Adherence to Follow-Up Among High-Risk NICU Patients

Background: Preterm infants, especially those ≤32 weeks' gestational age (GA) are at increased risk of vision and hearing loss. Risks of both vision and hearing loss can be ameliorated and in some cases prevented by conscientious screening, follow up and treatment. Universally, infants ≤32 weeks are cared for in neonatal intensive care units and there is considerable confidence that screenings and treatment occur according to established guidelines. At hospital discharge, follow up responsibility shifts to infant caretakers likely resulting in reduced compliance. Objective: We aimed to determine if preterm infants at risk for vision and hearing loss, attended follow up appointments with ophthalmology and audiology as prescribed by the medical team at hospital discharge and whether the families preferred language preference contributed to compliance. Design Method: As part of a QI project, charts for preterm infants ≤32 weeks’ GA cared for in the NICU of Hackensack University Medical Center between 1/1/22-12/31/22 were reviewed. The discharge summary of patients were reviewed, instructions for ophthalmology and audiology follow-up extracted and completed appointments for ophthalmology and audiology were compared to discharge instructions. The birthing parent’s preferred language was also noted. Patients whose discharge summary did not have ophthalmology and audiology follow-up appointment instructions were excluded from analysis. Chi-square (��2 ) test was used to compare follow-up data with a statistical significance level set at p<.05. Results: In 2022, 138 infants ≤32 weeks’GA were cared for in the NICU with 79 instructed to follow up with ophthalmology and 127 to follow up with audiology. Spanish was the preferred language of 18% of families included in the analysis. Only 54% of patients (n=43) completed ophthalmology follow-up, while 66% of patients (n=84) followed up with audiology. Of patients completing ophthalmology follow up, 40% followed up within a week of the recommended time (-352 to 325 days). Patients whose family had Spanish as a preferred language were more likely to complete follow up than those having English language preference (��2 p=.03). For audiology 31% (n=39) of appointments were completed within the recommended time (range). Although families with Spanish as preferred language compared to those with English language preference were more likely to follow up as recommended (53% vs 30%), this difference was not statistically significant (��2 p=.07). Conclusion: These results suggest limited compliance of families with prescribed outpatient ophthalmology and audiology follow-up that seems unrelated to language barriers. Future research should focus on potential for targeted education to impact follow-up compliance and understanding the challenges to outpatient follow-up experienced by parents of infants at risk for vision and hearing loss.