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Very Premature Babies Don't Get Follow-Up Care

The problem is particularly widespread among Medicaid families, study finds

MONDAY, Feb. 4 (HealthDay News) -- A groundbreaking study reports that most very low birth-weight babies born to low-income women failed to get critical follow-up care within their first two years of life.

The study illustrates how these premature infants, who are vulnerable to vision, hearing and speech impairments, are falling through the cracks of the U.S. health-care system, the researchers said.

Only 20 percent of the babies with hearing problems returned for specialized care within their first six months of life, while fewer than one in four underwent recommended vision tests between 1 and 2 years of age.

On average, it costs $250,000 to treat an extremely premature baby in the hospital, said study author Dr. C. Jason Wang, an assistant professor of pediatrics and public health at Boston University's Schools of Medicine and Public Health. "When they go home, the least we could do is make sure they can see and they can hear, to make sure they can be successful."

At issue are babies born at less than 3.3 pounds, typically because they are extremely premature. According to Wang, babies can now survive being born as early as after six months of gestation, although the infants often suffer from a variety of serious health problems.

"If they're earlier, their lungs aren't really developed, so they will have trouble breathing, taking in oxygen, and a lot of them will develop something called chronic lung disease," he said. "And there will be trouble in the brain because they don't get enough oxygen to the brain. If it's severe, that could have some consequences later on in terms of cognitive and other functions."

Wang and his colleagues chose to look at babies from poor families on Medicaid in South Carolina because the state has especially good records. Also, Wang said, poor and black women are prone to having very low-birth-weight babies.

The researchers reviewed the medical records of 2,182 very low-birth-weight children born between 1996 and 1998. Among those with hearing loss, just 20 percent received hearing "rehabilitation" by the time they were 6 months old, as guidelines recommend. And only 23 percent received eye exams between 1 and 2 years of age, the study found.

The findings are published in the February issue of Pediatrics.

"People have suspected for a long time that very low-birth-weight infants weren't getting the care that they need," Wang said. "We show for the first time that there's a significant gap in providing needed services."

There are some caveats to the findings, Wang said: The study only looked at one state, and it's not clear whether parents or the medical system contribute to the problem.

Whatever the case, "we need to improve the coordination of care for kids with complex conditions," he said.

Some families, especially those with several children, can be overwhelmed by many different doctors' appointments in different places, Wang explained. "They need a support system," he said.

The findings seemed valid to Dr. Maureen Hack, a professor of pediatrics at Case Western Reserve University School of Medicine, who believes the health-care system's lack of organization is to blame.

"It [the study] does express what is happening in this country with respect to indigent population," she said. "But I don't think it's just a problem with preemies. It's depressing."

Another study in the same issue of Pediatrics found other signs of disparities in health care based on race. Researchers from the University of Texas Southwestern Medical Center reported that children in five minority groups were less likely than whites to have recently visited a doctor or been given medical prescriptions.

More information

Learn more about premature babies from the U.S. National Institutes of Health.

SOURCES: C. Jason Wang, M.D., Ph.D., assistant professor, pediatrics and public health, Boston University Schools of Medicine and Public Health; Maureen Hack, M.D., professor, pediatrics, Case Western Reserve University School of Medicine, Cleveland; February 2008 Pediatrics

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