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Beyond the NICU: Supporting Development, Growth & Families After Early Beginnings · Meaningful Medicine with Novant Health

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  Amanda Wilde (Host): Meaningful Medicine is a Novant Health Podcast, bringing
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  you access to leading doctors who answer questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
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  decisions and build a healthier future.
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  I'm Amanda Wilde, and joining me today is physician assist.
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  Carrie Maureen will be discussing an essential but not well-known resource
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  for families who have spent time in the neonatal intensive care unit.
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  Novant Health's NICU Follow-up clinic.
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  Carrie, welcome to the podcast And for families who may not be
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  familiar with this service, what is the NICU Follow-Up Clinic, or we
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  also call it the NICU Developmental Clinic, and why is it important?
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  Kari Mohrien, PA-C: Yes.
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  Thank you guys so much for having me today.
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  So our overall role is to closely monitor developmental milestones up until age two.
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  So we have a multidisciplinary team, that closely monitors and evaluates, at.
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  The corrected ages of 3, 6, 12, 18, and 24 months for our families.
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  Amanda Wilde (Host): So at those times of three, six and 12 months, what types
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  of developmental or behavioral milestones are you monitoring during those visits?
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  Kari Mohrien, PA-C: At each visit we are specifically looking at, our, baby's
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  speech, and language development.
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  So early on at that first visit, at three months, we are, checking in making sure
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  that our babies are giving us those.
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  Good social smiles and cooing.
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  and as they continue to grow and develop, making sure that they're babbling,
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  saying their first words, And then developing into, those two word sentences.
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  we're also looking at their overall gross motor development.
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  So again, at that first visit at three months, tummy time
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  is really, really important.
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  as our babies, are able to do tummy time, they develop that core strength,
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  which is needed for all of those next necessary steps of sitting, crawling,
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  standing, running, climbing, all of those.
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  Things, over the first two years of life.
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  we're also monitoring, their visual motor and their fine motor skills so
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  early on just making sure that they're tracking appropriately with their eyes.
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  And then as they approach six months that they're making those
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  really good coordinated movement.
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  And then, starting to develop into more complex, abilities with
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  able to stack blocks or do, small puzzles and, able to scribble with
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  a cray, those types of things.
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  we're also looking at, as the babies start to get older and we're hitting,
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  early toddlerhood at that 18 to 24 months, we're also really starting to
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  look at behavior, and their overall.
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  Social skills at that time, and monitoring for any early symptoms
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  of an autism spectrum disorder.
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  Amanda Wilde (Host): So in light of doing all these assessments, how do you help
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  parents understand what's typical And what may need extra support as the baby grows?
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  Kari Mohrien, PA-C: Yes.
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  That's a great question.
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  So throughout the visit we, are really.
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  Explaining each thing that we're looking for.
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  So I use a standardized test, to look at each of these abilities, and I'm
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  explaining those to parents And what I'm seeing, if there's anything that
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  maybe we're already starting to show a delay, we're talking about that.
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  And then as I do the assessment, I let the families know, developmentally where
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  their child is in each area, And what to.
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  SPECT over the next three to six months before I see them again.
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  So the parents also know what they are looking for.
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  we also discuss age-appropriate toys that are going to help their development.
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  And we really stress how important it is to be reading to our babies from
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  day one, all through early childhood.
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  Amanda Wilde (Host): You've already touched on this a bit, but
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  can you walk us through what a.
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  It looks like you mentioned parents are involved, you're involved, who
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  else might be involved And what assessments and conversations take place.
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  Kari Mohrien, PA-C: Yes.
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  So, our involvement really starts, even while the babies are in the hospital.
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  So we have an RN outpatient navigator, her name is Riley Mehan.
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  and she gets to meet many of our families as well.
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  They are.
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  Still in the nicu.
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  and she gets to make that connection so they already have a familiar face for the
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  person that's going to be seeing them.
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  so she also, calls them, shortly after they are discharged from the hospital,
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  seeing how they're doing, and if they have any questions or concerns at that time.
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  and she helps coordinate any further follow-up with other specialty
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  teams that they have to see also.
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  When the babies, come to our office, so they come see us, for their first
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  visit at that three-month corrected age.
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  and at that visit, again, the visit really starts as soon as the medical
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  assistant goes out in the waiting room and brings them back, to room them
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  because she's getting really important information for the rest of the team.
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  She's getting their height, their weight.
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  Their, head circumference.
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  So all of those growth parameters are really, really important.
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  And then she's checking in on their therapies and specialty visits.
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  And then I come in the room and I see them, and review all of those
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  things that we talked about before.
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  And then comes in the rest of the team one by one.
