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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

Adharsh Ponnapakkam  ‡   **
1   Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
,
Nicholas R. Carr‡   **
1   Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
2   Department of Pediatrics, University of Utah, Salt Lake City, Utah
,
Bryan A. Comstock
3   Center for Biomedical Statistics, University of Washington, Seattle, Washington
,
Krystle Perez
4   Department of Pediatrics, University of Washington, Seattle, Washington
,
T. Michael O'Shea
5   Department of Pediatrics, University of North Carolina, Chapel Hill, NC
,
Veeral N. Tolia
6   Pediatrix Medical Group, Dallas TX
7   MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL
,
Reese H. Clark
7   MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL
,
Patrick J. Heagerty
3   Center for Biomedical Statistics, University of Washington, Seattle, Washington
,
Sandra E. Juul
4   Department of Pediatrics, University of Washington, Seattle, Washington
,
Kaashif A. Ahmad 
7   MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL
8   Pediatrix Medical Group of San Antonio, San Antonio, TX
9   Department of Pediatrics, Baylor College of Medicine, San Antonio, TX
10   Pediatrix and Obstetrix Specialists of Houston, Houston, TX
11   Department of Clinical Sciences, University of Houston, Houston, TX
,
for the Preterm Erythropoietin Neuroprotection Trial Consortium › Author Affiliations Funding This work is supported by grants (U01NS077955 and U01NS077953) from the National Institute of Neurological Disorders and Stroke.
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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

Clinical Trial Registration

NCT01378273. https://clinicaltrials.gov/ct2/show/NCT01378273


** AP and NRC contributed equally to this work.


* A complete list of study group members appears in the Acknowledgments.




Publication History

Received: 05 June 2021

Accepted: 04 November 2021

Accepted Manuscript online:
09 November 2021

Article published online:
29 December 2021

© 2021. Thieme. All rights reserved.

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