Abstract
Objective This study was aimed to determine factors associated with attendance at the second
high-risk infant follow-up (HRIF) visit (V2) by 20 months of corrected age after a
successful first visit (V1), and the impact of rural residence on attendance rates
in a statewide population of very low birth weight (VLBW; <1,500 g) infants.
Study Design Data linked from the California Perinatal Quality of Care Collaborative (CPQCC) Neonatal
Intensive Care Unit (NICU) database and CPQCC-California Children's Services (CCS)
HRIF database. Multivariable logistic regression evaluated independent associations
of sociodemographic, maternal, family, neonatal clinical, and individual HRIF program
differences (factors) with successful V2 in VLBW infants born in 2010 to 2012.
Results Of 7,295 eligible VLBW infants, 75% (5,475) attended V2. Sociodemographic factors
independently associated with nonattendance included maternal race of Black (adjusted
odds ratio [aOR] = 0.61; 95% confidence interval [CI]: 0.5–0.75), public insurance
(aOR = 0.79; 95% CI: 0.69–0.91), and rural residence (aOR = 0.74; 95% CI: 0.61–0.9).
Factors identified at V1that were associated with V2 attendance included attending
V1 within the recommended window (aOR = 2.34; 95% CI: 1.99–2.75) and early intervention
enrollment (aOR = 1.39; 95% CI: 1.12–1.61). Neonatal factors associated with attendance
included birth weight ≤750 g (aOR = 1.83; 95% CI: 1.48–2.5). There were significant
program differences with risk-adjusted rates ranging from 43.7 to 99.7%.
Conclusion Sociodemographic disparities and HRIF program factors are associated with decreased
attendance at V2 among VLBW infants. These findings highlight opportunities for quality
and process improvement interventions starting in the NICU and continuing through
transition to home and community to assure participation in HRIF.
Key Points
Only 75% of VLBW infants attended the second HRIF visit.
Those less likely to attend were Black or had rural residence.
Infants in early intervention or attending first visit within recommended ages were
more likely to attend.
Keywords neurodevelopmental - premature - disparity