Race, language, and neighborhood predict high-risk preterm Infant Follow Up Program participation

Abstract

Objectives Infant Follow Up Programs (IFUPs) provide developmental surveillance for preterm infants after hospital discharge but participation is variable. We hypothesized that infants born to Black mothers, non-English speaking mothers, and mothers who live in “Very Low” Child Opportunity Index (COI) neighborhoods would have decreased odds of IFUP participation. Study Design There were 477 infants eligible for IFUP between 1/1/2015–6/6/2017 from a single large academic Level III NICU. Primary outcome was at least one visit to IFUP. We used multivariable logistic regression to identify factors associated with IFUP participation. Result Two hundred infants (41.9%) participated in IFUP. Odds of participation was lower for Black compared to white race (aOR 0.43, p=0.03), “Very Low” COI compared to “Very High” (aOR 0.39, p=0.02) and primary non-English speaking (aOR 0.29, p=0.01). Conclusion We identified disparities in IFUP participation. Further study is needed to understand underlying mechanisms to develop targeted interventions for reducing inequities.

Does greater distance from the hospital exacerbate socioeconomic barriers to neonatal intensive care unit clinic attendance?

“…Education is a critical tool to be employed in addressing poor follow-up rates. It is unfair to assume that parents understand the vital role NICU follow-up clinics play in their child's development following NICU discharge, and so, it is important to address this before discharge, and at strategic times after | | doi: 10.2185/jrm.2022-035 2023; 18(2): 55-61 discharge 1,4,6,11,16,24) . Other strategies may include mindful scheduling of appointments when the patient has multiple specialist visits, utilizing satellite locations, targeting areas with a low COI, and creative solutions like telehealth, and transportation aid as needed 1,5,11,16,24) .…”

“…It is unfair to assume that parents understand the vital role NICU follow-up clinics play in their child's development following NICU discharge, and so, it is important to address this before discharge, and at strategic times after | | doi: 10.2185/jrm.2022-035 2023; 18(2): 55-61 discharge 1,4,6,11,16,24) . Other strategies may include mindful scheduling of appointments when the patient has multiple specialist visits, utilizing satellite locations, targeting areas with a low COI, and creative solutions like telehealth, and transportation aid as needed 1,5,11,16,24) . Focusing on parental education about the role of the NICU clinic in their child's long-term health and development, and continuing to attempt to identify the barriers to follow-up that each specific population faces through methods including survey-based research may be key in improving clinic attendance.…”

“…Infants born to mothers living in a very low COI neighborhood were less likely to attend NICU follow-up when compared to infants whose mothers lived in a very high COI neighborhood. This difference transcended race and geographical distance, serving as further evidence that the etiology behind NICU clinic non-attendance is multifactorial 16) .…”

“…Comparable follow-up rates to those of our study were reported in another study conducted in a rural area, where almost half of the families who missed follow-up visits cited distance and travel costs as barriers to clinic attendance 1) . The Child Opportunity Index (COI), a publicly accessible census-based measure of the resources and conditions of geographical areas has been used to assess the impact of certain social determinants of health on NICU follow-up attendance 16) . Infants born to mothers living in a very low COI neighborhood were less likely to attend NICU follow-up when compared to infants whose mothers lived in a very high COI neighborhood.…”

“…Children who are discharged from the NICU are also followed in the primary care setting and parents may believe that this follow-up is adequate, especially if the child appears to be doing well. However, it is important to teach families that maximum benefit is obtained when their child is followed in both primary care and dedicated NICU clinic settings 3,16,22) . Furthermore, a large retrospective study of primarily publicly insured or uninsured children found that the well child visits important for uncovering developmental delays were among the most frequently missed well child appointments 23) .…”