Developmental needs of infants and toddlers who require lengthy hospitalization

* Objectives. - To describe demographic and medical characteristics of a sample of children younger than age 3 years who required lengthy hospitalization in a tertiary care hospital. To determine the proportion of children in the sample with biologic handicaps, developmental delays, or risk factors for developmental disorders who met eligibility criteria for early intervention services based on federal law PL 99-457 and state regulations. Design. - Survey of medical records. Setting. - Large, urban, tertiary care children's hospital. Patients. - All 135 children younger than age 3 years hospitalized for more than 30 days during 1990 and 1991. Interventions. - None. Main Results. - The most prevalent cause of lengthy hospitalization was congenital anomaly followed by chronic and perinatal conditions; 38 patients (28%) required technology assistance at the time of discharge. Seventy-three children (54%) were eligible for early intervention services based on the presence of a biologic handicap or developmental delay. An additional 48 patients (36%) were eligible for developmental screening and periodic developmental monitoring on the basis of medical and social risk factors. Conclusions. - Because of the high prevalence of developmental disorders and risk factors in infants and toddlers requiring lengthy hospitalizations, hospital-wide systems for identification, developmental assessment, and early intervention services should be designed and implemented. (AJDC 1993;147:211-215)
Hospitals should implement programs to detect and address developmental disorders among infants and children hospitalized for long periods of time. While the risks of developmental disorders among premature infants are known and many programs have been installed to meet their needs, the developmental needs of hospitalized children outside of neonatal intensive care units (NICU) often go unrecognized. Of 135 children who were hospitalized for longer than 30 days in a Pennsylvania hospital, 85% had multisystem diseases, and 46% had birth defects. Fifty-four percent were eligible for early intervention services in Pennsylvania, and 36% were eligible for identification, screening and tracking due to medical or social risk factors. Overall, 90% were eligible for some developmental service. Identifying children outside of NICUs who need developmental services will require cooperation among pediatricians, nurses and administration but is critical given the high incidence of disorders among children with lengthy hospital stays.