{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T17:21:51Z","timestamp":1789924911413,"version":"4.0.1"},"reference-count":43,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T00:00:00Z","timestamp":1726704000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Attendance to neonatal follow-up programs presents a significant factor associated with positive long-term outcomes of high-risk infants. Strategies to maximize participation benefit not only future interventions\u2019 effectiveness but also healthcare systems and society. While a number of studies have focused on attrition or loss to follow-up, no studies have focused on the contributive risk factors to abstaining from neonatal follow-up programs specifically during the COVID-19 pandemic. This study aims to reveal the main factors linked to non-compliance in a neonatal follow-up program of a tertiary hospital. Methods: In this ambidirectional observational study, data from 1137 high-risk neonates who participated in a hospital follow-up program were collected (573 before and 564 after the COVID-19 pandemic). The study sample was grouped to three groups: G1 (N = 831), who maintained participation in the program; G2 (N = 196), who discontinued; and G3 (N = 110), who never visited the outpatient clinics. Data were obtained from the hospital\u2019s Systems Applications and Products (SAP) Software and a structured questionnaire, answered by parents of newborns either discontinuing (G2) or not attending (G3) the follow-up program through a telephone contact. Results: The most frequently reported reason for discontinuance before the pandemic onset was the parents\u2019 perception of no necessity to maintain participation (44.12%). During the COVID-19 pandemic, provider-related barriers to maintaining hospital access, inability to provide high-quality services (37.14%), and feelings of fear and insecurity (18.5%) emerged as factors for non-attendance. Citizenship and morbidity (respiratory distress syndrome, sepsis, necrotic enterocolitis, jaundice) acted as incentives to join the follow-up program during both study periods. Multiple regression analysis showed that multiple-gestation infants had higher odds of maintaining participation during the COVID-19 period (OR, 4.04; CI, 1.09\u201314.9). Conclusions: Understanding the potential impact of COVID-19 and the transformative changes in neonatal follow-up clinics is crucial for applying compliance strategies. Removing barriers to maintain family participation can lead to increased attendance rates.<\/jats:p>","DOI":"10.3390\/children11091138","type":"journal-article","created":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T11:51:46Z","timestamp":1726746706000},"page":"1138","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Attendance in a Neonatal Follow-Up Program before and in the Time of COVID-19 Pandemic: A Mixed Prospective\u2013Retrospective Observational Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3624-8861","authenticated-orcid":false,"given":"Evdoxia","family":"Nantsi","sequence":"first","affiliation":[{"name":"Laboratory of Primary Health Care, School of Medicine, General Medicine and Health Services Research Aristotle University, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5570-9514","authenticated-orcid":false,"given":"Ilias","family":"Chatziioannidis","sequence":"additional","affiliation":[{"name":"Second Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, \u201cPapageorgiou\u201d University Hospital, 56403 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0074-3619","authenticated-orcid":false,"given":"Abraham","family":"Pouliakis","sequence":"additional","affiliation":[{"name":"Second Department of Pathology, National and Kapodistrian University of Athens, \u201cAttikon\u201d University Hospital, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9796-1614","authenticated-orcid":false,"given":"Georgios","family":"Mitsiakos","sequence":"additional","affiliation":[{"name":"Second Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, \u201cPapageorgiou\u201d University Hospital, 56403 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9592-2830","authenticated-orcid":false,"given":"Elias","family":"Kondilis","sequence":"additional","affiliation":[{"name":"Laboratory of Primary Health Care, School of Medicine, General Medicine and Health Services Research Aristotle University, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2162","DOI":"10.1016\/S0140-6736(12)60820-4","article-title":"National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: A systematic analysis and implications","volume":"379","author":"Blencowe","year":"2012","journal-title":"Lancet"},{"key":"ref_2","unstructured":"World Health Organization (2023, May 28). Preterm Birth [Internet]. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/preterm-birth."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1146\/annurev-publhealth-090810-182459","article-title":"Prematurity: An Overview and Public Health Implications","volume":"32","author":"McCormick","year":"2011","journal-title":"Annu. Rev. Public Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.clp.2022.11.004","article-title":"High-Risk Infant Follow-Up after NICU Discharge","volume":"50","author":"Litt","year":"2023","journal-title":"Clin. Perinatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1053\/j.semperi.2016.09.006","article-title":"The role of early developmental intervention to influence neurobehavioral outcomes of children born preterm","volume":"40","author":"Spittle","year":"2016","journal-title":"Semin. Perinatol."