P0073 - Early Intervention Enrollment Among Infants Discharged from the Neonatal ICU at Morgan Stanley Children's Hospital

Background: Due to advances in perinatal intensive care, more children born prematurely are surviving into childhood. Earlier gestational age and lower birth weight have been associated with educational underachievement, higher rates of cognitive impairment, lower IQ scores, and long term adverse developmental outcomes. Timely enrollment in early intervention (EI) services has been shown to be helpful in developmental achievement among all children with disabilities. Studies have shown children born to mothers who are immigrants or do not speak English, are less likely to receive EI, and families with limited income and education report more difficulty obtaining EI services for their children. While these disparities have been found among all children referred for EI, premature infants are particularly vulnerable to developmental delays and should have rapid referral and enrollment in EI for optimal outcomes.

Objective: This study will aim to determine barriers to EI evaluation and enrollment among premature infants seen in a NICU follow-up clinic in an urban children’s hospital.

Methods: This is a retrospective cohort study utilizing a convenience sample involving all children born at Morgan Stanley Children’s Hospital (MSCHONY) between Jan 1, 2013 and March 31, 2017 with either gestational age less than or equal to 28 weeks OR gestational age less than or equal to 32 weeks AND birthweight less than or equal to 1250 grams. These children were eligible for NICU follow-up clinic where EI evaluation and receipt of services are monitored. Demographic and clinical data from the NICU course will be collected and controlled for to determine which factors render a child more or less likely to be evaluated for and receive EI. Children residing outside of NY state will be excluded.

Results: Preliminary data shows that between January 1st, 2015 and March 31, 2017, 305 infants were eligible for NICU follow-up clinic (less than or equal to 28 weeks OR less than or equal to 32 weeks AND BW less than or equal to 1250 grams). Of those, 217 were discharged from our facility, and 138 were seen in NICU Follow-Up clinic. At their first visit, 99 of the 138 (72%) had been evaluated for EI, and 77 of 138 (56%) were enrolled in EI services such as physical, occupational therapy and special instruction. Of the 217 discharged from our facility, 17 were eligible for follow-up clinic but never scheduled, and 62 were scheduled for follow-up clinic but canceled or never came.

Discussion: Based on preliminary results, a large number of high-risk infants were not receiving services through EI. Premature infants more frequently have poor neurodevelopmental outcomes, yet there are many barriers to their receipt of EI services. The goal of this study is to determine and address barriers to EI evaluation and enrollment.