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Updated: Jul 31, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Virtual Visits for Developmental Screening in High-Risk Infants
Madhangi Jayaraman1, Mandhir Gupta1, Ninu Varghese1
1Kaiser Permanente, Downey, CA, USA.
Insights
Virtual visits for high-risk infants are as effective as in-person visits for developmental assessments and referrals to therapy services. This study shows virtual care can maintain follow-up and service access for neonatal intensive care unit graduates.
Area of Science:
- Neonatal care
- Pediatric development
- Telehealth effectiveness
Background:
- The High-Risk Infant Follow-Up program identifies developmental delays in neonatal intensive care unit graduates.
- Referrals are made to physical, occupational, and speech therapy, and California Regional Center services.
- During the COVID-19 pandemic, assessments were conducted via video visits.
Purpose of the Study:
- To compare enrollment and referral rates for therapies and Regional Center services between virtual and in-person developmental assessments.
- To evaluate the impact of virtual visits on follow-up completion for high-risk infants.
Main Methods:
- Infants in the High-Risk Infant Follow-Up program (March 2020-March 2021) were assessed at 6, 12, and 18 months adjusted age.
- Compared rates of service enrollment and referral between virtual and in-person assessment groups.
- Assessed completion rates for all three developmental assessments based on initial visit type.
Main Results:
- No significant differences were found in enrollment or referral rates for therapy or Regional Center services.
- Referral rates were 8.6% for in-person visits and 10.9% for virtual visits (p=0.49).
- Infants whose first visit was virtual were equally likely to complete all three assessments.
Conclusions:
- Virtual visits proved effective, demonstrating no loss of follow-up and comparable referral rates to in-person visits.
- The COVID-19 pandemic's stay-at-home orders facilitated a natural experiment validating virtual assessment effectiveness.
- While virtual visits offer convenience, further research is needed to fully understand their utility.
Introduction:
The High-Risk Infant Follow-Up program screens neonatal intensive care unit graduates for developmental delays and refers patients to physical, occupational, or speech therapy. At Kaiser Permanente Downey, the High-Risk Infant Follow-Up program assessed development via video visits during the COVID-19 pandemic. This study compares rates of enrollment in and referral to therapies and California Regional Center services between infants assessed by video visits and those assessed in person.
Methods:
Study participants included infants in the High-Risk Infant Follow-Up program between March 2020 and March 2021 with developmental assessments at adjusted ages 6, 12, and 18 months. Rates of enrollment in services and referral to physical, occupational, and speech therapy and Regional Center services were compared between infants assessed virtually and in person.
Results:
There were no significant differences in rates of enrollment or referral to physical, occupational, or speech therapy services or Regional Center services. The rate of referral at any of the 3 visits was 8.6% at in-person visits and 10.9% at virtual visits (p = 0.49). Infants whose first visit was virtual were just as likely to complete all 3 developmental assessments as those whose first visit was in person.
Discussion:
The COVID-19 pandemic stay-at-home orders provided a "natural experiment" demonstrating the effectiveness of virtual visits as compared to in-person visits. Although the developmental assessment tool used was not standardized to be used virtually, virtual visits were just as likely to result in referrals to services and did not lead to loss of follow-up.
Conclusion:
Virtual visits may be useful and convenient for some families, but further study is required.
