1233 The Impact of Medical Home Model on Neurodevelopmental Outcomes of Very Preterm Infants

Abstract Introduction/Background Bronchopulmonary dysplasia (BPD) is a common complication of extreme prematurity and may require prolonged home respiratory support. BPD is associated with worse neurodevelopmental outcomes but the impact of home respiratory support on neurodevelopmental outcomes, rehospitalization rates and association with caregiver sociodemographics is less well studied. Objectives This study examines the impact of home respiratory support on neurodevelopmental outcomes in very preterm infants at 18-24 months corrected gestational age. Design/Methods This linked Canadian Neonatal Network and Canadian Neonatal Follow-Up Network (CNFUN) multicenter cohort study of infants born April 1, 2009-December 31, 2016 at <29 weeks’ gestational age assessed at 18-24 months corrected age at a CNFUN site compared significant neurodevelopmental impairment rates, rehospitalization rates and sociodemographics in children with and without home respiratory support using Chi-square and student t-tests. Results Of the 3918 infants, 622 (15.9%) received home respiratory support. As expected, infants on home respiratory support had a lower gestational age (mean 25.5 vs 26.5 weeks, p < 0.01), lower birth weight (mean 781 vs 955 grams, p < 0.01), longer NICU stay (mean 118 vs 76 days, p < 0.01) and more comorbidities: late onset sepsis (35.1% vs 22.9%, p < 0.01), NEC ≥ stage 2 (8.9% vs 5.9%, p = 0.01), grade 3-4 IVH or PVL (12.7% vs 8.4%, p < 0.01) and ROP ≥ grade 3 (28% vs 10.8%, p < 0.01). Infants on home respiratory support had higher significant neurodevelopmental impairment rates defined as Bayley-III motor, cognitive, language scores <70, nonambulatory cerebral palsy (GMFCS ≥ 3), hearing and/or visual impairment rates (Table 1), rehospitalization rates (63.3% vs 29.2%, p < 0.01) and >3 rehospitalizations (19.8% vs 5.0%, p < 0.01). With home respiratory support, fewer families had paid employment and more were on social welfare. Conclusion Children born preterm who are discharged home on respiratory support, compared to those without home support, are more likely to experience neurodevelopmental impairment and rehospitalization, and may have an adverse impact on family income. This is important for discharge planning and follow-up care of these high risk children.

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The Impact of Neonatal Morbidities on Smooth Pursuit Eye Movements in Very Preterm Infants

Pediatric Research ◽

10.1038/pr.2011.577 ◽

2011 ◽

Vol 70 ◽

pp. 352-352 ◽

Cited By ~ 2

Author(s):

K Strand Brodd ◽

K Rosander ◽

H Grönqvist ◽

G Holmström ◽

B Strömberg ◽

...

Keyword(s):

Eye Movements ◽

Preterm Infants ◽

Smooth Pursuit ◽

Smooth Pursuit Eye Movements ◽

Very Preterm Infants ◽

Very Preterm ◽

Pursuit Eye Movements ◽

The Impact

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Predictive Value of Cranial Ultrasound for Neurodevelopmental Outcomes of Very Preterm Infants with Brain Injury

Chinese Medical Journal ◽

10.4103/0366-6999.229895 ◽

2018 ◽

Vol 131 (8) ◽

pp. 920-926 ◽

Cited By ~ 2

Author(s):

Xue-Hua Zhang ◽

Shi-Jun Qiu ◽

Wen-Juan Chen ◽

Xi-Rong Gao ◽

Ya Li ◽

...

Keyword(s):

Brain Injury ◽

Preterm Infants ◽

Predictive Value ◽

Cranial Ultrasound ◽

Neurodevelopmental Outcomes ◽

Very Preterm Infants ◽

Very Preterm

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Impact of macro-socioeconomic determinants on perinatal healthcare quality for very preterm infants

European Journal of Public Health ◽

10.1093/eurpub/ckz186.006 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

J Doetsch ◽

S C S Marques ◽

T Krafft ◽

H Barros

Keyword(s):

Private Sector ◽

Preterm Infants ◽

Economic Crisis ◽

Healthcare Quality ◽

Wage Distribution ◽

Very Preterm Infants ◽

Socioeconomic Determinants ◽

Very Preterm ◽

Secondary Stage ◽

The Impact

Abstract The WHO identified the importance of macro-socioeconomic determinants and the political context as interlinked key factors affecting health equity. The 2008 economic crisis was associated with a significant low-birth-weight increase in Portugal, 2007-2014. The Economic Adjustment Programme (EAP), implemented to economize non-essential health care costs (2011-2014), substantially affected healthcare delivery and occupational environment of Healthcare Professionals (HCPs). This study aims to analyse the impact observed by HCPs of the economic crisis and EAP on equitable quality of perinatal healthcare for very preterm infants in Portugal. A Qualitative study design with 21 HCPs in clinical settings equally distributed among Portuguese mainland were selected according to their response. Semi-structured interviews were conducted between October 2018-April 2019 until saturation point was achieved. A content analysis was performed using Nvivo2011 software. Preliminary results on macro-socioeconomic determinants, classified and conceptualized into a three-stage-effect framework, disclosed an interrelation between factors impacting perinatal healthcare quality, according to HCPs. Primary-stage: increase in working hours and patient-ratio per HCPs, cuts in salaries and investment, increasing waiting time and HCPs demotivation. Secondary-stage: burnout, work-absence, time constraints, decreasing quality and consultation availability. Tertiary-stage: HCPs Brain-drain to private sector, double-shifts in public-private sector, increasing inadequacy of transmissivity within sector communication. The economic crisis and EAP were perceived to have modified equitable perinatal healthcare quality for very preterm infants in Portugal. Increased private-public sector transparency to maximise quality assurance, equal HCP wage distribution to sustain capability, strengthening of social maternity protection strategies to enhance socioeconomic equity in perinatal healthcare, is recommended. Key messages The added value is the disclosure of an in-depth understanding on the interrelation of macro-socioeconomic determinants and healthcare permitting a distinct representation from quantitative methods. The non-linearity between policy response and expected outcomes chiefly complements its comprehension and demonstrates its relevance for further research on assessing effects of austerity measures.

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