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Comparison of enrollment in interventional therapies between late-preterm and very preterm infants at 12 months'
Jessica L Kalia1, Paul Visintainer, Heather L Brumberg
1New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Department of Pediatrics, Division of Newborn Medicine, 95 Grasslands Rd, Valhalla, NY 10595, USA. jessica.kalia@gmail.com
Insights
Late-preterm infants admitted to the neonatal unit require therapeutic services at the same rate as very preterm infants. Neonatal morbidities significantly impact neurodevelopmental outcomes and the need for early intervention services.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Public Health
Background:
- Late-preterm infants (34-36 weeks' gestation) represent a significant proportion of births.
- These infants are often perceived as low-risk, yet may experience morbidities impacting neurodevelopment.
- Comparison with very preterm infants (<32 weeks' gestation) is crucial for understanding risk stratification.
Purpose of the Study:
- To compare the need for therapeutic services in late-preterm infants versus very preterm infants.
- To identify morbidities associated with developmental delays in late-preterm infants.
- To inform follow-up care and discharge planning for late-preterm infants.
Main Methods:
- Retrospective cohort study of preterm infants evaluated at a Neonatal Follow-up Program.
- Logistic regression used to compare early intervention service qualification between late-preterm and very preterm groups.
- Analysis adjusted for antenatal, demographic, and neonatal factors.
Main Results:
- Late-preterm infants showed lower initial enrollment in early intervention services compared to very preterm infants.
- However, after adjusting for neonatal comorbidities, the difference in enrollment disappeared.
- Specific therapies included physical, occupational, and speech therapy, as well as special education.
Conclusions:
- Late-preterm infants requiring neonatal unit admission have a similar risk of needing interventional therapies as very preterm infants.
- Neonatal morbidities, not just gestational age, profoundly influence neurodevelopmental outcomes.
- Follow-up care and discharge planning should consider the impact of neonatal morbidities on late-preterm infants.
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.