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Multicenter Study
. 2019 Dec:215:41-49.e4.
doi: 10.1016/j.jpeds.2019.07.063. Epub 2019 Sep 6.

Developmental Outcomes of Extremely Preterm Infants with a Need for Child Protective Services Supervision

Elisabeth C McGowan  1 , Abbot R Laptook  2 , Jean Lowe  3 , Myriam Peralta-Carcelen  4 , Dhuly Chowdhury  5 , Rosemary D Higgins  6 , Susan R Hintz  7 , Betty R Vohr  2 ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Collaborators, Affiliations
Multicenter Study

Developmental Outcomes of Extremely Preterm Infants with a Need for Child Protective Services Supervision

Elisabeth C McGowan et al. J Pediatr. 2019 Dec.

Abstract

Objective: To evaluate neurodevelopmental outcomes of preterm infants with need for Child Protective Services (CPS) supervision at hospital discharge compared with those discharged without CPS supervision.

Study design: For infants born at <27 weeks of gestation between 2006 and 2013, prospectively collected maternal and neonatal characteristics and 18- to 26-month corrected age follow-up data were analyzed. Bayley-III cognitive and language scores of infants with discharge CPS supervision were compared with infants without CPS supervision using regression analysis while adjusting for potentially confounding variables, including entering CPS after discharge from the hospital.

Results: Of the 4517 preterm infants discharged between 2006 and 2013, 255 (5.6%) were discharged with a need for CPS supervision. Mothers of infants with CPS supervision were significantly more likely to be younger, single, and gravida ≥3; to have less than a high school education; and to have a singleton pregnancy and less likely to have received prenatal care or antenatal steroids. Despite similar birth weight and medical morbidities, the CPS group had longer hospital stays compared with the non-CPS group. In adjusted analysis, cognitive scores were points lower (B = -1.94; 95% CI, -3.88 to -0.08; P = .04) in the CPS at discharge group compared with the non-CPS group. In children who entered CPS supervision after hospital discharge (an additional 106 infants), cognitive scores were 4 points lower (β = -4.76; 95% CI, -7.47 to -2.05; P < .001) and language scores were 5 points lower (β = -4.93; 95% CI, -8.00 to -1.86; P = .002).

Conclusion: Extremely preterm infants discharged from the hospital with CPS supervision or entering CPS postdischarge are at increased risk for cognitive delay at 2 years of age. Opportunities exist to intervene and potentially improve outcomes in this vulnerable group of children.

Keywords: behavior; cognitive and language outcome; foster care; growth; preterm.

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Figures

Figure.
Figure.
Study flow chart. The cohort of infants prospectively planned for analyses of primary and secondary outcomes. The cohort of infants for which post hoc analyses were performed.
See this image and copyright information in PMC

References

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