Provider Use of Corrected Age for Premature Infant Visits
Introduction: Correcting age for prematurity is recommended by the American Academy of Pediatrics and the Centers for Disease Control and Prevention. The use of chronological age instead of corrected age for infants born prematurely may result in incorrect interpretations regarding the adequacy of a child's growth or developmental progress and has the potential to negatively affect care. This study examined the frequency and impact of the use of corrected age by primary care providers.
Method: A retrospective cross-sectional electronic health record review was performed for all infants < 32 weeks' gestation who were seen for a health supervision visit in a 31-site pediatric network during a 1-year period. Primary care providers used an electronic health record that defaulted to chronological age information.
Results: Primary care providers used corrected age for developmental surveillance for 24% of visits, they used chronological age for 71% of visits, and the age used was unclear in 5% of visits. The lower a child's gestational age and the more that chronological age was used, the more concerns were identified by primary care providers. Dietary changes that included the introduction of solid foods, the start of fluoride, and the introduction of milk typically were recommended on the basis of chronological age.
Discussion: Primary care providers used chronological age more than corrected age, which influenced assessment and recommendations for care. This study illustrates the impact of not using corrected age, the importance of ensuring that care aligns with guidelines, and the possible influence of the design of the electronic health record on patient care. Because families of premature infants rely on primary care providers to accurately identify sequelae associated with prematurity, and to provide reassurance when it is warranted, these findings have implications for all health care providers who treat premature infants.
Correcting age for prematurity is recommended by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC; AAP/American Congress of Obstetricians and Gynecologists [ACOG], 2007; Bernbaum et al., 2009, Centers for Disease Control and Prevention, 2007). A review of the literature supports the use of age correction for prematurity (D'Agostino, 2010). Corrected age also commonly is referred to as adjusted age. The use of chronological age instead of corrected age may result in incorrect interpretations regarding the adequacy of a child's growth or developmental progress and has the potential to negatively affect care.
Infants who are born prematurely are at increased risk for numerous medical and neurodevelopmental sequelae including growth failure, cerebral palsy, developmental delay, and intellectual disability (Saigal & Doyle, 2008). Increased utilization of primary care services by premature infants has been well documented (Bird et al., 2010; Doyle et al., 2003; Goldfeld et al., 2003; Jackson et al., 2001; Spicer et al., 2008; Wade et al., 2008). As a result, the primary care provider plays a vital role in the assessment and care of premature infants.
Guidelines and recommendations regarding the care of premature infants by primary care providers have been published by the AAP (AAP/ACOG, 2007; Bernbaum et al., 2009). These guidelines include monitoring a child's growth and development with use of correction of age for the degree of prematurity until at least 24 months' corrected age. The CDC concurs with the use of corrected age when monitoring the growth of a premature infant (CDC, 2007). However, preventive health supervision visits and immunizations are based on a child's chronological age. As such, the primary care provider needs to remember to correct for prematurity to accurately assess a premature infant.
We did not find any reports that explored the actual clinical usage of age correction by health care providers during provision of care for premature infants. The objectives of this study were to determine if the recommendation to use corrected age for premature infants was being followed in a primary care setting and to describe how the use of corrected age affected primary care providers' assessments and recommendations for care.
Abstract and Introduction
Abstract
Introduction: Correcting age for prematurity is recommended by the American Academy of Pediatrics and the Centers for Disease Control and Prevention. The use of chronological age instead of corrected age for infants born prematurely may result in incorrect interpretations regarding the adequacy of a child's growth or developmental progress and has the potential to negatively affect care. This study examined the frequency and impact of the use of corrected age by primary care providers.
Method: A retrospective cross-sectional electronic health record review was performed for all infants < 32 weeks' gestation who were seen for a health supervision visit in a 31-site pediatric network during a 1-year period. Primary care providers used an electronic health record that defaulted to chronological age information.
Results: Primary care providers used corrected age for developmental surveillance for 24% of visits, they used chronological age for 71% of visits, and the age used was unclear in 5% of visits. The lower a child's gestational age and the more that chronological age was used, the more concerns were identified by primary care providers. Dietary changes that included the introduction of solid foods, the start of fluoride, and the introduction of milk typically were recommended on the basis of chronological age.
Discussion: Primary care providers used chronological age more than corrected age, which influenced assessment and recommendations for care. This study illustrates the impact of not using corrected age, the importance of ensuring that care aligns with guidelines, and the possible influence of the design of the electronic health record on patient care. Because families of premature infants rely on primary care providers to accurately identify sequelae associated with prematurity, and to provide reassurance when it is warranted, these findings have implications for all health care providers who treat premature infants.
Introduction
Correcting age for prematurity is recommended by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC; AAP/American Congress of Obstetricians and Gynecologists [ACOG], 2007; Bernbaum et al., 2009, Centers for Disease Control and Prevention, 2007). A review of the literature supports the use of age correction for prematurity (D'Agostino, 2010). Corrected age also commonly is referred to as adjusted age. The use of chronological age instead of corrected age may result in incorrect interpretations regarding the adequacy of a child's growth or developmental progress and has the potential to negatively affect care.
Infants who are born prematurely are at increased risk for numerous medical and neurodevelopmental sequelae including growth failure, cerebral palsy, developmental delay, and intellectual disability (Saigal & Doyle, 2008). Increased utilization of primary care services by premature infants has been well documented (Bird et al., 2010; Doyle et al., 2003; Goldfeld et al., 2003; Jackson et al., 2001; Spicer et al., 2008; Wade et al., 2008). As a result, the primary care provider plays a vital role in the assessment and care of premature infants.
Guidelines and recommendations regarding the care of premature infants by primary care providers have been published by the AAP (AAP/ACOG, 2007; Bernbaum et al., 2009). These guidelines include monitoring a child's growth and development with use of correction of age for the degree of prematurity until at least 24 months' corrected age. The CDC concurs with the use of corrected age when monitoring the growth of a premature infant (CDC, 2007). However, preventive health supervision visits and immunizations are based on a child's chronological age. As such, the primary care provider needs to remember to correct for prematurity to accurately assess a premature infant.
We did not find any reports that explored the actual clinical usage of age correction by health care providers during provision of care for premature infants. The objectives of this study were to determine if the recommendation to use corrected age for premature infants was being followed in a primary care setting and to describe how the use of corrected age affected primary care providers' assessments and recommendations for care.