Higher Maternal Parity and Previous Missed Visits Confer Higher Odds of Loss to Follow-up in the High-risk Neonatal Developmental Clinic

Lilia Popova, University of Michigan Medical School, United States; Emman Dabaja, Michigan Medicine Department of Pediatrics, Division of Neonatal-Perinatal Medicine, United States; Caroline McGowan, University of Michigan Medical School, United States; Sanaya Irani, University of Michigan Medical School, United States; Samantha Gondy, University of Michigan Medical School, United States; Cambrynne DeJong, epartment of Pediatrics, Doernbecher Children’s Hospital, Oregon Health & Science University, United States; Mohammad Attar, Michigan Medicine Department of Pediatrics, Division of Neonatal-Perinatal Medicine, United States

Background: Neonates at high risk for developmental complications are referred to developmental follow-up clinics because of the potential benefits of timely diagnosis and referral to services. There are disparities in developmental follow-up by race, maternal smoking status, distance from the hospital, gestational age, and medical complexity, but gaps in the literature remain.

Objectives: To determine whether higher maternal parity and missed follow-up visits are independently associated with higher odds of loss to follow-up from the neonatal developmental clinic.

Design/Methods: This was a retrospective cohort study of 150 randomly-selected patients born between January 1st, 2014 and December 31st, 2017, who had inpatient stays at a regional specialty hospital during the neonatal period, and were referred to the high-risk developmental clinic at that center. We reviewed electronic health records of all patients. We used multivariable logistic regression to model loss to follow-up, which was defined as not attending a recommended follow-up visit without informing the clinic of a reason for discontinuation. Potential confounders were determined by prior knowledge and added individually to the models to determine their effect on the exposure-outcome relationship. Variables were included in the fully adjusted model if they changed point estimates by approximately 10% or more.

Results: Of 150 randomly-selected patients, 66% were white, 16% were Black, 7% were Asian, and 5% were Hispanic. 31% of patients were extremely preterm (<=28 weeks), 29% were from a multiple gestation, and 63% had public insurance. 50% were the first child, 25% were the second child, and 25% were the third child or more. Younger maternal age, multiple gestation, maternal smoking during pregnancy, and public insurance were significantly associated with having more missed visits (p < 0.05). For each additional follow-up visit missed (either patient-canceled or no-show), the adjusted odds of ultimately being lost to follow-up were 1.7 times higher (95% CI: 1.2, 2.5). For maternal parity, the adjusted odds of loss to follow-up were 2.9 times higher for second children compared to first children and 3.4 times higher for third or more children compared to first children.

Conclusion: Higher maternal parity and having a history of any no-show or patient-canceled visits were both independently associated with higher odds of eventually being lost to follow-up from the high-risk neonatal developmental follow-up clinic.