For NICU-based SLPs, do you find yourself wondering when to consider advocating for an early intervention referral for your littles, especially when they are oh-so-small, high risk, and medically complex? Should the referral be coordinated by the neonatologist or pediatrician on discharge? What factors ultimately play into these decisions?
Martin and colleagues took a dive into this topic to assess timing of referral to early intervention for high-risk infants with bronchopulmonary dysplasia. The authors lament that EI services in the US currently take nearly two months, on average, to initiate following a multi-step referral process after hospital discharge. They wondered:
Does earlier referral lead to earlier initiation and faster time to services for these little ones?
In this study, early referral (defined as 7 days or less post-discharge from the initial neonatal hospitalization), was associated with earlier initiation of services. And factors associated with an EI referral were:
Hospital length of stay
Those with a longer length of stay received a referral to EI services within 56 days post-discharge compared to those with a shorter length of stay who received the referral 115 days post-discharge.
If an infant was discharged with home medical equipment
Not surprisingly, infants with medical equipment received a referral significantly quicker than those discharged without medical equipment.
Source of the referral
Neonatologists were quicker than pediatricians to initiate a referral for EI services.
The study also reports that many families with high-risk infants who are ultimately lost to follow-up (at least 10% according to another study), because they don’t understand the need for EI services.
What does this mean for us?
We are in a unique position to advocate for these services and educate parents about EI services, even when their little one is still in the NICU. SLPs, along with other members of the neonatal care team, can inform and discuss how each specialty is able to contribute to the development of their child’s skills after the NICU stay and throughout their early years. We play a vital role in parent education and advocacy for relevant early intervention services in speech, language, and feeding development.
Side note: The study also looked at long-term cognitive outcomes for these high-risk infants. Spoiler alert, they found no significant differences in the cognitive skills of infants who received an earlier referral to EI services. But, all patients in the sample did receive EI services and improvements in cognitive scores were seen. The earlier referral for more medically complex infants may have also allowed them to “catch up” to their very slightly less medically complex peers.
Martin, V., Brady, J., Wade, K., Gerdes, M., DeMauro, S. (2019). Timing of Referral to Early Intervention Services in Infants with Severe Brochopulmonary Dysplasia. Clinical Pediatrics. doi: 10.1177%2F0009922819867460