High Risk Infant Follow-Up Clinic

About Us

The UCLA Mattel Children's Hospital High Risk Infant Follow-Up (HRIF) program is dedicated to providing evidence based clinical care to our patients and their families, advocating for early intervention services and furthering the institutional goals of education and research.

Clinical Care

The UCLA Mattel Children's Hospital High Risk Infant Follow-Up (HRIF) clinic provides comprehensive medical care, neurodevelopmental follow-up, care coordination, resources and psychosocial support for Neonatal Intensive Care Unit (NICU) graduates and their families from the time of discharge until 3 years of age. Babies who go home from the NICU are at higher risk for medical and developmental problems and require close attention. Our goal is to identify these problems early and help connect families with interventions that will help maximize their baby’s developmental potential. Our multi-disciplinary team includes medical and developmental specialists with extensive experience in caring for NICU graduates, using the latest evidence-based tools to help identify developmental problems as early as possible. We work together with pediatricians and other community providers to facilitate optimal developmental support, early intervention and family support. Babies are usually referred to our clinic from the NICU at UCLA as well as by pediatricians and other community NICUs. The first visit to our clinic (HRIF or NICU follow up clinic) occurs at 3-4 months corrected age (i.e., 3-4 months after the due date). After that, babies are typically seen in this clinic 1-2 times a year depending on their need. Services that are available in our clinic include neuromotor, developmental, psychological, medical and nutritional assessments and treatment. Our team of experts will work with families to ensure appropriate and early intervention for developmental concerns.

Infants that Qualify for HRIF Clinic

We serve families with infants who are at risk due to issues experienced during the newborn period. These include, but are not limited to:

• < 32 weeks GA or Birth Weight ≤ 1500 grams
• Babies on ECMO
• Seizure activity or receiving antiepileptics
• Evidence of any intracranial pathology
• Any documented neurologic abnormality (ex. CNS infection, sepsis, excessive bilirubin, cardiovascular instability, CHD, PDA, NEC, etc.)
• Persistent apnea requiring treatment; required oxygen > 28 days + x-ray findings of CLD; received treatment for pulmonary hypertension
• Unstable infant due to hypoxia, acidemia, hypoglycemia, or hypotension requiring treatment
• pH < 7.0 on blood gas within 1 HOL or Apgar scores less than 3 @ 5 minutes or less than 5 @ 10 minutes.
• And other eligible diagnoses under the California Children’s Services criteria

Team NEMO Consult

A unique feature of our service includes a Team NEMO (Neurodevelopment and Early Movements Observation) consult, which is an in-patient consult service for families of babies that are referred to our follow-up clinic. Team NEMO is an inter-disciplinary consult service with providers from Developmental-Behavioral Pediatrics and Neonatology and was started with the goal of providing continuity of care to bridge the transition for families from NICU to outpatient care. As part of the consult, General Movements Assessments (GMA) are completed and families are counseled about the results and about the need for neuro-developmental follow up. We also help connect families with Early Intervention/ Regional Center and schedule their first HRIF clinic visit.

Education

Neonatology fellows routinely participate in the High-risk Infant follow up clinics and learn about different aspects of the developmental follow up and care coordination. In addition, pediatric residents and fellows in Developmental-Behavioral Pediatrics also have the opportunity to participate in clinic.

Research

Our team is actively involved in research focused on improving neurodevelopmental outcomes for children born preterm as well as quality improvement initiatives. We have been a part of the Neonatal Research Network (NRN), a consortium of 16 leading academic centers in the US since 2011 and continue to participate in NRN Follow-up studies. We are part of a multi-site implementation project focused on Early Detection and intervention for infants at high-risk for cerebral palsy, funded by the Cerebral Palsy Foundation. In addition, we work collaboratively with researchers within UCLA and across the country.