Ensuring Optimal Outcomes for Preterm Infants after NICU Discharge: A Life Course Health Development Approach to High-Risk Infant Follow-Up

Abstract

Children born prematurely (<37 weeks’ gestation) have an increased risk for chronic health problems and developmental challenges compared to their term-born peers. The threats to health and development posed by prematurity, the unintended effects of life-sustaining neonatal intensive care, the associated neonatal morbidities, and the profound stressors to families affect well-being during infancy, childhood, adolescence, and beyond. Specialized clinical programs provide medical and developmental follow-up care for preterm infants after hospital discharge. High-risk infant follow-up, like most post-discharge health services, has many shortcomings, including unclear goals, inadequate support for infants, parents, and families, fragmented service provisions, poor coordination among providers, and an artificially foreshortened time horizon. There are well-documented inequities in care access and delivery. We propose applying a life course health development framework to clinical follow-up for children born prematurely that is contextually appropriate, developmentally responsive, and equitably deployed. The concepts of health development, unfolding, complexity, timing, plasticity, thriving, and harmony can be mapped to key components of follow-up care delivery to address pressing health challenges. This new approach envisions a more effective version of clinical follow-up to support the best possible functional outcomes and the opportunity for every premature infant to thrive within their family and community environments over their life course.

NICU Graduates and Psychosocial Problems in Childhood: A Systematic Review

“…Litt et al's research titled "Ensuring Optimal Outcomes for Preterm Infants after NICU Discharge: A Life Course Health Development Approach to High-Risk Infant Follow-Up" recommends the life-course health development model for enhancing follow-up care of at-risk neonates after NICU discharge [ 12 ]. These infants are children who are born early, small for their gestational age, or underweight as per the American Academy of Pediatrics criteria.…”

“…As stated by Shaw et al, another quite alarming odds ratio recorded was 2.5 (95% CI: 1.8-3.5) suggesting that, for developmental disabilities in particular, preterm infants are at higher risk than full-term infants [ 17 ]. First, it proves that NICU graduates need much assistance and that necessary attempts should be made to identify problems in NICU-born children's development as early as possible, perform foster care at once, and provide strict follow-ups to minimize the consequences [ 12 ]. Moreover, the research of Hyun et al influenced the idea that children with autism spectrum disorder (ASD) need periodic neurodevelopmental surveillance and early services since their development entails distinctive protocols from the typical population [ 19 ].…”