448 - Impact of the COVID-19 Pandemic on Early Intervention Utilization and Need for Referral after NICU Discharge in VLBW infants

Poster Number: 448
Publication Number: 448.121

Jieun David, Rush Medical College of Rush University Medical Center, Chicago, IL, United States; Caroline G. Wambach, Rush Medical College of Rush University Medical Center, Chicago, IL, United States; Megan Kraemer, Rush University, Addison, IL, United States; Tricia J. Johnson, Rush University, Chicago, IL, United States; Michelle M. Greene, Rush Medical College of Rush University Medical Center, Chicago, IL, United States; Esther Lee, Rush Medical College of Rush University Medical Center, Chicago, IL, United States; Kousiki Patra, Rush Medical College of Rush University Medical Center, Chicago, IL, United States

Background: Preterm infants often utilize specialized therapy services after NICU discharge. NICU follow-up (FU) clinics support in identification of developmental delay (DD) and referral to Early Intervention (EI) services. Child and Family Connections (CFC) is the Illinois agency that evaluates infant eligibility for EI therapies. The COVID-19 pandemic has resulted in EI systems making a rapid shift to video services. Although telehealth may remove barriers by eliminating travel, need for childcare and time from work, new barriers may present themselves to families in need. The impact of COVID-19 on access to and utilization of EI in VLBW infants is unknown.

Objective: To compare CFC enrollment, EI utilization and need for referral from a NICU FU clinic for VLBW infants pre and during COVID-19 pandemic.

Design/Methods: 208 VLBW infants born in 2016-2018 who completed NICU FU visits pre-COVID-19 were compared to 132 infants born in 2019-2020 who were seen during or after start of the pandemic. All NICU FU visits were in-person. Infants were compared in terms of CFC enrollment; receipt, number and type (in-person or video) of therapies and need for CFC referral at 4, 8 and 20 months corrected age (CA). Bayley-III testing was also compared at 8 and 20 months CA. Binary logistic regression models were constructed to adjust for the effect of social and neonatal risk factors on need for CFC referral.

Results: Data on CFC enrollment, EI utilization and referral to CFC are shown. In adjusted regression analyses, infants seen during COVID-19 at 4, 8 and 20 months CA were 3.4 (OR, 95% CI 1.64, 6.98), 4.0 (1.77, 8.95) and 4.8 (2.10, 11.08) times more likely to need neonatologist referral to CFC at NICU FU visit based on severity of DD. Existing CFC enrollment was associated with fewer referrals at NICU FU for the 4 and 8 month visits. Infants followed during COVID-19 had significantly lower mean cognitive and language scores on Bayley-III compared to infants followed pre-COVID-19 at 20 months CA. During COVID-19, 50%, 53% and 65% of infants in therapies received at least 1 video therapy at 4, 8 and 20 months respectively while 44%, 41% and 48% received only video visits.Conclusion(s): VLBW infants seen in NICU FU during COVID-19 had significantly lower cognitive and language scores at 20 months CA and had significantly higher odds of needing EI referral at 4, 8 and 20 months CA as compared to infants pre-COVID-19 even after adjusting for neonatal and social risk factors. Over half of infants enrolled in services received a video therapy. Further research is needed to understand the impact of COVID-19 on EI services and DD.
Table 1. Sociodemographic and Neonatal Morbidity Data
Table 2. CFC Enrollment, Neonatologist Referral to CFC and Number of Therapies at 4, 8 and 20 months Corrected Age (CA)*39 infants in the mixed group and 21 infants in the during COVID-19 group had reached 20 months CA by the end of the study period.