Am J Perinatol
DOI: 10.1055/a-2328-6024
Original Article

Neonatologist at the Well-Child Clinic: A High-Risk Infant Follow-up Pilot Study

1   Department of Public Health, Municipality of Jerusalem, Jerusalem, Israel
Liora Yotvat
1   Department of Public Health, Municipality of Jerusalem, Jerusalem, Israel
Michael S. Schimmel
1   Department of Public Health, Municipality of Jerusalem, Jerusalem, Israel
2   Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
› Author Affiliations
Funding None.


Objective High-risk infant follow-up (HRIF) is a complex process lacking standardization. We present a simple, single-provider model that proved effective and is well-received by caregivers.

Study Design In this study, we measured caregiver use and satisfaction with an HRIF visit attended by an experienced neonatologist in a well-care setting, soon after discharge.

Results One hundred parents participated in the survey. Among the infants of these parents, 78% of infants were seen in the first 3 months of life and 39% within 1 month of discharge. Nutrition (98%) and development (97%) were the most commonly discussed topics, followed by general health (95%), iron supplementation (93%), and head size (90%). Using a 5-point Likert's scale, with 5 being the highest rating, parents responded that the meeting answered their questions (4.7, n = 93), organized their infants' needs (4.6, n = 90), and increased their confidence in caring for their infants (4.65, n = 92).

Conclusion HRIF with an experienced neonatologist is an effective means of increasing parents' understanding of their infants' medical needs and confidence in caring for their infants.

Key Points

  • Meeting with a neonatologist after discharge addressed many crucial aspects of patient care.

  • Meeting with a neonatologist after discharge was met with a high level of caregiver satisfaction.

  • Neonatal consultation in the community may promote caregiver confidence in caring for their infant.

  • Neonatal consultation reduced parental anxiety, especially regarding growth and development.

Authors' Contributions

M.S.S. and S.M.R. conceptualized and designed the study, drafted the manuscript, and critically reviewed and revised the manuscript.

L.Y. designed the data collection instruments, collected the data, performed initial analysis, and critically reviewed the manuscript.

All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Supplementary Material

Publication History

Received: 28 November 2023

Accepted: 15 May 2024

Accepted Manuscript online:
16 May 2024

Article published online:
18 June 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

