642 - Variability in ability of state-based Early Intervention (EI) eligibility criteria to predict neuromotor impairments in NICU graduates

Poster Number: 642
Publication Number: 642.141

Sophie Frankenthal, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Raye-Ann deRegnier, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Sarah Heigel, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Lynn D. Boswell, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Many infants discharged from the neonatal intensive care (NICU) are at risk for developmental impairments. Infants typically receive therapy services in the NICU, and in the interest of prevention, early intervention (EI) services should be initiated at discharge. Part C of the Individuals with Disabilities Education Act provides EI services for any infant with a diagnosed condition with high probability of developmental delay, though the designation of specific eligibility criteria is at the discretion of each state. The extent to which individual states’ eligibility criteria correctly identify NICU graduates with early neuromotor impairments is unknown. Recent evidence has established that early neuromotor impairments can be identified at 3-5 months corrected age (CA) using Prechtl’s General Movement Assessment (GMA) and the Hammersmith Infant Neurological Evaluation (HINE).

Objective: The goal of this study was to determine if variability in publicly documented state-based EI criteria is associated with disparities in eligibility for EI, as well as to determine the ability of state-specific EI criteria to adequately capture infants with early neuromotor impairments, as defined by atypical GMA and HINE outcomes.  

Design/Methods: We retrospectively identified infants evaluated using GMA and HINE at 3-5 months CA in a Neonatal Follow-up Clinic cohort. Medical records were reviewed for neonatal diagnoses qualifying infants for EI services.  We applied the EI criteria of 9 US states ( >50% of all US births) to the neonatal diagnoses and compared the ability of each state’s criteria to predict 3–5-month neuromotor impairments (defined as GMA Motor Optimality Score < 20 or HINE < 57, or >5 asymmetries). 

Results: Table 1. By 3-5 months CA, 76/467 infants in the sample population exhibited neuromotor impairment. Table 2. Eligibility criteria for the 9 states varied in sensitivity and specificity for the prediction of early neuromotor impairments. Figure 1. 26/76 (34.2%) infants exhibiting neuromotor impairment qualified for EI in all 9 states; 19/76 (25%) infants qualified in 4 or fewer states. 

Conclusion(s): Variability between states’ EI eligibility criteria creates a potential for disparities among infants qualifying for EI at NICU discharge. Additionally, no state’s eligibility criteria identified all infants within this cohort with early neuromotor impairments. Further study is necessary to identify appropriate EI criteria to effectively capture infants who already exhibit impairments at 3-5 months as well as to reduce disparities between states.