Published online March 26, 2007
PEDIATRICS Vol. 119 No. 4 April 2007, pp. e947-e957 (doi:10.1542/peds.2006-1717)
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ARTICLE

Follow-up Care for Infants With Chronic Lung Disease: A Randomized Comparison of Community- and Center-Based Models

T. Michael O'Shea, MD, MPHa,b, Savithri Nageswaran, MBBS, MPHa,b, Debbie C. Hiatt, BSN, RNa, Claudine Legault, PhDb, Mary Lou Moore, PhD, RNc, Michelle Naughton, PhD, MPHb, Donald J. Goldstein, PhDa and Robert G. Dillard, MDa

Departments of a Pediatrics
b Social Sciences and Health Policy
c Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, North Carolina

OBJECTIVES. Premature infants with chronic lung disease benefit from comprehensive care, which typically is based in tertiary medical centers. When such centers are not easily accessible, alternative models of care are needed. The purpose of this work was to compare community-based follow-up, provided via telephone contacts, to traditional center-based follow-up of premature infants with chronic lung disease.

PATIENTS AND METHODS. After discharge from neonatal intensive care, 150 premature infants with chronic lung disease were randomly assigned to either community-based (n = 75) or center-based (n = 75) follow-up. In community-based follow-up, a nurse specialist maintained telephone contact with the infant's primary caregiver and health care providers. Center-based follow-up consisted of visits to a medical center–based multidisciplinary clinic staffed by a neonatologist, a nurse specialist, and a social worker. The outcomes of interest were Bayley Scales of Infant Development mental developmental index and psychomotor developmental index, Vineland Adaptive Behavioral Composite, and growth delay (weight for length <5th percentile) at 1-year adjusted age and respiratory rehospitalizations through 1-year adjusted age.

RESULTS. In each randomization group, 73 infants survived, and 69 were evaluated at 1-year adjusted age. The median mental development index (corrected for gestational age) was 90 for both groups. The median psychomotor developmental index was 82 for the center-based group and 81 for the community-based group. The median Vineland Adaptive Behavioral Composite was 100 and 102 for the center-based and community-based groups, respectively. In the center-based and community-based groups, respectively, the proportions with growth delay were 13% and 26%, and the proportions rehospitalized for respiratory illness were 33% and 29%.

CONCLUSIONS. Infants randomly assigned to community-based, as compared with those randomly assigned to center-based follow-up, had similar developmental and health outcomes. The former approach might be a preferred alternative for families in rural settings or families for whom access to a tertiary care medical center is difficult.

Key Words: bronchopulmonary dysplasia • chronic lung disease • prematurity • health services research • neonatal follow-up

Abbreviations: CLD—chronic lung disease • BSID—Bayley Scales of Infant Development-Second Edition • MDI—mental developmental index • PDI—psychomotor developmental index • OR—odds ratio • CI—confidence interval

Accepted Oct 10, 2006.