789 - The Specialty Care Medical Burden and Appointment Adherence for Very Preterm Infants Following Initial Discharge from the Neonatal Intensive Care Unit

Very premature infants who survive to discharge from the neonatal intensive care unit (NICU) are faced with complex health care needs which commonly lead to chronic conditions and delays in neurodevelopment. This population has poor adherence to neonatal follow up program appointments, putting them at risk for delayed diagnosis and treatment. Less is known about their overall medical appointment burden and adherence, especially in the United States.

Objective:

To determine the burden of outpatient specialty care for families of very preterm infants (born ≤ 32 weeks) within the first six months from initial NICU discharge, and to identify infant, maternal, and sociodemographic factors associated with appointment adherence.

Design/Methods:

This is a single-center retrospective study of very preterm infants (n = 150) born between July 1, 2017, and June 30, 2019, who were discharged home prior to 52 weeks’ corrected gestational age. Medical records were queried to assess specialty appointments and characteristics of infants, mothers, and sociodemographic factors. Poisson regression modeling identified variables associated with the risk of missing a specialty appointment.

Results:

Our population had 1,182 appointments scheduled for a total of 20 different specialists over the six months from discharge. Infants had a median of 6 [Interquartile Range (IQR) 3 – 11] scheduled specialty appointments, with a median of 3 (IQR 2 – 4) types of specialists. Missed appointments accounted for 25.8% of all scheduled appointments, with varying rates across different specialties. In the adjusted model, the risk of missing an appointment was higher for males (Risk Ratio (RR) 1.29 [95% Confidence Interval (CI) 1.00, 1.66], p = 0.05) and infants with federally funded insurance (RR 1.33 [95% CI 1.04, 1.70], p = 0.03).

Conclusion(s):

There is a substantial and diverse medical burden of outpatient specialty care for this very preterm population. High rates of missed appointments, with associated risk factors including male sex and having federally funded insurance, indicate an opportunity to improve adherence rates and access to medical care for these infants.