  • References

  • 1 American Academy of Pediatrics Committee on Fetus and Newborn. Hospital discharge of the high-risk neonate. Pediatrics 2008; 122 (Suppl. 05) 1119-1126
  • 2 Follow-up care of high-risk infants. Pediatrics 2004; 114 (Suppl. 05) 1377-1397
  • 3 Litt JS, McCormick MC. Preterm infants are less likely to have a family-centered medical home than term-born peers. J Perinatol 2018; 38 (10) 1391-1397
  • 4 Wang CJ, McGlynn EA, Brook RH. et al. Quality-of-care indicators for the neurodevelopmental follow-up of very low birth weight children: results of an expert panel process. Pediatrics 2006; 117 (06) 2080-2092
  • 5 Carter BS, Madden W. The neonatologist as primary care physician. Am J Manag Care 1998; 4 (02) 249-254
  • 6 Kuppala VS, Tabangin M, Haberman B, Steichen J, Yolton K. Current state of high-risk infant follow-up care in the United States: results of a national survey of academic follow-up programs. J Perinatol 2012; 32 (04) 293-298
  • 7 Smith VC. Discharge planning considerations for the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 2021; 106 (04) 442-445
  • 8 Stewart J. Care of the NICU graduate. In: Post TW. ed. UpToDate. Waltham, MA: UpToDate; 2023. . Accessed July 4, 2023 at:
  • 9 Litt JS, Campbell DE. High-risk infant follow-up after NICU discharge: current care models and future considerations. Clin Perinatol 2023; 50 (01) 225-238
  • 10 Thomas DG, Bradley L, Servi A. et al. Parental knowledge and recall of concussion discharge instructions. J Emerg Nurs 2018; 44 (01) 52-56
  • 11 Acharya K, Rholl E, Malin K. et al. Parent health-related quality of life for infants with congenital anomalies receiving neonatal intensive care. J Pediatr 2022; 245: 39-46.e2
  • 12 Zimmerman DR, Verbov G, Edelstein N, Stein-Zamir C. Preventive health services for young children in Israel: historical development and current challenges. Isr J Health Policy Res 2019; 8 (01) 23
  • 13 Israel Ministry of Health. Policy for the treatment of infants and children at Family Care Centers [Hebrew]. 2004 . Accessed July 4, 2023 at:
  • 14 Clarfield AM, Manor O, Nun GB. et al. Health and health care in Israel: an introduction. Lancet 2017; 389 (10088): 2503-2513
  • 15 Israel Ministry of Health. Policy for the follow-up community care for the complex and premature infant post-discharge [Hebrew]. 2016 . Accessed July 4, 2023 at:
  • 16 Kim WJ, Lee E, Kim KR, Namkoong K, Park ES, Rha DW. Progress of PTSD symptoms following birth: a prospective study in mothers of high-risk infants. J Perinatol 2015; 35 (08) 575-579
  • 17 Schecter R, Pham T, Hua A. et al. Prevalence and longevity of PTSD symptoms among parents of NICU infants analyzed across gestational age categories. Clin Pediatr (Phila) 2020; 59 (02) 163-169
  • 18 Persson C, Ericson J, Salari R, Eriksson MH, Flacking R. NICU parents' mental health: a comparative study with parents of term and healthy infants. Acta Paediatr 2023; 112 (05) 954-966
  • 19 Vigod SN, Villegas L, Dennis CL, Ross LE. Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: a systematic review. BJOG 2010; 117 (05) 540-550
  • 20 Girchenko P, Robinson R, Rantalainen VJ. et al. Maternal postpartum depressive symptoms partially mediate the association between preterm birth and mental and behavioral disorders in children. Sci Rep 2022; 12 (01) 947
  • 21 de Paula Eduardo JAF, de Rezende MG, Menezes PR, Del-Ben CM. Preterm birth as a risk factor for postpartum depression: a systematic review and meta-analysis. J Affect Disord 2019; 259: 392-403
  • 22 Janvier A, Lantos J, Aschner J. et al. Stronger and more vulnerable: a balanced view of the impacts of the NICU experience on parents. Pediatrics 2016; 138 (03) e20160655
  • 23 Halbmeijer NM, Jeukens-Visser M, Onland W, Flierman M, van Kaam AH, Leemhuis A. SToPC the TOP program study group. Neurodevelopmental outcomes at two years' corrected age of very preterm infants after implementation of a Post-Discharge Responsive Parenting Intervention Program (TOP Program). J Pediatr 2023; 257: 113381
  • 24 Patel T, Ilardi D, Kochilas L. Neurodevelopmental outcomes in children with congenital heart disease: ten years after the American Heart Association Statement. Clin Perinatol 2023; 50 (01) 53-66
  • 25 McGowan EC, Vohr BR. Neurodevelopmental follow-up of preterm infants: what is new?. Pediatr Clin North Am 2019; 66 (02) 509-523
  • 26 Bockli K, Andrews B, Pellerite M, Meadow W. Trends and challenges in United States neonatal intensive care units follow-up clinics. J Perinatol 2014; 34 (01) 71-74
  • 27 Vohr B, McGowan E, Keszler L. et al. Impact of a transition home program on rehospitalization rates of preterm infants. J Pediatr 2017; 181: 86-92.e1
  • 28 Horbar JD, Edwards EM, Ogbolu Y. Our responsibility to follow through for NICU infants and their families. Pediatrics 2020; 146 (06) e20200360
  • 29 Bora S. Beyond survival: challenges and opportunities to improve neurodevelopmental outcomes of preterm birth in low- and middle-income countries. Clin Perinatol 2023; 50 (01) 215-223
  • 30 Greenberg JO, Barnett ML, Spinks MA, Dudley JC, Frolkis JP. The “medical neighborhood”: integrating primary and specialty care for ambulatory patients. JAMA Intern Med 2014; 174 (03) 454-457
  • 31 Schiltz NK, Finkelstein Rosenthal B, Crowley MA. et al. Rehospitalization during the first year of life by insurance status. Clin Pediatr (Phila) 2014; 53 (09) 845-853
  • 32 Ambalavanan N, Carlo WA, McDonald SA, Yao Q, Das A, Higgins RD. Generic Database and Follow-up Subcommittees of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Identification of extremely premature infants at high risk of rehospitalization. Pediatrics 2011; 128 (05) e1216-e1225
  • 33 Azuine RE, Singh GK, Ghandour RM, Kogan MD. Geographic, racial/ethnic, and sociodemographic disparities in parent-reported receipt of family-centered care among US Children. Int J Family Med 2015; 2015: 168521
  • 34 Bennett AC, Rankin KM, Rosenberg D. Does a medical home mediate racial disparities in unmet healthcare needs among children with special healthcare needs?. Matern Child Health J 2012; 16 (Suppl. 02) 330-338