Community Supports After Surviving Extremely Low-Birth-Weight, Extremely Preterm Birth

Introduction

The article ‘Community Supports After Surviving Extremely Low-Birth-Weight, Extremely Preterm Birth’ by Susan Hintz and partners addresses the issue of extremely preterm children who have a dire need for resource services.In the recent past, there has been a high survival rate of very low-birth-weight (VLBW) of close to ninety percent. From other research studies, the financial expenses, application of services as well as risk factors linked with high resource use in times of the first hospitalization of extremely preterm and ELBW of less than 1000 g are addressed. Evaluation of post discharge special outpatient services (SOS) application for previous preterm infants have emphasized on educational services as well as therapies linked to functional limitations during school age. Research on ELBW infants during advanced childhood has shown a link between the requirement for services as well as severe neurodevelopmental outcomes. Other studies have emphasized on the economic impact linked with re-hospitalizations following the initial discharge.

Purpose of the study

From the article, the study aims “To determine special outpatient services (SOS) use, need, associated factors, and neurodevelopmental and functional outcomes among extremely preterm infants at 18 to 22 months’ corrected age” (Hintz, 2008 pr. 1). The research is a retrospective analysis conducted at the National Institute of Child Health and Human Development (NICHD). For infants born less than twenty eight weeks’ estimated gestational age (EGA) at NICHD Neonatal Research Network centers, various aspects were to be determined. These included the range of SOS applied since the initial hospital discharge up to eighteen to twenty two months corrected age, the apparent SOS need not given and the link between perinatal, neonatal as well as socio-demographic aspects with more application of SOS and need. The link of neurodevelopmental as well as functional outcome with need and more application of SOS were evaluated.

Method

The research involved infants less than twenty eight weeks ‘gestational age whose birth weight was below 1000 g. it was held at the Neonatal Research Network center since first January 1997 up to thirty first December the year 2000. The infants had a follow-up at eighteen to twenty two months’ corrected age. The interventions involved use of questionnaires during the eighteen to twenty two months follow-up concerning SOS application from the time of hospital discharge as well as the apparent requirement for SOS. The SOS included services on social work, medical specialty, visiting nurse, speech & language, early intervention, occupational & physical therapy as well as neurodevelopmental & behavioral amenities. The SOS needs were evaluated with regard to gestational age. Besides, logistic regression analysis pointed out the aspects independently linked to application of over five services and with the requirement for additional services.

Results

Out of 2, 315 infants, 54.7 percent used over three SOS by eighteen to twenty two months while 19.1 percent used six to seven SOS. The requirement for any SOS was determined as 37 percent. From the article, ‘Sepsis, birth weight, postnatal corticosteroid use, bronchopulmonary dysplasia, and cystic periventricular leukomalacia or grade 3 or 4 intraventricular hemorrhage’ (pr.7) are the Variables that mostly linked to severe neurodevelopment results as well as the need for over five SOS. The male gender was also linked with a need for any SOS. While more SOS application was particularly probable for infants having severe neurodevelopmental outcomes, there was also a notable need for SOS for children with mild developmental impairment, adding up to 39.7 percent as well as those with cerebral palsy, who added up to 42.2 percent.

Conclusions

High use of SOS is not only common but it is also associated with notable neonatal risk factors. Besides, it is linked with neurodevelopmental impairment. Those who survive extremely preterm pose a significant need for community aids irrespective of the level of impairment. As a result, there is a need to upgrade comprehensive conveyance of family-centered community-based programs.

Relevance to psychology

12.8 percent of children less than eighteen years in the U.S show a specialized healthcare requirement every year. The range of SOS application has not been exhausted for extremely preterm children ranging from the initial hospitalization up to early childhood. Post discharge services application in extremely preterm infants during the early childhood and determining linked perinatal as well as neonatal risk factors may be essential for fiscal budgeting of the local, state and national government. This awareness might result to targeted referrals, enhanced multidisciplinary approach and anticipatory counseling to families at the time of first hospital discharge (Hintz, 2008).

Chapter one of the book ‘Development through the lifespan’ focus on the theories of human development (Berk, 2010). In relation, the research study reflects that development is a continuous process in that the later stages of early childhood are dependent on perinatal and neonatal factors. The research helps to show that development is continuous and changes as new experiences such as SOS are administered to extremely preterm infants. It also depict that development is multidimensional in that it is affected by biological, social as well as psychological factors. The complex human changes are seen to have been affected by various factors, which could be independent or interact with one another as seen in them lifespan perspective (Berk, 2010). From the study, these include neonatal risk factors, neurodevelopmental impairment, ELBW and socio-demographic aspects that pose a higher need for SOS. Besides, the study was essential to help upgrade the comprehensive delivery of SOS for extremely preterm infants who survive in order to enhance their development and overall wellbeing.

References

Berk, E. L. (2010). Development through the lifespan. 5^th ed. Boston: Allyn & Bacon.

Hintz, S. R. (2008).Community Supports After Surviving Extremely Low-Birth-Weight, Extremely Preterm Birth. Archives of Pediatrics and Adolescence Medicine, 162(8):748- 755. Retrieved on June 21, 2011 from http://archpedi.ama- assn.org/cgi/content/full/162/8/748