Factors Associated with Outpatient Therapy Utilization in Extremely Preterm Infants

Adharsh Ponnapakkam; Nicholas R. Carr; Bryan A. Comstock; Krystle Perez; T. Michael O'Shea; Veeral N. Tolia; Reese H. Clark; Patrick J. Heagerty; Sandra E. Juul; Kaashif A. Ahmad; for the Preterm Erythropoietin Neuroprotection Trial Consortium

doi:10.1055/a-1692-0544

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(04): 458-469
DOI: 10.1055/a-1692-0544

Original Article

Factors Associated with Outpatient Therapy Utilization in Extremely Preterm Infants

Authors

Adharsh Ponnapakkam ‡^**

¹Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
Nicholas R. Carr‡^**

¹Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas

²Department of Pediatrics, University of Utah, Salt Lake City, Utah
Bryan A. Comstock

³Center for Biomedical Statistics, University of Washington, Seattle, Washington
Krystle Perez

⁴Department of Pediatrics, University of Washington, Seattle, Washington
T. Michael O'Shea

⁵Department of Pediatrics, University of North Carolina, Chapel Hill, NC
Veeral N. Tolia

⁶Pediatrix Medical Group, Dallas TX

⁷MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL
Reese H. Clark

⁷MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL
Patrick J. Heagerty

³Center for Biomedical Statistics, University of Washington, Seattle, Washington
Sandra E. Juul

⁴Department of Pediatrics, University of Washington, Seattle, Washington
Kaashif A. Ahmad

⁷MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL

⁸Pediatrix Medical Group of San Antonio, San Antonio, TX

⁹Department of Pediatrics, Baylor College of Medicine, San Antonio, TX

¹⁰Pediatrix and Obstetrix Specialists of Houston, Houston, TX

¹¹Department of Clinical Sciences, University of Houston, Houston, TX

for the Preterm Erythropoietin Neuroprotection Trial Consortium

Abstract

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.

Keywords

early intervention - extremely preterm - physical therapy - speech therapy - occupational therapy

Full Text

References

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