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Bourque SL, Weikel BW, Hwang SS. Prevalence and Predictors of Early Intervention Referral Among Substance-Exposed Newborns. Hosp Pediatr 2023; 13:945-953. [PMID: 37750209 DOI: 10.1542/hpeds.2023-007161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
OBJECTIVES Substance-exposed newborns (SENs) are at risk for developmental delay(s). Early intervention (EI) access, key to addressing these risks, is inequitable. Objectives were to: 1. determine prevalence of EI referral in the Colorado Hospitals Substance-Exposed Newborn Quality Improvement Collaborative; and 2. evaluate predictors of referral. METHODS Within participating Colorado Hospitals Substance-Exposed Newborn hospitals, maternal-infant dyads with exposure to medications for opioid use disorder (MOUD), illicit/prescription opioids, and/or nonopioid substances were included on the basis of electronic medical record documentation. χ2, Fisher's exact, and analysis of variance tests evaluated differences in maternal/infant characteristics by referral. Multivariable Poisson regression models assessed the independent association of characteristics with referral. RESULTS Among 1222 dyads, 504 (41%) SENs received EI referral. Infants born to mothers with non-MOUD (adjusted risk ratio [aRR] 2.15, 95% confidence interval [CI] 1.67-2.76) and polysubstance (aRR 1.58, 95% CI 1.26-1.97) exposure were less likely to receive referral compared with infants born to mothers with MOUD exposure. Those with private (aRR 1.26, 95% CI 1.03-1.55) or self-pay/no insurance (aRR 12.32, 95% CI 10.87-13.96) were less likely to receive referral compared with infants with public insurance. CONCLUSIONS Less than half of identified SENs received EI referral, with variation by substance exposure and maternal insurance status. Systems to ensure equitable access to services are crucial.
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Affiliation(s)
- Stephanie L Bourque
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado
| | - Blair W Weikel
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado
| | - Sunah S Hwang
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado
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Fraiman YS, Barrero-Castillero A, Litt JS. Implications of racial/ethnic perinatal health inequities on long-term neurodevelopmental outcomes and health services utilization. Semin Perinatol 2022; 46:151660. [PMID: 36175260 DOI: 10.1016/j.semperi.2022.151660] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Infants born preterm and with low birth weight have increased risk for neurodevelopmental challenges later in life compared to term-born peers. These include functional motor impairment, cognitive and speech delays, neurobehavioral disorders, and atypical social development. There are well-documented inequities in the population distributions of preterm birth and associated short-term morbidities by race, ethnicity, language, and nativity. Far less is known about how these inequities affect long-term outcomes, though the impact of unequal access to post-discharge support services for preterm infants raises concerns about widening gaps in health, development, and functioning. In this review, we describe what is currently known about the impact of race, ethnicity, nativity, and language on long-term outcomes. We provide a framework for understanding inequities in social, political, and historical context. And we offer guidance for next steps to delineate mechanistic pathways and to identify interventions to eliminate inequities in long-term neurodevelopmental outcomes through research, intervention, and advocacy.
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Affiliation(s)
- Yarden S Fraiman
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Alejandra Barrero-Castillero
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Jonathan S Litt
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Lakshmanan A, Sunshine I, Escobar CM, Kipke M, Vanderbilt D, Friedlich PS, Mirzaian CB. Connecting to Early Intervention Services After Neonatal Intensive Care Unit Discharge in a Medicaid Sample. Acad Pediatr 2022; 22:253-262. [PMID: 34757023 PMCID: PMC8901461 DOI: 10.1016/j.acap.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe caregiver perspectives regarding connecting to early intervention (EI) services after neonatal intensive care unit discharge in a Medicaid sample. METHODS Open-ended semistructured interviews and focus groups were conducted with English- or Spanish-speaking families enrolled in Medicaid in an urban high-risk infant follow-up clinic at a safety-net center, which serves preterm and high-risk term infants. We generated salient themes using inductive-deductive thematic analysis. RESULTS Thirty-two participants completed the study. The infant's median (interquartile range) birth weight was 1365 (969, 2800) grams; 50% were Hispanic; 31% reported living in a neighborhood with fourth quartile economic hardship. Eighty-one percent were classified as having chronic complex disease per the Pediatric Medical Complexity Algorithm and 63% had a diagnosis of developmental delay. A conceptual model was constructed and the analysis revealed major themes describing families' challenges and ideas to facilitate connection to EI. We identified subthemes related to the person in environment: health care environment/support and socio-economic resources, parent perspectives and built environment; provider level factors such as appointment scheduling, staff limitations, and parent suggestions to improve health care and service navigation, which included improved information sharing, the importance of patient advocates, video resources, early referrals to EI facilitated by the discharging hospital and system workarounds. CONCLUSIONS The results from this study may provide a granular roadmap for providers to help facilitate referrals to EI services. We identified several ideas such as using advocates and providing transitional resources, including online media, that might improve the connection to EI services.
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Affiliation(s)
- Ashwini Lakshmanan
- Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California (A Lakshmanam), Los Angeles, Calif; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (A Lakshmanam), Los Angeles, Calif.
| | - Isabel Sunshine
- Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif
| | - Cindy M Escobar
- Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif
| | - Michele Kipke
- Division of Research on Children, Youth and Families, Children's Hospital, Keck School of Medicine, University of Southern California (M Kipke), Los Angeles, Calif; Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California (M Kipke), Los Angeles, Calif
| | - Douglas Vanderbilt
- Section of Developmental-Behavioral Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California (D Vanderbilt), Los Angeles, Calif
| | - Philippe S Friedlich
- Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif
| | - Christine B Mirzaian
- Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California (CB Mirzaian), Los Angeles, Calif
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