PC1092: Longitudinal Medical and Developmental Needs for Periviable NICU Survivors

Background: Recent reports indicate that rates of survival and survival free of neurodevelopmental impairment (NDI) are improving for periviable infants (22 0/7 - 24 6/7 weeks gestation). Given this trend, clinicians must consider the best means to support these children and their families after discharge. Our study objective is to report comprehensive post-discharge outcome data inclusive of post-discharge technology needs, prescribed medications, utilization of early intervention services, and short term developmental outcomes for a cohort of periviable infants who survived to discharge. This data can help inform prenatal counseling, postnatal decision making, and post-discharge support for clinicians and parents.

Methods: Infants born between 22 0/7 and 24 6/7 weeks’ gestation who survived to discharge and were enrolled in a comprehensive NICU follow-up clinic at a single academic center between 2012 and 2017. We report technology needs, medication use, and early intervention service enrollment at discharge and at 1, 6, and 12 months after discharge. We also report the percentage of infants with severe developmental delays at 12 months corrected age, defined as Bayley-III cognitive, language, or motor composite scores < 70. In a sensitivity analysis, the last observations available for infants who died or were lost to follow-up were carried forward for missing variables and reported separately as imputed data.

Results: There were 54 infants in this study cohort. Infants requiring at least one medical technology decreased 46% a year after discharge (Table 1). Infants receiving at least one medication decreased 64%. There was a concomitant increase in utilization of early intervention services with 85% of infants in our cohort enrolled or receiving services by 12-months and 51% were receiving multiple services (Table 2). The overall trends held true in imputed data analysis as well. At 12 months corrected age, 27%, 20%, and 42% of infants had severe delays in cognitive, language and/or motor development respectively.

Conclusion: Periviable infants at our academic center who survived to discharge and were followed in our comprehensive NICU follow-up clinic had decreased technology needs and prescribed medications at 12 months after discharge, with increasing utilization of interventional services. In addition, the majority of periviable infants in our cohort survived without evidence of severe developmental delay at 12 months corrected age. Further studies are needed to corroborate our results to a larger and institutionally diverse population.