Iowa Neonatology Handbook: General

High Risk Infant Follow-up Program

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

1. Background
   1. 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.
      1. To identify developmental and special health needs in children born at risk;
      2. To determine how new treatments offered by the perinatal care system influence long-term outcome.
   2. In response to these needs, the Iowa High Risk Infant Follow-up Program was developed in 1978. Its goal is to provide developmental screening 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, and in Cedar Rapids, Ottumwa, Sioux City, Mason City, Waterloo, and Davenport. Other evaluation centers are also located in Spencer, Fort Dodge, Council Bluffs, Carroll, and Creston. Satellite evaluation centers that the UIHC nurse practitioners staff in Davenport and Waterloo are for children from those areas who spent most or all of their hospitalization at the University of Iowa. Des Moines has a follow-up program similar to this and accepts transfers for follow-up services.
   3. The follow-up program provides developmental screening by a pediatric nurse practitioner. This program will not diminish the role of the local physician who provides primary health care for the child.
2. Entry Criteria
   1. 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.
      2. Respiratory distress syndrome (RDS) requiring mechanical ventilation for two hours or more.
      3. Other forms of respiratory distress requiring mechanical ventilation for more than two hours.
      4. 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 40 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, with resolution of signs.
      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
          2. SGA
          3. Hyperbilirubinemia (requiring exchange transfusion)
          4. Intraventricular hemorrhage
          5. Sibling meets criteria
          6. Intrauterine transfusion
          7. Those who will be entering living environments which present serious psychosocial concerns.
   2. Infants moving into Iowa from other states are accepted if one or more of the above criteria occurred within the neonatal period.
3. Process
   1. Developmental screening is done by pediatric nurse practitioners supervised by a pediatrician. In Iowa City, patients are seen in the Hospital School Outpatient Clinic. Appointments are scheduled at 4, 9, 18 and 30 months of age. Fees are waived for the screening evaluation except in Cedar Rapids where a fee is charged. At each appointment physical and neurological examinations and the Denver II screening test are performed.
   2. Infants who are at greater risk or who require more detailed evaluations may be scheduled in a Neonatology Clinic staffed by a neonatologist. Usual clinic fees apply for this clinic. Examples of children who may be served in the Neonatology Clinic are as follows: infants with unresolved medical problems, such as bronchopulmonary dysplasia or significant intraventricular hemorrhage, and infants 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.
   3. Appointments for screening examinations and for Neonatology Clinic may be made by calling 353-6880.
   4. Infants eligible for follow-up should be identified by the pediatric nurse practitioner or the resident physician relatively early in the hospital course. The parents can then be contacted and informed of the availability of follow-up services.

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

• Diane Eastman, RN, CPNP - 319-353-6880 (Iowa City)
• Darla Noel, RN, CPNP - 319-353-6880 (Iowa City)
• Mary Ann Gureno. - 319 369-7166 (Cedar Rapids)
• Cyndy Hockman, RN, CPNA - 515-964-9987 (Des Moines)
• Cheryll Jones, RN, PNP; 515-682-8145 (Ottumwa); 712-279-3411 (Sioux City)
• Maureen Horsley, RN, PNP - 712-279-3411 (Sioux City)
• Peg Macek, RN, PNP - 319-383-1441 or 1442 (Davenport)
• Jean Westendorf RN, PNP - 515-424-7388 (Mason City)
• Jane Sielman, RN, PNP - 319-236-4560 (Waterloo)
• Kathleen Richardson, RN, PNP - 712-792-5530 (Carroll)
• Kieran Einwalter, RN, PNP - 515-955-8326 (Fort Dodge)
• Judith Anderson, RN, PNP - 712-328-6798 (Council Bluffs)
• Jan Foote, RN, PNP - 515-782-6435 (Creston)

Questions pertaining to administrative matters should be addressed to Tina Howsare. The central office is located in Hospital School, Room S267 319-353-6880.

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