Factors Associated with Outpatient Therapy Utilization in Extremely Preterm Infants.

Autor:	Ponnapakkam A; Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas., Carr NR; Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas.; Department of Pediatrics, University of Utah, Salt Lake City, Utah., Comstock BA; Center for Biomedical Statistics, University of Washington, Seattle, Washington., Perez K; Department of Pediatrics, University of Washington, Seattle, Washington., O'Shea TM; Department of Pediatrics, University of North Carolina, Chapel Hill, NC., Tolia VN; Pediatrix Medical Group, Dallas TX.; MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL., Clark RH; MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL., Heagerty PJ; Center for Biomedical Statistics, University of Washington, Seattle, Washington., Juul SE; Department of Pediatrics, University of Washington, Seattle, Washington., Ahmad KA; MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL.; Pediatrix Medical Group of San Antonio, San Antonio, TX.; Department of Pediatrics, Baylor College of Medicine, San Antonio, TX.; Pediatrix and Obstetrix Specialists of Houston, Houston, TX.; Department of Clinical Sciences, University of Houston, Houston, TX.
Jazyk:	angličtina
Zdroj:	American journal of perinatology [Am J Perinatol] 2024 Mar; Vol. 41 (4), pp. 458-469. Date of Electronic Publication: 2021 Nov 09.
DOI:	10.1055/a-1692-0544
Abstrakt:	Objective: Factors influencing utilization of outpatient interventional therapies for extremely low gestational age newborns (ELGANs) after discharge remain poorly characterized, despite a significant risk of neurodevelopmental impairment. We sought to assess the effects of maternal, infant, and environmental characteristics on outpatient therapy utilization in the first 2 years after discharge using data from the Preterm Erythropoietin Neuroprotection (PENUT) Trial. Study Design: This is a secondary analysis of 818, 24 to 27 weeks gestation infants enrolled in the PENUT trial who survived through discharge and completed at least one follow-up call or in-person visit between 4 and 24 months of age. Utilization of a state early intervention (EI) program, physical therapy (PT), occupational therapy (OT), and speech therapy (ST) was recorded. Odds ratios and cumulative frequency curves for resource utilization were calculated for patient characteristics adjusting for gestational age, treatment group, and birth weight. Results: EI was not accessed by 37% of infants, and 18% did not use any service (PT/OT/ST/EI). Infants diagnosed with severe morbidities (intraventricular hemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis), discharged with home oxygen, or with gastrostomy placement experienced increased utilization of PT, OT, and ST compared with peers. However, substantial variation in service utilization occurred by the state of enrollment and selected maternal characteristics. Conclusions: ELGANs with severe medical comorbidities are more likely to utilize services after discharge. Therapy utilization may be impacted by maternal characteristics and state of enrollment. Outpatient therapy services remain significantly underutilized in this high-risk cohort. Further research is required to characterize and optimize the utilization of therapy services following NICU discharge of ELGANs. Key Points: · Outpatient therapy is underutilized in ELGANs.. · Medical comorbidities may impact therapy use.. · Maternal characteristics may impact therapy use.. · State of enrollment may impact therapy use.. Competing Interests: None declared. (Thieme. All rights reserved.)
Databáze:	MEDLINE
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