Evaluation/Procedures | Hospital Stay | Hospital Discharge | 1 month post discharge | 3 months of agea | 6 months of agea | 9 months of agea | 12 months of agea | 18 months of agea | 24 months of agea |
---|---|---|---|---|---|---|---|---|---|
Maternal and infant medical history | X | Â | Â | Â | Â | Â | Â | Â | Â |
Neonatal opioid withdrawal scoring/ assessments | X | Â | Â | Â | Â | Â | Â | Â | Â |
Date/time of initiation and number of doses of opioid replacement therapy administered (Infant) | X | Â | Â | Â | Â | Â | Â | Â | Â |
Date/time of initiation dose and number of doses of adjuvant therapy administered (Infant) | X | Â | Â | Â | Â | Â | Â | Â | Â |
Date/time when medically ready for discharge (Infant) | X | Â | Â | Â | Â | Â | Â | Â | Â |
Date/time discharged (Infant) | Â | X | Â | Â | Â | Â | Â | Â | Â |
Weight, length and head circumference (Infant) | X | X | Â | Â | Â | Â | Â | Â | O |
Feeding type (Infant) | X | X | Â | Â | Â | Â | Â | Â | Â |
Seizures, accidental trauma (i.e., dropped infants) and respiratory insufficiency (Infant) | X | X | Â | Â | Â | Â | Â | Â | Â |
Serious Adverse Events (Infant) | X | X | Â | Â | Â | Â | Â | Â | Â |
Acute/urgent care and/or ER visits and hospital readmissions | Â | Â | Â | X | Â | Â | Â | Â | Â |
Non-accidental trauma & death (Infant) | Â | X | Â | X | Â | Â | Â | Â | X |
Infant Behavioral Questionnaire (IBQ) – very short form (Infant) |  |  |  | O |  |  | O |  |  |
Caregiver questionnaire (CQ) (enteral feeds, acute/urgent care and/or ER visits and readmissions) (Infant) | Â | Â | O | O | O | Â | O | Â | O |
Brief Infant Sleep Questionnaire (BISQ) (Infant) | Â | Â | Â | O | Â | Â | O | Â | Â |
Patient Reported Outcome Measurement Information System (PROMIS) Short Forms (Caregiver(s)) | Â | O | Â | Â | O | Â | Â | Â | O |
Maternal Postnatal Attachment Questionnaire (MPAQ) (Caregiver(s)) | Â | O | Â | Â | O | Â | Â | Â | Â |
Parenting Sense of Competence Scale (PSOC) (Caregiver(s)) | Â | O | Â | Â | O | Â | Â | Â | Â |
Adverse Childhood Experiences (ACE) questionnaire | Â | Â | Â | Â | Â | Â | Â | Â | O |
Family Environmental Scale (FES) – Relationship Dimension Form R (Caregiver(s)) |  |  |  | O |  |  |  |  |  |
Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-4): Cognitive, Language and Motor | Â | Â | Â | Â | Â | Â | Â | Â | O |
Brief Infant-Toddler Social and Emotional Assessment (BITSEA) | Â | Â | Â | Â | Â | Â | Â | Â | O |
Contact information update | O | O | O | O | O | O | O | O | Â |