BACKGROUND: The number of children under state (Child Protective Services (CPS)) supervision is increasing. Approximately 20% are < 2 years of age, a vulnerable time for brain growth and development. There are limited data on high risk preterm infants under CPS supervision. OBJECTIVE: We hypothesize that EPT infants < 27wks gestational age (GA) discharged from the hospital under CPS supervision will have lower Bayley III (BSID III) cognitive and language scores compared to non-CPS infants at 2 years of age. METHODS/DESIGN: Prospectively collected data by the NICHD NRN for EPT infants born 2006-2013 with 18-26 month corrected age follow up. Infants discharged under CPS supervision (permanent or temporary foster care, or mother/infant under supervision) were compared to non-CPS EPT infants for a primary outcome of BSID III cognitive and language composite scores. Secondary outcomes were behavior, growth, moderate-severe cerebral palsy(CP), and frequency of rehospitalization. Regression analysis compared mean BSID III scores adjusted for covariates. RESULTS: 5.6% (255/4517) of EPT infants were discharged to CPS supervision. Mothers (244/3877) of CPS infants were more likely younger (26.0y±6.7 vs 27.5y±6.3; p=.0004), single (84% vs 55; p < .0001), > gravida 2 (62% vs 44; p < .0001), < high school educated (33% vs 17; p < .0001) singleton pregnancy (89% vs 83; p=0.2) and less likely to have received prenatal care (76% vs 96%; p= < .0001) or antenatal steroids (78% vs 89%; p= < .0001). Groups had similar GA (25.0±1.0 vs 24.9±1.0; p=.12), and birthweight (774.2g±156 vs 756.3±153.6; p=.07). Despite similar rates of SGA, BPD, late sepsis, NEC, high grade IVH, cystic PVL(cPVL),and severe ROP, the CPS group had longer hospital stay (127d±66 vs 116d±45; p=.0007). The CPS at discharge group had lower cognitive scores (p=.0009), similar language scores, and increased CP and growth failure (table 1). After adjusting for center, SES, maternal and infant risk factors (table 2), cognitive differences persisted (-1.94 95% CI; -3.88,-0.08;p=.04). For children who entered CPS supervision after discharge (n=106), cognitive and language differed from non-CPS (-4.76 (-7.47,-2.05);p=.0006; -4.93 (-8.00, -1.86);p=.002), respectively. CONCLUSIONS: EPT infants discharged from the hospital under state supervision are at increased risk for cognitive delay at 2 years. Cognitive and language delays were also seen in infants entering CPS supervision after hospital discharge. Further investigation is needed to explore adverse outcomes, including growth and CP.
Developmental Outcomes of Extremely Preterm Infants Under State Supervision at Hospital Discharge
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Elisabeth C. McGowan, Abbot Laptook, Jean Lowe, Myriam Peralta, Dhuly Chowdhury, Betty Vohr, Rosemary Higgins, NICHD Neonatal Research Network; Developmental Outcomes of Extremely Preterm Infants Under State Supervision at Hospital Discharge. Pediatrics May 2018; 142 (1_MeetingAbstract): 195. 10.1542/peds.142.1MA2.195
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