期刊
MATERNAL AND CHILD HEALTH JOURNAL
卷 12, 期 1, 页码 24-33出版社
SPRINGER/PLENUM PUBLISHERS
DOI: 10.1007/s10995-007-0227-y
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资金
- PHS HHS [S3485-23/23, S1887-21/23] Funding Source: Medline
Objectives Access to Early Intervention (EI) services may improve cognitive and behavioral outcomes in very low birth weight infants, but few states have population-based data to evaluate EI outreach efforts. We analyzed Massachusetts (MA) infants born weighing < 1,200 g to identify maternal and birth characteristics that predicted EI referral and timing of referral. Methods MA birth and hospital discharge records (Jan. 1998 - Sept. 2000) were linked to EI referral records (Jan. 1998 - Sept. 2003) via probabilistic and deterministic methods (88% linkage). Timing of EI referral among infants weighing < 1,200 g was examined by infant and maternal characteristics using categorical (0 - 12 months, 12 - 36 months, or no referral) time comparisons in the crude analysis. Survival functions calculating median time to referral, and adjusted hazard ratios (HR) with 95% confidence intervals (CI) were calculated for continuous time comparisons of EI referral from birth to 36 months. Results Of 1,233 infants weighing < 1,200 g, 93.2% were referred to EI. After risk adjustment, referral was more likely among multiple-birth infants (HR=1.17, 95% CI 1.06 - 1.30) and less likely among infants < 28 weeks (HR=0.70; 95% CI 0.64 - 0.77) or with low Apgar scores (< 5 at 5 min; HR=0.75; 95% CI 0.62 - 0.92). EI referrals were lower for infants of black non-Hispanic mothers, and mothers without private insurance (HR = 0.85; 95% CI 0.74 - 0.98 and HR=0.77; 95% CI 0.68 - 0.86, respectively). Conclusions In MA, most infants born < 1,200 g are referred to EI, but disparities exist. Analysis of linked population-based health and developmental services can inform programs in order to reduce disparities and improve access for all high-risk infants.
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