},{"key":"ref_6","first-page":"3","article-title":"Neonatal high-risk follow-up clinics: How to improve attendance in very low birth weight infants","volume":"4","author":"Patra","year":"2014","journal-title":"E-J. Neonatal Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.pcl.2018.12.015","article-title":"Neurodevelopmental Follow-up of Preterm Infants","volume":"66","author":"McGowan","year":"2019","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1053\/j.nainr.2012.09.011","article-title":"Who Is at Risk? High-Risk Infant Follow-up","volume":"12","author":"Purdy","year":"2012","journal-title":"Newborn Infant Nurs. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1111\/j.1469-8749.2009.03414.x","article-title":"Do early intervention programmes improve cognitive and motor outcomes for preterm infants after discharge? A systematic review: Early Intervention for Preterm Infants","volume":"51","author":"Orton","year":"2009","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Doyle, L.W., Anderson, P.J., Battin, M., Bowen, J.R., Brown, N., Callanan, C., Campbell, C., Chandler, S., Cheong, J., and Darlow, B. (2014). Long term follow up of high risk children: Who, why and how?. BMC Pediatr., 14.","DOI":"10.1186\/1471-2431-14-279"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.pediatrneurol.2020.10.014","article-title":"Assessments and Interventions for Spasticity in Infants with or at High Risk for Cerebral Palsy: A Systematic Review","volume":"118","author":"Ayala","year":"2021","journal-title":"Pediatr. Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1038\/jp.2011.97","article-title":"Current state of high-risk infant follow-up care in the United States: Results of a national survey of academic follow-up programs","volume":"32","author":"Kuppala","year":"2012","journal-title":"J. Perinatol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Needelman, H., and Jackson, B.J. (2018). The State of Neonatal Follow-Up Programs. Follow-Up for NICU Graduates: Promoting Positive Developmental and Behavioral Outcomes for At-Risk Infants, Springer International Publishing.","DOI":"10.1007\/978-3-319-73275-6"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/S0146-0005(03)00045-4","article-title":"Longitudinal multicenter follow-up of high-risk infants: Why, who, when, and what to assess","volume":"27","author":"Vohr","year":"2003","journal-title":"Semin. Perinatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1001\/jama.288.6.728","article-title":"Cognitive and Behavioral Outcomes of School-Aged Children Who Were Born Preterm: A Meta-analysis","volume":"288","author":"Bhutta","year":"2002","journal-title":"JAMA"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"xxi","DOI":"10.1016\/j.clp.2022.12.002","article-title":"Neurologic and Developmental Outcomes of High-Risk Neonates","volume":"50","author":"Maitre","year":"2023","journal-title":"Clin. Perinatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1017\/S2040174410000590","article-title":"Analysis of compliance, morbidities and outcome in neurodevelopmental follow-up visits in urban African-American infants at environmental risk","volume":"1","author":"Perenyi","year":"2010","journal-title":"J. Dev. Orig. Health Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1055\/s-0038-1629899","article-title":"Programmatic and Administrative Barriers to High-Risk Infant Follow-Up Care","volume":"35","author":"Tang","year":"2018","journal-title":"Am. J. Perinatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1097\/JPN.0b013e31823f900b","article-title":"Transition to Neonatal Follow-up Programs: Is Attendance a Problem?","volume":"26","author":"Ballantyne","year":"2012","journal-title":"J. Perinat. Neonatal Nurs."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1177\/0009922813477237","article-title":"Factors associated with neonatal intensive care follow-up appointment compliance","volume":"52","author":"Harmon","year":"2013","journal-title":"Clin. Pediatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1111\/apa.14265","article-title":"Why do children with severe bronchopulmonary dysplasia not attend neonatal follow-up care? Parental views of barriers","volume":"107","author":"Brady","year":"2018","journal-title":"Acta Paediatr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1038\/s41372-020-0659-4","article-title":"Social disparities negatively impact neonatal follow-up clinic attendance of premature infants discharged from the neonatal intensive care unit","volume":"40","author":"Swearingen","year":"2020","journal-title":"J. Perinatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1159\/000494105","article-title":"Patient, Family, and Center-Based Factors Associated with Attrition in Neonatal Clinical Research: A Prospective Study","volume":"115","author":"DeMauro","year":"2019","journal-title":"Neonatology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e20180793","DOI":"10.1590\/0034-7167-2018-0793","article-title":"Factors associated with the discontinuance of outpatient follow-up in neonatal units","volume":"73","author":"Duarte","year":"2020","journal-title":"Rev. Bras. Enferm."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1111\/cch.12202","article-title":"Mothers\u2019 and health care providers\u2019 perspectives of the barriers and facilitators to attendance at Canadian neonatal follow-up programs","volume":"41","author":"Ballantyne","year":"2015","journal-title":"Child. Care Health Dev."