Factors Associated with Outpatient Therapy Utilization in Extremely Preterm Infants.

Objective Factors influencing utilization of outpatient interventional therapies for extremely low gestational age newborns (ELGANs) after discharge remain poorly characterized, despite significant risk of neurodevelopmental impairment. We sought to assess the effects of maternal, infant, and environmental characteristics on outpatient therapy utilization in the first two years after discharge using data from the Preterm Erythropoietin Neuroprotection (PENUT) Trial. Study Design This is a secondary analysis of 818 24-27 weeks' gestation infants enrolled in the PENUT trial who survived through discharge and completed at least one follow-up call or in-person visit between 4 and 24 months of age. Utilization of a state early intervention program (EI), physical (PT), occupational (OT), and speech (ST) therapies was recorded. Odds ratios and cumulative frequency curves for resource utilization were calculated for patient characteristics adjusting for gestational age, treatment group, and birth weight. Results 37% of infants did not access EI and 18% did not use any service (PT/OT/ST/EI). Infants diagnosed with severe morbidities (IVH, ROP, BPD, NEC), discharged with home oxygen, or with gastrostomy placement experienced increased utilization of PT, OT and ST compared to peers. However, substantial variation in service utilization occurred by state of enrollment and selected maternal characteristics. Conclusions ELGANs with severe medical comorbidities are more likely to utilize services after discharge. Therapy utilization may be impacted by maternal characteristics and state of enrollment. Outpatient therapy services remain significantly underutilized in this high-risk cohort. Further research is required to characterize and optimize utilization of therapy services following NICU discharge of ELGANs.