44 - Neurodevelopmental Care Utilization Among Preterm Infants in the Military Health Care System

Publication Number: 4043.44

Genesis James, Walter Reed National Military Medical Center, North Bethesda, MD, United States; Rasheda J. Vereen, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Fort Hood, TX, United States; Zachary Weber, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Amanda Banaag, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Suffolk, VA, United States; Tracey Koehlmoos, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Caitlin Drumm, USUHS, Bethesda, MD, United States

Background: Preterm infants are at increased risk of neurodevelopmental delays and disabilities, requiring specialized follow-up after discharge. While guidelines prioritize infants born < 32 weeks or < 1500 grams as the highest risk, research shows late preterm infants also face neurodevelopmental challenges. Lower-resource areas often rely on county early-intervention programs, whereas tertiary centers may offer multidisciplinary clinics. The Military Health System (MHS) provides universal healthcare to over four million military-connected children worldwide, yet access to neurodevelopmental care varies.

Objective: Evaluate neurodevelopmental care utilization among military-connected preterm neonates.

Design/Methods: Healthcare utilization data were analyzed for 30,300 preterm infants born within the MHS. Preterm births were classified as extreme ( < 28 weeks), very (28-31 weeks), moderate (32-33 weeks), and late (34-36 weeks). Demographic factors-sex, race/ethnicity, military sponsor rank, and geographic region-were evaluated. Specialty visits were categorized as direct care (military facility-based) or private-sector care. Multiple linear regression models assessed differences in specialty care utilization based on gestational age (GA), race, region, and military sponsor rank.

Results: The cohort was 53.6% male, 53.1% White, and 48% from senior-enlisted families, most in the South Atlantic region. Late preterm infants accounted for the highest total neurodevelopmental care visits, with moderate preterm infants at the lowest. For average total visits, GA significantly influenced healthcare utilization: extreme preterm infants averaged 47.15 specialty visits, compared to 25.10 for very preterm, 13.55 for moderate preterm, and 6.18 for late preterm. The South Atlantic had the highest number of preterm infants, corresponding to higher visit rates (Figure 1). Racial disparities were evident: Black infants had fewer total specialty visits (−1.54, p< 0.05) and fewer total mean visits (Figure 2) despite slightly higher direct care utilization compared to White infants. Regional differences were observed-South Atlantic had the most specialty care, corresponding with the highest preterm population, and Pacific and West South-Central regions had significantly less (p < 0.05). No utilization differences were observed by rank.

Conclusion(s): This study highlights differences in neurodevelopmental care utilization among preterm infants in the MHS, driven by GA, race, and geography. These findings support the need for a standardized, equitable neurodevelopmental follow-up policy and further research to evaluate long-term impacts.

Figure 1
Total Mean Specialty Care Visits by US Census Division.

Figure 2
Mean Specialty Care Visits by Race/Ethnicity & Preterm GA Category.