Nurse-led redesign cut loss to follow-up among NICU graduates

A quality improvement study published in the Journal of Perinatology reports that a redesigned follow-up program at Children’s Wisconsin was associated with a sharp drop in the proportion of high-risk NICU graduates lost to follow-up by 24 months adjusted age, falling from 35 percent under the original model to 17 percent after the redesign.

The study, led by Katherine Carlton and colleagues, evaluated whether a nurse-coordinated, two-clinic high-risk infant follow-up (HRIF) model supported by automated data tracking could keep more of these vulnerable children engaged in developmental surveillance. The researchers conducted a quasi-experimental pre/post analysis of 2174 NICU graduates treated between 2019 and 2024, comparing two consecutive epochs of care.

The redesigned model, introduced for the 2022 to 2024 cohort, added several structural changes: nurse-led discharge coordination beginning before families left the NICU, clinics stratified by diagnosis so that children with similar risk profiles were seen together, standardized developmental assessments, expanded eligibility criteria that broadened who could enroll, and a REDCap-based data warehouse that automated tracking of each child’s follow-up status.

The primary outcome was loss to follow-up by 24 months adjusted age. Across 4956 completed visits, the redesigned model was associated with substantially better retention. Attendance at the six-month follow-up visit improved from 49 percent to 73 percent.

The analysis also identified which children were most likely to remain in care.

The authors conclude that the HRIF redesign, supported by its data infrastructure, was associated with substantially lower loss to follow-up and may improve developmental surveillance for high-risk infants. Because the study used a quasi-experimental pre/post design rather than randomization, the findings show association rather than proven causation, and changes over the study period other than the redesign could have contributed to the improvement.

Subject of Research: A quality improvement study of a redesigned high-risk infant follow-up program for NICU graduates

Article Title: A two-clinic NICU follow-up model: where are we now?

Article References: Carlton, K., Cabacungan, E., Miller, L. E., Adams, S., & Cohen, S. (2026). A two-clinic NICU follow-up model: where are we now?. Journal of Perinatology. https://doi.org/10.1038/s41372-026-02933-1

Image Credits: AI Generated

DOI: 10.1038/s41372-026-02933-1

Keywords: NICU graduates, high-risk infant follow-up, loss to follow-up, quality improvement, developmental surveillance, nurse-led coordination, REDCap data warehouse, preterm infants, quasi-experimental study, Journal of Perinatology, two-clinic, NICU