Amanda Wilde (Host): Meaningful Medicine is a Novant Health Podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. I'm Amanda Wilde. And joining me today is physician assistant, Kari Mohrien, who will be discussing an essential but not well-known resource for families who have spent time in the neonatal intensive care unit, Novant Health's NICU Followup Clinic.

Kari, welcome to the podcast. And for families who may not be familiar with this service, what is the NICU Follow-Up Clinic, or we also call it the NICU Developmental Clinic, and why is it important?

Kari Mohrien, PA-C: Yes. Thank you guys so much for having me today. So, our overall role is to closely monitor developmental milestones up until age two. So, we have a multidisciplinary team that closely monitors and evaluates at the corrected ages of 3, 6, 12, 18, and 24 months for our families.

Host: So at those times of 3, 6 and 12 months, what types of developmental or behavioral milestones are you monitoring during those visits?

Kari Mohrien, PA-C: At each visit, we are specifically looking at our baby's speech and language development. So, early on at that first visit, at three months, we are checking and making sure that our babies are giving us those good social smiles and cooing. And as they continue to grow and develop, making sure that they're babbling, saying their first words, and then developing into those two-word sentences.

We're also looking at their overall gross motor development. So again, at that first visit at three months, tummy time is really, really important. As our babies are able to do tummy time, they develop that core strength, which is needed for all of those next necessary steps of sitting, crawling, standing, running, climbing, all of those things, over the first two years of life. We're also monitoring their visual motor and their fine motor skills. So, early on, just making sure that they're tracking appropriately with their eyes. And then, as they approach six months, that they're making those really good coordinated movement and then starting to develop into more complex abilities with able to stack blocks or do small puzzles and able to scribble with a crayon, those types of things.

As the babies start to get older and we're hitting early toddlerhood at that 18 to 24 months, we're also really starting to look at behavior and their overall social skills at that time, and monitoring for any early symptoms of an autism spectrum disorder.

Host: So in light of doing all these assessments, how do you help parents understand what's typical and what may need extra support as the baby grows?

Kari Mohrien, PA-C: Yes. That's a great question. So throughout the visit, we are really explaining each thing that we're looking for. So, I use a standardized test to look at each of these abilities, and I'm explaining those to parents and what I'm seeing. If there's anything that maybe we're already starting to show a delay, we're talking about that.

And then, as I do the assessment, I let the families know developmentally where their child is in each area, and what to expect over the next three to six months before I see them again. So, the parents also know what they are looking for. We also discuss age-appropriate toys that are going to help their development. And we really stress how important it is to be reading to our babies from day one, all through early childhood.

Host: You've already touched on this a bit. But can you walk us through what a visit looks like. You mentioned parents are involved, you're involved. Who else might be involved and what assessments and conversations take place?

Kari Mohrien, PA-C: Yes. So, our involvement really starts even while the babies are in the hospital. So, we have an RN outpatient navigator, her name is Riley Meechan. And she gets to meet many of our families while they are still in the nicu. And she gets to make that connection so they already have a familiar face for the person that's going to be seeing them. So, she also calls them shortly after they are discharged from the hospital, seeing how they're doing, and if they have any questions or concerns at that time. And she helps coordinate any further followups with other specialty teams that they have to see also.

When the babies come to our office, so they come see us for their first visit at that three-month corrected age. And at that visit, again, the visit really starts as soon as the medical assistant goes out in the waiting room and brings them back to room them because she's getting really important information for the rest of the team. She's getting their height, their weight, their head circumference. So, all of those growth parameters are really, really important. And then, she's checking in on their therapies and specialty visits.

And then, I come in the room and I see them and review all of those things that we talked about before. And then, comes in the rest of the team one by one. So, Megan Rispoli is our physical therapist. She's going to come in and really touch on all of the important gross motor abilities that each baby should be presenting with. And if there's any concern, she's going to do a more in depth evaluation, and make further recommendations for therapy.

Next to come in is Chanel Tignor and she is our speech-language pathologist and she specializes in feeding therapy. So, she is helping to assess if our babies have any lip or tongue ties, if there's any choking or gagging that may indicate that we need a further swallow study. And then, also along with myself, she's really further assessing those speech concerns as the babies get older, and if we need any further formal speech therapy.

We also have a dietician. Her name is Sarah Lamb. She's going to review the caloric need for each individual baby that comes in. If there's any concern that one of our babies is not tolerating their formula or breast milk that they are receiving, she can make those changes. If overall growth-wise, it looks like we're not hitting parameters that we wish we were, she can also increase caloric need and tell the families about that. And then, as our babies get a little bit older, so they're starting to hit that 18 to 24 month range, if there's any picky eating or concern, she can really touch on that too, because we know that's always a big one for families. And then lastly, we have Michelle Hare and she's our social worker.

So as you can hear, the rest of our team is really, really focused on the baby and what the baby is doing. Michelle is looking at the entire family and what the entire family's needs are. So, she is making sure, you know, if there are any mental health concerns, if there's any housing or food insecurity. And she's making connections for the family.

Host: This sounds like really comprehensive multidisciplinary support. How does this intervention change outcomes for babies that are born prematurely or with medical complexities?

Kari Mohrien, PA-C: Yeah. So, early intervention is really crucial for any of our little ones. That is when brain development is very rapid. So if we can get early access to our appropriate therapies and the things our babies and families need, we can see more improvement and progress over time. The majority of premature infants, they are meeting appropriate developmental milestones by age two. And that's always really reassuring for families to hear.

Host: What are some common concerns or questions you hear from families before they've even gone home but are transitioning home from the NICU?

Kari Mohrien, PA-C: Yes. The most common concern we hear-because I'm seeing them after they've been discharged, sometimes as soon as a couple of weeks, but sometimes it's a couple of months later by the time I'm seeing them. So, the biggest concern that we typically hear is, "Is my child always going to have a delay? What's this difference between my baby's actual age and their corrected age for prematurity?" So, we always really review that with families that, if the baby was born at 27 weeks, you know, they might be six months old when they first come to see me, but they're corrected age is three months. And so, it's really important for families to remember we want to make sure they're at least hitting those three-month milestones. As long as they're doing that, we are happy with their overall development at that time. And I think that provides some reassurance for the families too.

Host: I think that the fact that the clinic exists sort of addresses this next question, but for parents who may feel overwhelmed, what reassurance or advice would you most want them to hear?

Kari Mohrien, PA-C: Yes. First, I want them all to know they're doing a really wonderful job. Parenthood is challenging. Parenting a premature baby, or some of our babies that are very medically complex just adds another layer to it. And our families are very incredible. And we remind them that they also have to take some time for themselves. But we also remind them again that the majority of our premature babies are meeting those appropriate developmental milestones by the time they're two. For our babies that are demonstrating more significant delays or that are more medically complex, we really remind the families to celebrate all of those little wins. Because over time, that turns into big progress. And that's what we want to continue to see.

Host: So, you're there for all those small steps.

Kari Mohrien, PA-C: Exactly.

Host: Well, Kari, thank you so much for explaining the crucial role of the NICU Developmental Clinic and supporting the growth and development of children after their early beginnings in the NICU.

Kari Mohrien, PA-C: Thank you. It truly is so amazing to be a part of it, And we all, as our team, feel really honored that the parents and families let us be a part of that journey.

Host: To find a physician, visit novanthealth.org. For more health and wellness information from our experts, visit healthyheadlines.org. And thank you for listening to Meaningful Medicine, a Novant Health podcast.