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An innovative postnatal risk assessment and corresponding care pathways in Preventive Child Healthcare
Minke R C Van Minde1,2, Jacqueline Lagendijk1, Hein Raat2
1Department of Obstetrics and Gynecology, Division of Obstetrics and Fetal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Insights
A new postnatal risk assessment (R4U) in Preventive Child Healthcare (PCHC) effectively reduced catch-up growth in infants. This implementation demonstrates feasibility and highlights PCHC
Area of Science:
- Pediatric Health
- Preventive Medicine
- Child Development
Background:
- Preventive Child Healthcare (PCHC) plays a crucial role in monitoring child growth and development.
- Effective postnatal risk assessments are scarce, limiting early intervention for potential developmental issues.
- Addressing risk factors early can prevent long-term health consequences.
Purpose of the Study:
- To evaluate the effectiveness of the postnatal Rotterdam Reproductive Risk Reduction checklist (R4U) and associated care pathways within PCHC.
- To assess the impact of the R4U on catch-up growth in infants.
- To gauge PCHC professional satisfaction with the new risk assessment tool.
Main Methods:
- A historically controlled study design was employed across four PCHC organizations in high-risk municipalities.
- The study included an intervention cohort (n=1,953) and a historical cohort (n=7,436) from 2008-2017.
- Catch-up growth (increase >0.67 SDS weight-for-height in 6 months) was the primary outcome; professional satisfaction was surveyed.
Main Results:
- Catch-up growth was significantly less prevalent in the intervention cohort (14.9%) compared to the historical cohort (19.5%, p<0.001).
- Regression analysis confirmed a reduced odds ratio (0.957) for catch-up growth in the intervention group.
- Most participating PCHC professionals (74 surveyed) remained neutral regarding the postnatal R4U's benefits.
Conclusions:
- The implementation of the novel postnatal risk assessment (R4U) within PCHC is feasible and effective in reducing catch-up growth.
- PCHC provides a vital platform for identifying and managing growth and developmental risk factors.
- Widespread implementation of evidence-based postnatal risk assessments is recommended to prevent adverse long-term effects of catch-up growth.
Aims:
This study aims to evaluate the effectiveness of an innovative postnatal risk assessment (the postnatal Rotterdam Reproductive Risk Reduction checklist: R4U) and corresponding care pathways in Preventive Child Healthcare (PCHC), along with PCHC professional satisfaction.
Design:
Four PCHC organizations located in three municipalities with a higher adverse perinatal outcome than the national average were selected for participation. The study concerns a historically controlled study design.
Methods:
The study enrolled participants from September 2016 until December 2017. The historical cohort existed of children born in previous years from 2008 until 2016. The outcome measure was defined as catch-up growth: more than 0.67 standard deviation score weight for height increase in the first 6 months of life. PCHC professional opinion was assessed with a digital survey.
Results:
After the inclusion period, 1,953 children were included in the intervention cohort and 7,436 children in the historical cohort. Catch-up growth was significantly less common in the intervention cohort; 14.9% versus 19.5% in the historical cohort (p < 0.001). A regression sensitivity analysis, using matching, showed an odds ratio of 0.957 (95% CI 0.938-0.976) for the intervention cohort. In the survey, 74 PCHC physicians and nurses participated; most of them were neutral concerning the benefits of the postnatal R4U.
Conclusion:
This study shows that the implementation of a novel postnatal risk assessment including in PCHC is feasible and effective. Final efforts to ensure a widespread implementation should be taken.
Impact:
PCHC offers a unique opportunity to recognize and address risk factors for growth and development in children and to implement care pathways. Effective and widely implemented risk assessments in antenatal and PCHC are scarce. To our knowledge, this kind of evidence-based postnatal risk assessment has not been implemented in PCHC before and seizes the opportunity to prevent catch-up growth and its long-term effects.
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