P3.278: Neurodevelopmental Care Utilization Among Preterm Infants in Military Health Care System

Background: Preterm infants are at increased risk of neurodevelopmental delays and disabilities, necessitating specialized follow-up care after discharge. While guidelines prioritize infants born < 32 weeks gestation or < 1500 grams as highest risk, research indicates that late preterm infants (34–37 weeks) also face neurodevelopmental challenges. Lower-resource areas often rely on county-provided early intervention programs, whereas tertiary centers may offer multidisciplinary clinics. Even within these centers, service availability varies.
The Military Health System (MHS) provides universal healthcare to over four million military-connected children worldwide, yet access to neurodevelopmental care is inconsistent

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

Results: The cohort was 53.6% male, predominantly White (53.1%), with most children born to senior enlisted families (48%) and concentrated in the South Atlantic region. Gestational age 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 region had the highest number of preterm infants which corresponded to higher visit rates (Figure 2). Racial disparities were evident with Black infants having fewer total specialty visits (-1.54, p< 0.05; Figure 1), despite slightly higher direct care utilization compared to White infants. Regional disparities persisted, with South Atlantic infants receiving the most specialty care, and Pacific and West South Central regions receiving significantly less (p < 0.05). No significant differences in utilization were observed by rank.

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