154 - Infant Medical Risk, Maternal Psychosocial Factors and Associations with NICU Follow-up Clinic Attendance at 24 Months

Poster Number: 154
Publication Number: 154.363

Emman F. Dabaja, University of Michigan, Ann Arbor, MI, United States; Lilia Popova, University of Michigan Medical School, Ann Arbor, MI, United States; Sanaya Irani, University of Michigan Medical School, Ann Arbor, MI, United States; Caroline McGowan, University of Michigan Medical School, Ann Arbor, MI, United States; Prachi E.. Shah, University of Michigan Medical School, Ann Arbor, MI, United States

Background: Neonatal follow-up clinics provide neurodevelopmental monitoring for many former premature infants, but a high attrition rate is a well-known limitation for these clinics. Previous studies have assessed risk factors for loss of follow-up, with few studies focusing on neonates with complex medical needs.

Objective: The objective of this study was to examine the association of patient medical complexity, maternal psychosocial factors, and attendance at NICU follow-up clinic at 24 months.

Design/Methods: In a cohort of nearly 500 patients from 2014 to 2017 who were referred to the NICU follow-up clinic at our tertiary center, 262 patients were randomly selected for retrospective chart review. Primary outcome included number/percentage of NICU follow-up visits attended at 24 months. Predictors included a 9 item composite score of medical complexity which included length of stay, medical needs at discharge (tracheostomy, gastrostomy tube, home ventilator, home gavage feeding, home oxygen), number of medications at discharge, number of surgeries, and 3 or more subspecialty follow-up visits scheduled at discharge. Maternal risk factors obtained included age, parity, prenatal care, race, smoking and substance use. Multivariate linear regression was used to examine the association of patient medical complexity, maternal psychosocial factors and attendance at NICU follow-up clinic at 24 months.

Results: Sample characteristics were as follows: gestational age less than 37 weeks was 72% (190/262), Non-White race was 29% (75/259), birth weight (M= 1900 grams, SD= 1066 grams), length of NICU stay (M= 52 days, SD= 41days), maternal age 29 years old or younger was 51% (134/262). In adjusted models, lower NICU follow-up attendance was associated with multiple gestation (B= 0.061, p = .023), inadequate maternal prenatal care (B= -0.251, p=.003), maternal smoking status (B= 0.207, p < .001), and prenatal substance use (B=0.172, p=.008). Higher NICU follow-up attendance was associated with younger maternal parity (B=0.070, p=.023) and older maternal age (B= -0.127, p < .001). Infant medical complexity was not associated with NICU follow-up attendance (B= -0.005, p=.209).

Conclusion(s): Although neonatal follow-up clinics provide essential neurodevelopmental care for high risk neonates, lower NICU follow-up attendance was associated with various maternal psychosocial risk factors, but not patient medical complexity. Strategies to promote NICU follow-up should focus on families with psychosocial risk factors to bridge health inequities.