O0702 Oct.3: 5:25pm - The Effect of Socioeconomic Risk Factors on Post-Discharge Special Services Utilization in ELGANs.

Purpose: To assess the effects of maternal age, ethnicity, and state of birth on post-discharge special-services utilization for Extremely Low Gestational Age Newborns (ELGANs) enrolled in the Preterm Epo Neuroprotection (PENUT) Trial.

Background:
Outpatient special therapy services may improve neurodevelopmental outcomes in premature infants. While most ELGANs qualify for these special services, factors associated with special service utilization remains poorly characterized. The effect of socioeconomic factors and geography on special service utilization among ELGANs remains poorly characterized.

Methods:
The PENUT Trial is a randomized, double-blinded, placebo-controlled, clinical trial of infants born between 24-0/7 and 27-6/7 weeks of gestation and enrolled 941 infants at 19 sites. This secondary analysis included all enrolled infants who survived through discharge and had at least one follow-up telephone call or in-person visit between 4 and 24 months. Infant use of special services (physical therapy (PT), occupational therapy (OT), speech therapy (ST), home duty nursing, and early childhood intervention (EI)) was recorded through parental questionnaire at 4, 8, 12, and 24 months. Cumulative frequency curves were derived for each individual service based on parent indicated use of that service at any time from discharge through the plotted postmenstrual age.

Results:
A total of 832 infants survived through discharge and 818 infants met study inclusion criteria. Overall, 674 infants (82%) utilized at least one post-discharge special service after NICU discharge, with 63% utilizing early intervention (EI) services. We found a correlation between increasing maternal age and increasing use of EI. After correction for gestational age, there was no significant variation in EI or other special therapy utilization by maternal ethnicity, education level, or ethnicity (Table 1).

We found significant variability in EI utilization by state of enrollment with greatest utilization from infants cared for in Massachusetts and lowest utilization by those cared for in Texas. Beyond EI, PT, OT, and ST had wide ranges of utilization by state of enrollment after correction for gestational age and birthweight (Figure 1).

Conclusion:
The utilization of EI may be impacted by socioeconomic factors and maternal characteristics. Further, we found substantial variability in the use of outpatient therapy services based on state of enrollment. More research is required to characterize the potential disparities impacting utilization of special services following NICU discharge in ELGANs.