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Updated: Oct 28, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
A two-clinic NICU follow-up model: where are we now?
Katherine Carlton1, Erwin Cabacungan2, Lauren E Miller3
1Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA. kcarlton@mcw.edu.
Objective:
To evaluate whether a nurse-coordinated, two-clinic high-risk infant follow-up (HRIF) clinical model supported by automated data tracking was associated with reduced loss to follow-up (LTFU) by 24 months adjusted age.
Study Design:
We conducted a quasi-experimental pre/post quality improvement study of 2174 NICU graduates (2019-2024). Epoch 1 (2019-2021) received care under the original HRIF model. Epoch 2 (2022-2024) received a redesigned model incorporating nurse-led discharge coordination, diagnosis-stratified clinics, standardized developmental assessments, expanded eligibility criteria, and a REDCap data warehouse. The primary outcome was LTFU by 24 months, adjusted for age.
Results:
Among 4956 completed visits, LTFU decreased from 35% to 17%. Attendance at 6 months improved from 49% to 73%. Patients with neurologic diagnoses or greater subspecialty engagement were more likely to remain in follow-up.
Conclusion:
The HRIF redesign supported by data infrastructure was associated with substantially lower LTFU and may improve developmental surveillance for high-risk infants.
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