar to the eligible NICU population with respect to neonatal illness variables, with

the exception of an overrepresentation of infants with abnormal cranial imaging. All respondents were able to identify a primary care provider or clinic, and 94% reported that their

child's immunizations were up-to-date. At one year of age, 29% were still on a home apnea monitor, oxygen, nebulizer or feeding pump and 43% were on chronic medications. Nearly half

(47%) reported that their child was diagnosed with chronic lung disease (CLD), asthma or reactive airway disease during the first year. The rate of rehospitalization and surgery after NICU

discharge (43% and 38%, respectively) is similar to previously published studies. As many as 82% saw medical or surgical subspecialists after NICU discharge and 35% saw ≥3 subspecialists.

The mean language quotient was 84±21 and the mean motor quotient was 89±30. 42% of children had cognitive or language delay, and 16% had cerebral palsy (CP). All 6 (7%) children with

disabling CP had multiple disabilities. All infants with motor quotients ≤50 received physical and occupational therapy, but only 65% of infants with a language score ≤65 received speech and

language services. Parents of children with multiple disabilities reported more difficulty arranging breaks (p≤0.01) and more behavior problems in their child (p=0.07). 21% of infants

eligible for federally mandated early intervention services were never evaluated by the program. More than half (52%, 64%) reported barriers (cost, transportation, time, medical care system

problems) to receiving medical and specialized care. Cost as a barrier to care was more frequently reported by those in Medical Assistance/Managed Care Organizations (MA/MCOs) (p<0.04).

Infants with CLD/asthma in MA/MCOs were less likely to see a pulmonologist than those with private insurance (72% vs. 33%, p<0.05). Infants who were back transported to community

hospitals were more likely to go home on specialized medical equipment (p<0.01) and saw more subspecialists (p<0.04) than infants discharged from our NICU. CONCLUSIONS: VLBW infants,

especially those with CLD or disabilities, require substantial health and developmental resources not only in the NICU, but also long after NICU discharge. This survey suggests some

rationing of post NICU health and developmental resources occurs. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Pediatrics, The Johns Hopkins University, Baltimore, MD Marilee C Allen, Sarah

F Baker & Pamela K Donohue Authors * Marilee C Allen View author publications You can also search for this author inPubMed Google Scholar * Sarah F Baker View author publications You

can also search for this author inPubMed Google Scholar * Pamela K Donohue View author publications You can also search for this author inPubMed Google Scholar RIGHTS AND PERMISSIONS

Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Allen, M., Baker, S. & Donohue, P. Resource Utilization after Discharge for Very Low Birthweight (VLBW) Infants. _Pediatr

Res_ 45, 235 (1999). https://doi.org/10.1203/00006450-199904020-01399 Download citation * Issue Date: 01 April 1999 * DOI: https://doi.org/10.1203/00006450-199904020-01399 SHARE THIS ARTICLE

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