Overview
In developed countries, follow-up for neonatal intensive care unit (NICU) patients is commonly performed at designated clinics.
From their inception, NICU-related follow-up clinics have focused on outcomes of premature infants. Some clinics perform follow-up for medical conditions (eg, bronchopulmonary dysplasia,
posthemorrhagic hydrocephalus); however, the intent in all NICU-related clinics is to determine neurodevelopmental outcomes. (For example, some evidence suggests potential risk factors for autism in children who require NICU stays.
Separately, there may be an association between inotrope use and neurodevelopment outcomes [higher risk for sensorineural or mixed hearing loss] in preterm infants [< 29 weeks’ gestation]).
Many clinics do both, especially if the institution is part of a research network.
The intent of the NICU-related follow-up should be several-fold. Less-than-acceptable outcomes may result in practice changes within individual NICUs. Most importantly, professionals in the clinic should direct “NICU graduates” to appropriate rehabilitative or social services if they are not aligned with optimal care in their community.
The growth of NICU-related follow-up clinics reflects the increase in a population of infants with complex needs.
Currently, many neonates born prematurely or term infants with major malformations or perinatal hypoxic insult survive, whereas just a few decades ago, neonates born with these birth defects died.
At the same time, pediatricians and family practitioners have less experience with the advances in NICU care than they did 2-3 decades ago. In addition, current clinical training schedules give pediatric and family practice house staff only limited time to spend in the follow-up care of NICU graduates. The evaluation of preterm and term infants with complex conditions requires the involvement of professionals from multiple medical, rehabilitative, psychological, and social-service subspecialties.
Follow-up of extremely low-birth-weight infants (ELBW), who have a birth weight of less than 1000 g, from infancy to adulthood has revealed subtle neurodevelopmental problems that require evaluations and interventions that are more complex than previously appreciated.
A retrospective analysis of information on ELBW infants from the National Institutes of Child Health and Human Development revealed that these patients have high use of special outpatient services, and efforts to improve these services are needed.
This article is intended to inform pediatricians, family practitioners, other health professionals, and families about the follow-up care of NICU graduates, focusing particularly on the needs of premature infants.