Frequently Asked Questions
Q. What is the High-Risk Infant (HRI) Clinic?
A. The High-Risk Infant Follow-Up Clinic is designed to assist families with follow-up care for infants and young children who are at high risk for developmental and neurological problems following discharge from the neonatal intensive care unit. We provide ongoing evaluation of the growth and development of these high-risk infants and young children, coordinate care with your infant’s pediatrician and recommend referrals to specialty services and clinics when needed.
The Clinic sees infants and young children from birth to 3 years of age who are at risk due to premature birth, low birth weight or other problems at birth. We see children who were cared for in the NICU at Rady Children’s and other participating hospitals. We also welcome children who have not been cared for in the NICU if their primary care doctor has a concern for developmental delay.
Q. Why does the Clinic exist?
A. California Children’s Services (CCS) is a state medical program created to treat children with physically handicapping conditions. CCS mandates that all hospitals with level 3 NICUs provide a means to assess and follow their high-risk infants after discharge. We are here to work with your pediatrician to provide optimal screening and needed follow-up referrals.
Q. Who are the staff?
A. They are:
- Brian Lane, M.D., Medical Director
- Mary Louise Schreiber, Certified Pediatric Nurse Practitioner/Clinical Coordinator
- Pamela Vik, Neonatal Nurse Practitioner
- Claudia Horita, Administrative Coordinator
- Kristin Gist, M.S., Senior Director Developmental Services
- Jeanne Gordon, M.A., Director Developmental Services
Q. What specific risk factors place an infant or child at risk for developmental and/or neurological problems?
A. CCS mandates follow-up for certain at-risk infants:
- Gestational age at birth was less than 32 weeks
- Birth weight less or equal to 1,500 grams
- Cardiorespiratory depression at birth
- Apgar score of less than or equal to 3 at five minutes
- Prolonged hypoxia, acidemia, hypoglycemia and/or hypotension requiring pressor support
- Persistent apnea which required medication (e.g., caffeine) for the treatment of apnea at discharge
- Required oxygen for more than 28 days of hospital stay and diagnosed with chronic lung disease
- Were on ECMO
- Received inhaled nitric oxide
- Had or have documented seizure activity
- Documented brain injury or intracranial pathology
- Other problems that could result in neurologic abnormalities
Q. How many visits can my child receive?
A. Your infant or child can be seen up to three times in our clinic before the age of 3 years. With any further follow-up needs, children can continue to be followed through the Developmental Evaluation Clinic (DEC).
Q. At what age is my child seen?
A. Infants are usually seen at about 6 months, 12 -18 months, and one last visit after the age of two (use adjusted age if infant was born prematurely).
Q. How can my child be referred to this clinic?
A. As parents of an infant graduating from an intensive care unit, after discharge from the NICU you can start the process by calling us at 858-966-8801. Your pediatrician may also refer your infant or young child to us.
Q. What happens during a neurodevelopmental visit?
A. The clinic visit takes approximately 1 ½ to 2 hours. The child and family are seen by a nurse practitioner. She will gather information about your child’s health history since discharge or last High Risk Infant Follow-Up visit. Next, she will evaluate your child using a developmental screening exam, followed by a physical exam, specifically looking for neuromuscular findings. You will be asked to report your child’s early language milestones. At the end of the exam, your child’s weight, height and head circumference will be measured. Finally, testing results and recommendations will be discussed.
Q. What tests are used?
A. The following tests are used:
- The Bayley Scales of Infant and Toddler Development/Screening Test, 3rd Edition, is used to identify risk for developmental delay.
- The Amiel-Tison Neuromuscular Exam is used to evaluate muscle tone, range of motion and reflexes.
- The REEL-3 uses parent/guardian report to evaluate your infant or child's language skills (as needed).
- The M-CHAT is a screening tool for toddlers between the ages of 16 and 30 months to assess risk for autism spectrum disorders.
Q. What happens after the visit?
A. Results are reviewed by the medical director and a copy of the visit report, including recommendations and follow up, are sent to your pediatrician.
Q. Where will you refer my infant or child if there are concerns for delay?
A. We may recommend referrals to specialists, California Early Start (CES) or to Rady Children's developmental services, which includes occupational therapy, physical therapy, speech therapy and audiology. Your child’s pediatrician will be involved in this process.
- High-Risk Infant Follow-Up Clinic
8010 Frost Street, Suite 200
San Diego, CA 92123
- Phone: 858-966-8801