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  so Megan Rispoli is our physical therapist, she's going to come in and
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  really touch on all of the important gross motor, abilities that each
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  baby, should be presenting with.
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  And if there's any concern, she's going to do a more in depth evaluation, and
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  make further recommendations for therapy.
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  Next to come in, is Chanel Ignor and she is our speech language pathologist
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  and she specializes in, feeding therapy.
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  so she is helping to assess if our babies have any lip or tongue ties, if there's
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  any choking or gagging that may indicate that we need a further swallow study.
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  And then also along with myself, she's really further assessing those.
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  Speech, concerns as the babies get older, and if we need any
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  further formal speech therapy.
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  We also have a dietician.
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  Her name is Sarah Lamb.
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  she's going to review the caloric need for each individual baby that comes in.
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  if there's any concern that one of our babies is not tolerating, their
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  formula or breast milk that they are receiving, she can make those changes.
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  if.
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  Overall growth wise, it looks like we're not, hitting,
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  parameters that we wish we were.
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  She can also increase caloric need and tell the families about that.
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  And then as our babies get a little bit older, so they're starting
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  to hit that 18 to 24 month range.
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  If there's any picky eating or concern, she can really touch on that too.
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  cause we know that's always a big one for families.
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  And then lastly, we have Michelle Hare and she's our social worker.
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  So as you can hear, the rest of our team is really, really focused on
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  the baby And what the baby is doing.
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  Michelle is looking at the entire family And what the entire family's needs are.
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  so she is making sure, you know, if there are any mental health concerns, if
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  there's any housing or food insecurity.
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  And she's, making connections for the family.
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  Amanda Wilde (Host): This sounds like really comprehensive
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  multidisciplinary support.
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  How?
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  Does this intervention change outcomes for babies that are born prematurely
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  or with medical complexities?
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  Kari Mohrien, PA-C: Yeah, so early intervention is really crucial, for
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  any of our, little ones That is when brain development is very rapid.
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  so if we can get early access to our appropriate therapies And the things our,
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  babies and families need, we can see more improvement, and progress over time.
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  the majority of premature infants.
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  they are meeting appropriate developmental milestones, by age two.
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  and that's always really reassuring for families to hear.
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  Amanda Wilde (Host): What are some common concerns or questions you hear from
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  families before they've even gone home but are transitioning home from the new?
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  Q.
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  Kari Mohrien, PA-C: Yes.
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  the most common concern we hear, cause I'm seeing them after they've been
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  discharged, sometimes as soon as a couple of weeks, but sometimes it's a couple of
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  months later by the time I'm seeing them.
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  So the biggest, concern that we.
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  Typically here, is, is my child always going to have a delay?
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  what's this difference between, my baby's actual age and their
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  corrected age for prematurity?
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  So we always really review that with families that, if the BB was born at.
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  27 weeks.
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  You know, they might be six months old when they first come to see me, but
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  they're corrected ages three months.
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  And so it's really important for families to remember.
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  we want to make sure they're at least hitting those three-month milestones.
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  As long as they're doing that, we are happy with their overall
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  development at that time.
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  And I think that provides some reassurance for the families too.
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  Amanda Wilde (Host): I think that the fact that the clinic exists sort of addresses
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  this next question, but for parents who may feel overwhelmed, what reassurance or
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  advice would you most want them to hear?
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  Kari Mohrien, PA-C: Yes.
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  First I want them all to know they're doing a really wonderful job.
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  parenthood is.
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  Challenging, parenting a premature baby or, some of our babies
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  that are very medically complex, just adds another layer to it.
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  And our families are, very incredible.
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  And we remind them, that they also have to, take some time for themselves.
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  but we also remind them, again, that.
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  The majority of our premature babies are meeting those appropriate developmental
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  milestones, by the time they're two.
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  for our babies that are demonstrating more significant delays or that
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  are more medically complex, we really remind the families to
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  celebrate all of those little wins.
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  because over time, that turns into, big progress.
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  And that's what we want to continue to see.
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  Amanda Wilde (Host): You're there for ev, all those small steps.
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  Well, Carrie, thank you so much for explaining the crucial role of the NICU
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  developmental clinic and supporting the growth and development of children after
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  their early beginnings in the nicu.
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  I.
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  Kari Mohrien, PA-C: Thank you.
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  It, truly is so amazing to be a part of it, And we all, as our team feel really
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  honored that the parents and families let us be a part of that journey.
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  Amanda Wilde (Host): To find a physician, visit novant health.org.
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  For more health and wellness information from our experts,
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  visit healthy headlines.org.
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  And thank you for listening to Meaningful Medicine, a Novant Health podcast.