Abstract
Objective: To evaluate neurodevelopmental outcomes of preterm infants with need for Child Protective Services (CPS) supervision at hospital discharge compared with those discharged without CPS supervision. Study design: For infants born at <27 weeks of gestation between 2006 and 2013, prospectively collected maternal and neonatal characteristics and 18- to 26-month corrected age follow-up data were analyzed. Bayley-III cognitive and language scores of infants with discharge CPS supervision were compared with infants without CPS supervision using regression analysis while adjusting for potentially confounding variables, including entering CPS after discharge from the hospital. Results: Of the 4517 preterm infants discharged between 2006 and 2013, 255 (5.6%) were discharged with a need for CPS supervision. Mothers of infants with CPS supervision were significantly more likely to be younger, single, and gravida ≥3; to have less than a high school education; and to have a singleton pregnancy and less likely to have received prenatal care or antenatal steroids. Despite similar birth weight and medical morbidities, the CPS group had longer hospital stays compared with the non-CPS group. In adjusted analysis, cognitive scores were points lower (B = −1.94; 95% CI, −3.88 to −0.08; P = .04) in the CPS at discharge group compared with the non-CPS group. In children who entered CPS supervision after hospital discharge (an additional 106 infants), cognitive scores were 4 points lower (β = −4.76; 95% CI, −7.47 to −2.05; P < .001) and language scores were 5 points lower (β = −4.93; 95% CI, −8.00 to −1.86; P = .002). Conclusion: Extremely preterm infants discharged from the hospital with CPS supervision or entering CPS postdischarge are at increased risk for cognitive delay at 2 years of age. Opportunities exist to intervene and potentially improve outcomes in this vulnerable group of children.
| Original language | English |
|---|---|
| Pages (from-to) | 41-49.e4 |
| Journal | Journal of Pediatrics |
| Volume | 215 |
| DOIs | |
| State | Published - Dec 2019 |
Bibliographical note
Publisher Copyright:© 2019
Keywords
- behavior
- cognitive and language outcome
- foster care
- growth
- preterm
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
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In: Journal of Pediatrics, Vol. 215, 12.2019, p. 41-49.e4.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Developmental Outcomes of Extremely Preterm Infants with a Need for Child Protective Services Supervision
AU - McGowan, Elisabeth C.
AU - Laptook, Abbot R.
AU - Lowe, Jean
AU - Peralta-Carcelen, Myriam
AU - Chowdhury, Dhuly
AU - Higgins, Rosemary D.
AU - Hintz, Susan R.
AU - Vohr, Betty R.
AU - Polin, Richard A.
AU - Laptook, Abbott R.
AU - Keszler, Martin
AU - Hensman, Angelita M.
AU - Alksninis, Barbara
AU - Basso, Kristin M.
AU - Burke, Robert
AU - Caskey, Melinda
AU - Johnson, Katharine
AU - Keszler, Mary Lenore
AU - Knoll, Andrea M.
AU - Leach, Theresa M.
AU - Little, Emilee
AU - McGowan, Elisabeth C.
AU - Vieira, Elisa
AU - Watson, Victoria E.
AU - Ventura, Suzy
AU - Walsh, Michele C.
AU - Fanaroff, Avroy A.
AU - Hibbs, Anna Marie
AU - Wilson-Costello, Deanne E.
AU - Newman, Nancy S.
AU - Payne, Allison H.
AU - Siner, Bonnie S.
AU - Bhola, Monika
AU - Yalcinkaya, Gulgun
AU - Friedman, Harriet G.
AU - Truog, William E.
AU - Pallotto, Eugenia K.
AU - Kilbride, Howard W.
AU - Gauldin, Cheri
AU - Holmes, Anne
AU - Johnson, Kathy
AU - Knutson, Allison
AU - Schibler, Kurt
AU - Donovan, Edward F.
AU - Grisby, Cathy
AU - Bridges, Kate
AU - Alexander, Barbara
AU - Fischer, Estelle E.
AU - Mincey, Holly L.
AU - Hessling, Jody
AU - Gratton, Teresa L.
AU - Jackson, Lenora
AU - Kirker, Kristin
AU - Muthig, Greg
AU - Steichen, Jean J.
AU - Tepe, Stacey
AU - Yolton, Kimberly
AU - Goldberg, Ronald N.
