Diane L. Eastman, RN, ARNP, C.P.N.P.
Peer Review Status: Internally Peer Reviewed

Background

Follow-up for children who have required special care as neonates is an integral part of the continuum of their care. There are several reasons why follow-up services are important.

  • To identify developmental and special health needs in children born at risk;
  • To determine how new treatments offered by the perinatal care system influence long-term outcome.

In response to these needs, the Iowa High Risk Infant Follow-up Program was developed in 1978. Its goal is to provide developmental testing for certain categories of high risk infants. At this time follow-up services are available nearly statewide. Currently, enrollment and evaluation centers are located at University of Iowa Hospitals & Clinics.  Child Health Specialty Clinics have regional sites across the state that offer follow-up as does Cedar Rapids.  Des Moines has follow-up programs at Blank and Mercy similar to this and accepts transfers for follow-up services

The follow-up program provides developmental testing by a pediatric nurse practitioner. This program supplements the role of the local physician who provides primary health care for the child.

Entry Criteria

Certain categories of infants have been defined as being at risk and who therefore should receive follow-up. The criteria for the program include:

  1. Birth weight less than 1500 grams and/or gestational age of 32 weeks or less.
  2. Respiratory distress syndrome (RDS) requiring mechanical ventilation for two hours or more.
  3. Other forms of respiratory distress requiring ventilatory assistance for more than two hours.
  4. Clinical evidence of CNS infection.
  5. Asphyxia neonatorum as indicated by a five-minute Apgar score below 7.
  6. Hypoglycemia as proven by two consecutive blood glucose levels below 30 mg/dl.
  7. Neonatal seizures, as documented by physician observation with concurrence of staff neonatologist in Iowa City, or attending pediatrician in Level II Centers.
  8. Hypotonia on discharge examination.
  9. Polycythemia: Venous hematocrit of 65 or higher or 60-64 with signs and partial exchange transfusion.
  10. Maternal substance abuse during pregnancy.
  11. Other: Infants not included in criteria 1 through 10 but felt to be at risk by the attending physician. Examples include:
    1. Sepsis by positive culture
    2. SGA
    3. Hyperbilirubinemia with Total Bilirubin of 20 or greater
    4. Intraventricular hemorrhage
    5. Sibling meets criteria
    6. Intrauterine transfusion
    7. Chorioamnionitis
    8. Those who will be entering living environments which present serious psychosocial concerns.

Infants moving into Iowa from other states are accepted if one or more of the above criteria occurred within the neonatal period.

Process

Developmental screening is done by pediatric nurse practitioners supervised by a pediatrician. In Iowa City, patients are seen in the Pediatric Specialty Clinic. Appointments are scheduled at chronological ages 4, 9, 18 and 30 months. At each appointment physical and neurological examinations and the Denver II developmental test are performed.  The ASQ-3 is also completed at each visit.  Behavioral and autism screening are also completed.

Infants who are discharged with ongoing medical issues are scheduled in the Neonatology Clinic staffed by a neonatologist. Examples of children who are seen in the Neonatology Clinic are as follows: infants with bronchopulmonary dysplasia discharged on oxygen, monitors, or respiratory stimulant drug. In Neonatology Clinic, the same neonatologist and nurse practitioner follow an infant, in cooperation with his local physician, until the infant’s care can be fully transferred to the local physician.

Appointments for screening examinations and for Neonatology Clinic may be made by calling 319-353-6880.

Infants eligible for follow-up should be identified by the follow-up pediatric nurse practitioners relatively early in the hospital course. The parents are then be contacted and informed of follow-up services prior to discharge.

Contacts

Questions concerning any aspects of the follow-up process may be directed to:

  • Diane Eastman, ARNP, CPNP - 319-353-6880
  • Katie Breitbach, ARNP, CPNP -319-353-6880
  • Kathy Ruppenkamp, ARNP, CPNP -319-353-6880

Questions pertaining to administrative matters should be addressed to Teresa Schmidt. The office is located 8900 JPP, 319-353-6880.