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.jpeds.2019.03.007","article-title":"Factors Associated with Successful First High-Risk Infant Clinic Visit for Very Low Birth Weight Infants in California","volume":"210","author":"Hintz","year":"2019","journal-title":"J. Pediatr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1111\/cch.12015","article-title":"Maternal and infant predictors of attendance at Neonatal Follow-Up programmes","volume":"40","author":"Ballantyne","year":"2014","journal-title":"Child. Care Health Dev."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Kim, N.H., Youn, Y.A., Cho, S.J., Hwang, J.-H., Kim, E.-K., Kim, E.A.-R., Lee, S.M., and Network, K.N. (2018). The predictors for the non-compliance to follow-up among very low birth weight infants in the Korean neonatal network. Gurgel RQ, editor. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0204421"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1515\/JPM.2009.135","article-title":"Indicators of compliance for developmental follow-up of infants discharged from a regional NICU","volume":"37","author":"Nehra","year":"2009","journal-title":"J. Perinat. Med."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Tuczy\u0144ska, M., Matthews-Kozanecka, M., and Baum, E. (2021). Accessibility to Non-COVID Health Services in the World During the COVID-19 Pandemic: Review. Front. Public Health, 9.","DOI":"10.3389\/fpubh.2021.760795"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1093\/ageing\/afaa118","article-title":"The COVID-19 rehabilitation pandemic","volume":"49","author":"Cook","year":"2020","journal-title":"Age Ageing"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.puhe.2021.06.025","article-title":"Essential public healthcare services utilization and excess non-COVID-19 mortality in Greece","volume":"198","author":"Kondilis","year":"2021","journal-title":"Public Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e901","DOI":"10.1016\/S2214-109X(20)30229-1","article-title":"Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: A modelling study","volume":"8","author":"Roberton","year":"2020","journal-title":"Lancet Glob. Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1038\/s41372-020-0745-7","article-title":"The downstream effects of COVID-19: A call for supporting family wellbeing in the NICU","volume":"40","author":"Erdei","year":"2020","journal-title":"J. Perinatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1111\/dmcn.14557","article-title":"New clinical needs and strategies for care in children with neurodisability during COVID-19","volume":"62","author":"Fazzi","year":"2020","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e2022057865","DOI":"10.1542\/peds.2022-057865","article-title":"Racial Inequity in High-Risk Infant Follow-Up among Extremely Low Birth Weight Infants","volume":"151","author":"Fraiman","year":"2023","journal-title":"Pediatrics"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1055\/s-0041-1729889","article-title":"Rural Residence and Factors Associated with Attendance at the Second High-Risk Infant Follow-up Clinic Visit for Very Low Birth Weight Infants in California","volume":"40","author":"Fuller","year":"2023","journal-title":"Am. J. Perinatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1038\/sj.jp.7211203","article-title":"Barriers to Screening Infants for Retinopathy of Prematurity after Discharge or Transfer from a Neonatal Intensive Care Unit","volume":"25","author":"Attar","year":"2005","journal-title":"J. Perinatol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Panda, S., Somu, R., Maitre, N., Levin, G., and Singh, A.P. (2021). Impact of the Coronavirus Pandemic on High-Risk Infant Follow-Up (HRIF) Programs: A Survey of Academic Programs. Children, 8.","DOI":"10.3390\/children8100889"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.jnn.2016.04.002","article-title":"Examining disparities in the long term follow-up of Neonatal Intensive Care Unit graduates in Nebraska, U.S.A.","volume":"22","author":"Roberts","year":"2016","journal-title":"J. Neonatal. Nurs."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1542\/hpeds.2022-006874","article-title":"Telemedicine Improves Rate of Successful First Visit to NICU Follow-up Clinic","volume":"13","author":"Watson","year":"2023","journal-title":"Hosp. Pediatr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1111\/cch.12812","article-title":"Challenges and opportunities for early intervention and neurodevelopmental follow-up in preterm infants during the COVID-19 pandemic","volume":"47","author":"Caporali","year":"2021","journal-title":"Child. Care Health Dev."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"105813","DOI":"10.1016\/j.earlhumdev.2023.105813","article-title":"Previous missed visits and independent risk of loss to follow-up in the high-risk neonatal follow-up clinic","volume":"183","author":"Christner","year":"2023","journal-title":"Early Hum. Dev."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/9\/1138\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:59:48Z","timestamp":1760111988000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/9\/1138"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,19]]},"references-count":43,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["children11091138"],"URL":"https:\/\/doi.org\/10.3390\/children11091138","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,19]]}}}