AU - Cotten, C. Michael
AU - Goldstein, Ricki F.
AU - Ashley, Patricia L.
AU - Malcolm, William F.
AU - Auten, Kathy J.
AU - Fisher, Kimberley A.
AU - Grimes, Sandra
AU - Gustafson, Kathryn E.
AU - Lohmeyer, Melody B.
AU - Finkle, Joanne
AU - Laughon, Matthew M.
AU - Bose, Carl L.
AU - Bernhardt, Janice
AU - Bose, Gennie
AU - Clark, Cindy
AU - Manor, Linda
AU - Warner, Diane
AU - Wereszczak, Janice
AU - Carlton, David P.
AU - Stoll, Barbara J.
AU - Adams-Chapman, Ira
AU - Hale, Ellen C.
AU - Loggins, Yvonne
AU - Archer, Stephanie Wilson
AU - Sokol, Gregory M.
AU - Poindexter, Brenda B.
AU - Dusick, Anna M.
AU - Papile, Lu Ann
AU - Gunn, Susan
AU - Hamer, Faithe
AU - Herron, Dianne E.
AU - Hines, Abbey C.
AU - Lytle, Carolyn
AU - Minnich, Heike M.
AU - Smiley, Lucy
AU - Wilson, Leslie Dawn
AU - Sanchez, Pablo J.
AU - Nelin, Leif D.
AU - Jadcherla, Sudarshan R.
AU - Luzader, Patricia
AU - Fortney, Christine A.
AU - Besner, Gail E.
AU - Parikh, Nehal A.
AU - Das, Abhik
AU - Wallace, Dennis
AU - Gantz, Marie G.
AU - Poole, W. Kenneth
AU - Newman, Jamie E.
AU - O'Donnell Auman, Jeanette
AU - Crawford, Margaret M.
AU - Petrie Huitema, Carolyn M.
AU - Zaterka-Baxter, Kristin M.
AU - Van Meurs, Krisa P.
AU - Stevenson, David K.
AU - Hintz, Susan R.
AU - Ball, M. Bethany
AU - Davis, Alexis S.
AU - Palmquist, Andrew W.
AU - Proud, Melinda S.
AU - Bentley, Barbara
AU - Bruno, Elizabeth
AU - DeAnda, Maria Elena
AU - DeBattista, Anne M.
AU - Earhart, Beth
AU - Huffman, Lynne C.
AU - Kohn, Jean G.
AU - Krueger, Casey
AU - Weiss, Hali E.
AU - Frantz, Ivan D.
AU - Fiascone, John M.
AU - MacKinnon, Brenda L.
AU - Furey, Anne
AU - Nylen, Ellen
AU - McGowan, Elisabeth C.
AU - Carlo, Waldemar A.
AU - Ambalavanan, Namasivayam
AU - Peralta-Carcelen, Myriam
AU - Collins, Monica V.
AU - Cosby, Shirley S.
AU - Biasini, Fred J.
AU - Johnston, Kristen C.
AU - Nelson, Kathleen G.
AU - Patterson, Cryshelle S.
AU - Phillips, Vivien A.
AU - Whitley, Sally
AU - Devaskar, Uday
AU - Garg, Meena
AU - Purdy, Isabell B.
AU - Chanlaw, Teresa
AU - Geller, Rachel
AU - Finer, Neil N.
AU - Vaucher, Yvonne E.
AU - Kaegi, David
AU - Rasmussen, Maynard R.
AU - Arnell, Kathy
AU - Demetrio, Clarence
AU - Fuller, Martha G.
AU - Rich, Wade
AU - Bell, Edward F.
AU - Colaizy, Tarah T.
AU - Acarregui, Michael J.
AU - Ellsbury, Dan L.
AU - Widness, John A.
AU - Johnson, Karen J.
AU - Campbell, Donia B.
AU - Eastman, Diane L.
AU - Walker, Jacky R.
AU - Brumbaugh, Jane E.
AU - Duara, Shahnaz
AU - Bauer, Charles R.
AU - Everett-Thomas, Ruth
AU - Fajardo-Hiriart, Sylvia
AU - Rigaud, Arielle
AU - Calejo, Maria
AU - Frade Eguaras, Silvia M.
AU - Berkowits, Michelle Harwood
AU - Garcia, Andrea
AU - Pierre, Helina
AU - Stoerger, Alexandra
AU - Watterberg, Kristi L.
