Frequency of services for premature infants at high risk

[Marie Snyder]

I seem to be struggling the most with questions regarding recommended frequency/setting of services (especially for former preemies). Specifically, thinking about the one case in the case base exam of an ex-28 weeker with grade IV IVH and PVL. The question stated that she was low average on the TIMP at evaluation but the recommendation was for re-evaluation at 3-4 months CGA instead of weekly OP PT services. My rationale for choosing OP 1x/week was that she has a significant medical history that places her at higher risk for CP and she’s already showing mild delays. I would want to initiate services early rather than waiting a couple months to see if she is more delayed. Can you help me understand why this is an incorrect rationale. Thanks!

[Helen Carey]

Hi Marie,
If I have the question correct, it states that the infant was 1 month CCA. The purpose of the question was to focus on interpretation of the TIMP and it’s predictive validity. The TIMP is most predictive of motor delay when administered around 90 days CCA, therefore, a child’s score at that age would provide the most meaningful information for clinical-decision-making. Because the child is not delayed or demonstrating atypical movement patterns or motor signs at 1 mo CCA, a HEP and follow up would provide targeted education, a follow up plan, and appropriate utilization of insurance resources. In some regions, this child might not quality for weekly OP services just because of PMH and risk factors. Your reasoning for intensity of services is not incorrect, although some might say it is over-utilization of services since the child is so young and not demonstrating delays or motor deficits at this time. It might also be stressful on the family who likely just returned home from the NICU.

Nice question!
Helen

[Judith Loebl]

CCA? Do you mean CGA?

[Marie Snyder]

The question stated CCA which is why I referred to it as that in my question, but yes I meant CGA. I believe they’re the same thing

[Marie Snyder]

Thank you for the clarification, Helen! I appreciate it

[Judith Loebl]

Thanks Marie. CCA: Corrected conceptual age? I find these acronyms get confusing after a while.

[Marie Snyder]

corrected chronological age is what they used CCA for in the question

[Helen Carey]

Yes, premie age is usually described by CCA (corrected chronological age) or AA (adjusted age).

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