Two interventions will be assessed in a randomized controlled trial. Subjects (150) will be recruited from a geographically-based birth cohort of very low birth weight infants with CLD. The intervention will begin when subjects are discharged from the hospital. Infants will be randomly assigned either to multidisciplinary center-based follow-up or care coordinated by a center-based nurse, via telephone contacts. The multidisciplinary center-based care will be provided by a neonatologist, a nurse, and a social worker; it will consist of visits to the home of the infant and visits by the infant to an outpatient clinic. The nurse-coordinated community-based care will be provided by a nurse via telephone contacts and by community-based providers of primary medical care and non-medical services. This group is to have limited (if any) contact with the medical center, with the expectation that the cost of care for these infants will be reduced by the use of community-based services. The study hypothesis is that subjects who receive the nurse-coordinated community-based care (c.f., multidisciplinary center-based care) will have equivalent or improved infant health and development, and equivalent or improved family functioning, with lower medical expenses related to the follow-up care. For both groups, follow-up care will begin when the infant is discharged from the hospital and will end when the infant reaches one year of adjusted age (as measured by the Bayley Scales of Infant Development). Eligibility for the study will be considered by the clinicians caring for a subject after the decision is made to discharge the infant from the hospital. Intervention effects will be measured using three outcomes: 1) infant health and developmental status through twelve months adjusted age; 2) family psychosocial functioning; and 3) total health care costs. Both direct health care costs and indirect costs to the family, will be measured through twelve months of age (adjusted for prematurity). These data will be used to compare the two strategies for after-hospital follow-up care. The results may have implications for the type of medical care to be provided to infants with CLD and their families. The study will also provide descriptive data on the family burden and cost of CLD.
