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.

Table 1

Two Year Outcomes of Extremely Preterm Infants with or without CPS Supervision

Table 1

Two Year Outcomes of Extremely Preterm Infants with or without CPS Supervision

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Table 2

Adjusted Linear Regression of BSID-III Cognitive and Language composite scores

Table 2

Adjusted Linear Regression of BSID-III Cognitive and Language composite scores

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