814 - History of Neonatal Intensive Care Follow-up Programs

Publication Number: 814.5491

Elizabeth T.. Heyne, UTSWMC, Dallas, TX, United States; Erin Rebecca. McDougald, University of Texas Southwestern Medical School, Irving, TX, United States; Roy Heyne, University of Texas Southwestern Medical School, Southlake, TX, United States

Background: Although survival of high-risk infants has improved over time due to advances in Neonatal Intensive Care Unit (NICU) care, rates of neonatal morbidity remain high and require specialized outpatient follow-up from both a clinical, research and educational perspective. To better understand and address the limitations and strengths of such programs, a review of their evolution is needed.

Objective: To give a historical perspective on the development of NICU Follow Up Programs (NFP) that sheds light on limitations/strengths, challenges, future needs and opportunities.

Design/Methods: Review of the literature: Key words: NICU follow up, program or history. Databases searched included PubMed, Scopus

Results: Limited research from 1950-1970 focused on outcomes such as growth and development and laid the groundwork for future NICU care and NFP. Over the next two decades NFP included more developed clinical care of complex NICU grads and education of trainees. A 1995 review showed why multidisciplinary NFP are needed to assist primary care practitioners with care and resources. In 2000 the first randomized controlled trial (RCT) of a comprehensive FUP was published, that demonstrated significant reduction in life-threatening illnesses among high-risk inner-city Dallas NICU grads without increasing the overall costs of care. Another RCT published in 2014 showed similar results for complex care in Houston. From 1980-2000 an increasing number of regional and national networks (e.g. Neonatal Research Network [NRN] and Vermont Oxford) were established to foster collaboration, process improvement, and standard data collection. Recommended NFP elements were specified both by the NRN and the American Academy of Pediatrics from 2000 to 2010. A national survey of academic NFP directors published in 2012 found a variable spectrum of multidisciplinary services, multiple sources of funding, and common involvement of trainees. A subsequent survey from 2014, also including private NFP, showed similar variability in services, funding challenges, no-show rates and various clinical challenges. A review from 2023 discussed NFP models and noted inconsistencies in eligibility criteria and visit timing/logistics and financing and equity barriers. A 2024 review proposed a life course health development approach to address many NFP shortcomings, including unclear goals, inadequate psychosocial support for infants/families, fragmented service provisions, poor coordination, and limited duration

Conclusion(s): A historical review of NFP reveals significant progress, but ongoing challenges requiring further process improvement

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Figure 1 PAS NICU FU2024 rev.pdfNICU Follow up, NICU follow up program, History NICU follow up


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Figure 2 PAS NICU FU2024.pdfIncluded article counts by year from PubMed