PM2011: Maternal Parity and Familial Ability to Meet High-risk Neonatal Developmental Clinic Follow-up Recommendations

Background: Neonatal intensive care units are required to have follow-up clinics for infants at high risk for developmental complications. There are known disparities in follow-up rates in these clinics by race, maternal smoking status, distance from the hospital, gestational age, and medical complexity, but there remain gaps in the literature, such as the effect of maternal parity on follow-up rates. Higher maternal parity of live-born children often indicates larger family size and may be associated with more barriers to follow-up care as a result of difficulties with transportation or childcare.

Methods: The objective of our study was to assess how maternal parity, defined as the birth order of the child referred for the high-risk neonatal developmental clinic, affected compliance with follow-up recommendations, which was defined as returning for all follow-up visits that were recommended. As part of our preliminary analysis, we used simple random sampling to select 100 patients among a retrospective cohort of patients born between January 1st, 2014 and December 31st, 2017, who had neonatal or pediatric intensive care unit stays at a regional specialty hospital during the neonatal period, and who were referred to the high-risk developmental clinic at that same center. We used a three-year follow-up period was used to assess compliance with visit recommendations. We developed a retrospective database with variables coded in a way that would provide comparability to previous literature and populated the database using manual chart review. Multivariable logistic regression was used to model odds of compliance.

Results: Of the 100 patients who were randomly selected, 61% of babies were white and non-Hispanic, 18% were black, 4% were Hispanic, and 8% were Asian. 43% were the first child born to their mother, 26% were the second child, and 31% were the third child or more. 70% of patients were born prematurely, at less than 37 completed weeks and 27% of patients were born extremely prematurely at less than 29 completed weeks. 27% of patients were from a multiple gestation. For each additional child, the odds of being compliant with follow-up visits in the high-risk neonatal developmental clinic were 48% lower (OR: 0.52, 95% CI: 0.30, 0.93; p = 0.03), unadjusted. This remained significant after adjusting for confounding covariates including multiple gestation and race (adjusted OR: 0.56, p = 0.04).

Conclusion: Maternal parity was independently associated with lower odds of compliance with follow-up visits in the high-risk neonatal developmental clinic. More research is needed on how family size affects long-term follow-up rates and how follow-up rates affect developmental outcomes. Early childhood policies should address the additional barriers that families with more than one child face that make keeping up with follow-up medical appointments more challenging.