AU - Lowe, Jean R.
AU - Fuller, Janell F.
AU - Ohls, Robin K.
AU - Lacy, Conra Backstrom
AU - Duncan, Andrea F.
AU - Montman, Rebecca
AU - Schmidt, Barbara
AU - Kirpalani, Haresh
AU - DeMauro, Sara B.
AU - Chaudhary, Aasma S.
AU - Abbasi, Soraya
AU - Mancini, Toni
AU - Cucinotta, Dara M.
AU - Bernbaum, Judy C.
AU - Gerdes, Marsha
AU - Hurt, Hallam
AU - D'Angio, Carl T.
AU - Phelps, Dale L.
AU - Guillet, Ronnie
AU - Lakshminrusimha, Satyan
AU - Johnson, Julie Babish
AU - Reubens, Linda J.
AU - Horihan, Cassandra A.
AU - Hust, Diane
AU - Jensen, Rosemary L.
AU - Kushner, Emily
AU - Merzbach, Joan
AU - Myers, Gary J.
AU - Rowan, Mary
AU - Wadkins, Holly I.M.
AU - Bowman, Melissa
AU - Hunn, Julianne
AU - Guilford, Stephanie
AU - Maffett, Deanna
AU - Osman, Farooq
AU - Prinzing, Diane
AU - Reynolds, Anne Marie
AU - Rowan, Mary
AU - Sacilowski, Michael G.
AU - Williams, Ashley
AU - Wynn, Karen
AU - Yost, Kelley
AU - Zorn, William
AU - Zwetsch, Lauren
AU - Kennedy, Kathleen A.
AU - Tyson, Jon E.
AU - McDavid, Georgia E.
AU - Alaniz, Nora I.
AU - Arldt-McAlister, Julie
AU - Burson, Katrina
AU - Evans, Patricia W.
AU - Duncan, Andrea F.
AU - Garcia, Carmen
AU - Green, Charles
AU - Harris, Beverly Foley
AU - Jiminez, Margarita
AU - John, Janice
AU - Jones, Patrick M.
AU - Lillie, Layne M.
AU - Lis, Anna E.
AU - Martin, Karen
AU - Martin, Sara C.
AU - Morris, Brenda H.
AU - Poundstone, M. Layne
AU - Robichaux, Peggy
AU - Rodgers, Shawna
AU - Siddiki, Saba
AU - Simmons, Maegan C.
AU - Sperry, Daniel
AU - Pierce Tate, Patti L.
AU - Wright, Sharon L.
AU - Wyckoff, Myra H.
AU - Brion, Luc P.
AU - Heyne, Roy J.
AU - Salhab, Walid A.
AU - Rosenfeld, Charles R.
AU - Vasil, Diana M.
AU - Chen, Lijun
AU - Guzman, Alicia
AU - Hensley, Gaynelle
AU - Leps, Melissa H.
AU - Miller, Nancy A.
AU - Morgan, Janet S.
AU - Adams, Sally S.
AU - Boatman, Catherine Twell
AU - Heyne, Elizabeth T.
AU - Madden, Linda A.
AU - Torres, Lizette E.
AU - Faix, Roger G.
AU - Yoder, Bradley A.
AU - Osborne, Karen A.
AU - Spencer, Cynthia
AU - Weaver-Lewis, Kimberlee
AU - Baker, Shawna
AU - Bird, Karie
AU - Burnett, Jill
AU - Steffen, Michael
AU - Jensen, Jennifer J.
AU - Winter, Sarah
AU - Zanetti, Karen
AU - O'Shea, T. Michael
AU - Dillard, Robert G.
AU - Washburn, Lisa K.
AU - Jackson, Barbara G.
AU - Peters, Nancy
AU - Chiu, Korinne
AU - Allred, Deborah Evans
AU - Goldstein, Donald J.
AU - Halfond, Raquel
AU - Peterson, Carroll
AU - Waldrep, Ellen L.
AU - Welch, Cherrie D.
AU - Morris, Melissa Whalen
AU - Hounshell, Gail Wiley
AU - Shankaran, Seetha
AU - Pappas, Athina
AU - Barks, John
AU - Bara, Rebecca
AU - Goldston, Laura A.
AU - Natarajan, Girija
AU - Christensen, Mary
AU - Wiggins, Stephanie A.
