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
Funding Information:Supported by the National Institutes of Health , Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) ( U10 HD21364 , U10 HD27871 , U10 HD21373 , U10 HD21385 , U10 HD21397 , U10 HD27851 , U10 HD27853 , U10 HD27856 , U10 HD27880 , U10 HD27904 , U10 HD34216 , U10 HD36790 , U10 HD40461 , U10 HD40498 , U10 HD40689 , U10 HD40492 , U10 HD40521 , U10 HD53089 , U10 HD53109 , U10 HD53119 , U10 HD53124 , U10 HD68244 , U10 HD68263 , U10 HD68270 , U10 HD68278 , U10 HD68284 ) and the National Center for Advancing Translational Sciences ( M01 RR30 , M01 RR32 , M01 RR39 , M01 RR44 , M01 RR54 , M01 RR59 , M01 RR64 , M01 RR70 , M01 RR80 , M01 RR125 , M01 RR633 , M01 RR750 , M01 RR997 , M01 RR7122 , M01 RR8084 , M01 RR16587 , UL1 TR42 , ULTR142 , UL1 TR1111 , UL1 TR1117 , UL1 RR25764 ). The NIH , NICHD , National Center for Research Resources , and National Center for Advancing Translational Sciences provided grant support for the Neonatal Research Network's (NRN) generic database and follow-up studies through cooperative agreements. Recruitment was between January 1, 2006 through December 31, 2013, and follow-up was between approximately June 1, 2008, and October 31, 2015. Although the NICHD staff did have input into the study design, conduct, analysis, and manuscript drafting, the content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Data collected at participating sites of the NICHD NRN were transmitted to RTI International, the data coordinating center (DCC) for the network, which stored, managed, and analyzed the data for this study. On behalf of the NRN, Abhik Das (DCC Principal Investigator) and Douglas Kendrick (DCC statistician) had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. The authors declare no conflicts of interest.
Funding Information:
Supported by the National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (U10 HD21364, U10 HD27871, U10 HD21373, U10 HD21385, U10 HD21397, U10 HD27851, U10 HD27853, U10 HD27856, U10 HD27880, U10 HD27904, U10 HD34216, U10 HD36790, U10 HD40461, U10 HD40498, U10 HD40689, U10 HD40492, U10 HD40521, U10 HD53089, U10 HD53109, U10 HD53119, U10 HD53124, U10 HD68244, U10 HD68263, U10 HD68270, U10 HD68278, U10 HD68284) and the National Center for Advancing Translational Sciences (M01 RR30, M01 RR32, M01 RR39, M01 RR44, M01 RR54, M01 RR59, M01 RR64, M01 RR70, M01 RR80, M01 RR125, M01 RR633, M01 RR750, M01 RR997, M01 RR7122, M01 RR8084, M01 RR16587, UL1 TR42, ULTR142, UL1 TR1111, UL1 TR1117, UL1 RR25764). The NIH, NICHD, National Center for Research Resources, and National Center for Advancing Translational Sciences provided grant support for the Neonatal Research Network's (NRN) generic database and follow-up studies through cooperative agreements. Recruitment was between January 1, 2006 through December 31, 2013, and follow-up was between approximately June 1, 2008, and October 31, 2015. Although the NICHD staff did have input into the study design, conduct, analysis, and manuscript drafting, the content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Data collected at participating sites of the NICHD NRN were transmitted to RTI International, the data coordinating center (DCC) for the network, which stored, managed, and analyzed the data for this study. On behalf of the NRN, Abhik Das (DCC Principal Investigator) and Douglas Kendrick (DCC statistician) had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. The authors declare no conflicts of interest.
Publisher Copyright:
© 2019
Keywords
- behavior
- cognitive and language outcome
- foster care
- growth
- preterm
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health