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High Risk Infant Follow-Up Program


The only program of its kind in Central California, the Regional High Risk Infant Follow-Up (HRIF) Program at Children’s Hospital assesses the developmental, medical, nutritional, and psychosocial needs of infants born prematurely or who have been hospitalized in a neonatal intensive care unit (NICU).

Our HRIF program is an extension of our 88-bed regional tertiary Level III NICU and integrates seamlessly with the Hospital’s more than 40 pediatric subspecialties to make sure premature newborns receive the best treatment possible. HRIF sees about 700 patients annually and serves a seven-county area, including Fresno, Madera, Merced and Tulare counties. A number of local hospitals with community level neonatal intensive care units depend on our program to provide the necessary developmental follow-up care high-risk neonates require.

Medically compromised newborns often are at risk for delays in growth, speech, motor, sensory or cognitive development. Early intervention is important to reduce the effect of potential health issues. Our specialized staff has extensive experience identifying and managing these children’s ongoing needs to help them catch up with their full-term peers.

This monitoring along with regular visits to the pediatrician helps prevent long-term problems and provides caregivers vital information to enhance a child’s growth and development. If a delay or health problem is detected, a referral is made to the appropriate pediatric subspecialist. Close communication with the primary care providers and pediatric subspecialists is maintained to ensure a coordinated medical care plan is carried out.

Services Offered and Conditions Treated

HRIF services begin shortly after discharge and continue up to 3 years of age. Children are seen at 4–6 months adjusted age, 9–12 months adjusted age and 18–36 months. HRIF staff may recommend a child be seen more often.

Services include:

  • Comprehensive history and physical exam with a neurologic assessment
  • Developmental assessment
  • Family psychosocial assessment
  • Hearing assessment
  • Ophthalmologic assessment
  • Coordination of services with primary care provider, referrals to pediatric subspecialists and community intervention programs
  • Education to assist families in promoting the growth and development of their child

Entry into the HRIF program is limited to infants who meet specific criteria established by California Children’s Services (CCS):

  • Met CCS medical eligibility criteria for NICU care, in a CCS-approved NICU or had a CCS-eligible medical condition in a CCS-approved NICU, and the birth weight was less than 1,500 grams or the gestational age at birth was less than 32 weeks.
  • If the birth weight was 1,500 grams or more and the gestational age at birth was 32 weeks or more, one of the following criteria was met during the NICU stay:
    • Cardiorespiratory depression at birth (defined as pH less than 7.0 on an umbilical blood sample or blood gas obtained within one hour of life) or an Apgar score of less than or equal to three at five minutes.
    • A persistently and severely unstable infant manifested by prolonged hypoxia, acidemia, hypoglycemia and/or hypotension requiring pressor support.
    • Persistent apnea that required medication (e.g., caffeine) for the treatment of apnea at discharge.
    • Required oxygen for more than 28 days of hospital stay and had radiographic finding consistent with chronic lung disease (CLD).
    • Infants placed on extracorporeal membrane oxygenation (ECMO).
    • Infants who received inhaled nitric oxide greater than four hours for persistent pulmonary hypertension of the newborn (PPHN).
    • History of documented seizure activity.
    • Evidence of intracranial pathology, including but not limited to, intracranial hemorrhage (grade II or worse), periventricular leukomalacia (PVL), cerebral thrombosis, cerebral infarction, developmental central nervous system (CNS) abnormality or “other CNS problems associated with adverse neurologic outcome.”
    • Other problems that could result in a neurologic abnormality (e.g., history of CNS infection, documented sepsis, bilirubin in excess of usual exchange transfusion level, cardiovascular instability, hypoxic ischemic encephalopathy, etc.)

Multidisciplinary Services

HRIF services are provided by a multidisciplinary team which includes a board certified neonatologist, pediatric nurse practitioners, developmental specialists, HRIF nurse coordinator, social worker, clinical dietician, physical therapists, occupational therapists, psychologist, speech therapists, ophthalmologist, and audiologists.
 
If a delay or health concern is identified, a referral is made to the appropriate pediatric subspecialist, including:

 

 

 

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