AU - White, Diane
AU - Ehrenkranz, Richard A.
AU - Jacobs, Harris
AU - Butler, Christine G.
AU - Cervone, Patricia
AU - Greisman, Sheila
AU - Konstantino, Monica
AU - Poulsen, Jo Ann
AU - Taft, Janet
AU - Williams, Joanne
AU - Romano, Elaine
N1 - Publisher Copyright: © 2019
PY - 2019/12
Y1 - 2019/12
N2 - Objective: To evaluate neurodevelopmental outcomes of preterm infants with need for Child Protective Services (CPS) supervision at hospital discharge compared with those discharged without CPS supervision. Study design: For infants born at <27 weeks of gestation between 2006 and 2013, prospectively collected maternal and neonatal characteristics and 18- to 26-month corrected age follow-up data were analyzed. Bayley-III cognitive and language scores of infants with discharge CPS supervision were compared with infants without CPS supervision using regression analysis while adjusting for potentially confounding variables, including entering CPS after discharge from the hospital. Results: Of the 4517 preterm infants discharged between 2006 and 2013, 255 (5.6%) were discharged with a need for CPS supervision. Mothers of infants with CPS supervision were significantly more likely to be younger, single, and gravida ≥3; to have less than a high school education; and to have a singleton pregnancy and less likely to have received prenatal care or antenatal steroids. Despite similar birth weight and medical morbidities, the CPS group had longer hospital stays compared with the non-CPS group. In adjusted analysis, cognitive scores were points lower (B = −1.94; 95% CI, −3.88 to −0.08; P = .04) in the CPS at discharge group compared with the non-CPS group. In children who entered CPS supervision after hospital discharge (an additional 106 infants), cognitive scores were 4 points lower (β = −4.76; 95% CI, −7.47 to −2.05; P < .001) and language scores were 5 points lower (β = −4.93; 95% CI, −8.00 to −1.86; P = .002). Conclusion: Extremely preterm infants discharged from the hospital with CPS supervision or entering CPS postdischarge are at increased risk for cognitive delay at 2 years of age. Opportunities exist to intervene and potentially improve outcomes in this vulnerable group of children.
AB - Objective: To evaluate neurodevelopmental outcomes of preterm infants with need for Child Protective Services (CPS) supervision at hospital discharge compared with those discharged without CPS supervision. Study design: For infants born at <27 weeks of gestation between 2006 and 2013, prospectively collected maternal and neonatal characteristics and 18- to 26-month corrected age follow-up data were analyzed. Bayley-III cognitive and language scores of infants with discharge CPS supervision were compared with infants without CPS supervision using regression analysis while adjusting for potentially confounding variables, including entering CPS after discharge from the hospital. Results: Of the 4517 preterm infants discharged between 2006 and 2013, 255 (5.6%) were discharged with a need for CPS supervision. Mothers of infants with CPS supervision were significantly more likely to be younger, single, and gravida ≥3; to have less than a high school education; and to have a singleton pregnancy and less likely to have received prenatal care or antenatal steroids. Despite similar birth weight and medical morbidities, the CPS group had longer hospital stays compared with the non-CPS group. In adjusted analysis, cognitive scores were points lower (B = −1.94; 95% CI, −3.88 to −0.08; P = .04) in the CPS at discharge group compared with the non-CPS group. In children who entered CPS supervision after hospital discharge (an additional 106 infants), cognitive scores were 4 points lower (β = −4.76; 95% CI, −7.47 to −2.05; P < .001) and language scores were 5 points lower (β = −4.93; 95% CI, −8.00 to −1.86; P = .002). Conclusion: Extremely preterm infants discharged from the hospital with CPS supervision or entering CPS postdischarge are at increased risk for cognitive delay at 2 years of age. Opportunities exist to intervene and potentially improve outcomes in this vulnerable group of children.
KW - behavior
KW - cognitive and language outcome
KW - foster care
KW - growth
KW - preterm
UR - http://www.scopus.com/inward/record.url?scp=85071902146&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071902146&partnerID=8YFLogxK
U2 - 10.1016/j.jpeds.2019.07.063
DO - 10.1016/j.jpeds.2019.07.063
M3 - Article
C2 - 31500860
AN - SCOPUS:85071902146
SN - 0022-3476
VL - 215
SP - 41-49.e4
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -