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Investigators at Women & Infants’ Neonatal Follow-Up Program are active participants in single-center and multicenter clinical research studies and prospective randomized trials under the leadership of Betty Vohr, MD, who has been the coordinator for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network Follow-Up Studies (currently 16 centers) since 1997. Studies have included examining the comprehensive neurodevelopmental, cognitive, speech and language, motor, functional, educational, and behavioral outcomes of high-risk, very low birth weight infants and pre-term infants, full-term infants with asphyxia, and infants with congenital hearing loss.
Neonatal Follow-Up Program
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Studies at Women & Infants of infants with congenital hearing loss confirmed the importance of very early identification and intervention in the first three months to decrease the interval of language deprivation and significantly improve the language outcomes. Children with hearing loss who were enrolled in early intervention before three months of age had significantly higher MacArthur-Bates percentile scores for number of words understood, words produced, and early, later, and total gestures, compared with those enrolled older than three months. Regression analyses to test the independent effects on language skills of children with hearing loss identified enrollment in early intervention earlier than tt56hree months as an independent predictor of percentile scores for word and early gesture production. In a second report, the children with hearing loss who were enrolled in early intervention prior to three months had a larger expressive vocabulary score compared with children with hearing enrolled at 18 to 24 months, and the greatest growth in vocabulary between 12 to 16 and 18 to 24 months.
Research led by a team at Women & Infants and Brown was published in Pediatrics, indicating that premature infants benefit from being exposed to adult talk as early as possible. The goal of the study was to test the association of the amount of talking that a baby was exposed to at what would have been 32 and 36 weeks gestation if a baby had been born full-term, using the Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley – III) cognitive and language scores. It was hypothesized that preterm infants exposed to higher word counts would have higher cognitive and language scores at seven and 18 months corrected age. At 32 weeks and 36 weeks, staff recorded the NICU environment for 16 hours with a Language Environment Analysis (LENA) microprocessor. The adult word count, child vocalizations, and “conversation turns” (words of mother or vocalizations of the infant within five seconds) between mother and infant are recorded and analyzed by computer. The study demonstrates the powerful impact of parents visiting and talking to their infants in the NICU on their developmental outcomes.
Preterm infants, especially those on Medicaid, are at increased risk of rehospitalization. Researchers at Women & Infants have been studying the effects of a transition home program on rehospitalization rates, following a study that demonstrated the benefits of this program for very preterm infants. The current study is analyzing the results of a Centers for Medicare and Medicaid Services (CMS) Innovation Challenge grant to determine the effects of the intervention on nearly 1,000 early, moderate, and late preterm infants, with a goal of improving care, improving outcomes, and decreasing costs. Results showed that being on Medicaid, not speaking English, and being pregnant for the first time are risk factors, and the transition intervention provided by a team that includes family resource specialists minimizes the impact of that risk.