![](https://assets.reachrx.ai/images/10.1038%E2%98%8Ds41390-025-04709-3/_page_0_Picture_1.jpeg) ![](https://assets.reachrx.ai/images/10.1038%E2%98%8Ds41390-025-04709-3/_page_0_Picture_2.jpeg) #### **COMMENT OPEN** ![](https://assets.reachrx.ai/images/10.1038%E2%98%8Ds41390-025-04709-3/_page_0_Figure_4.jpeg) # A collaborative "THRIVE Fetus to Five" neonatal brain program review Lina Chalak^1™, Margaret K. Hoge¹, June Hu¹, Jennifer Thomas¹, Michelle Machie¹, Lizette Lee¹, Elizabeth T. Heyne¹, Rebecca McDougald¹, Kristine Tolento Plata¹ and Roy Joseph Heyne¹ © The Author(s) 2026 After Neonatal Intensive Care Unit (NICU) discharge, vulnerable babies at risk of neurodevelopmental impairment and other chronic problems often require specialized follow-up care to monitor their development and address any potential issues. Typically, this involves multiple follow-up visits usually focused on neurodevelopment and growth. With advances in obstetric care, high-risk fetuses are being identified earlier, marking another timepoint in which personalized medicine can be delivered from before birth to after discharge including neuronicu care. Our program embeds this focus into a comprehensive, multi-disciplinary primary care model, which offers significant benefits for at-risk infants, and provides an integrated approach to their care. We present the benefits of integrating this model of care with other specialty clinic services into a cohesive, multi-disciplinary follow-up system that maximizes the potential for optimal care and outcomes. Through close collaboration of our multiple specialists at each point of the medical journey of each infant from "Fetus to Five," we describe our program where the priority is each child's needs to be met efficiently and comprehensively, as a pathway to thriving developmental outcomes and overall family satisfaction. Pediatric Research: https://doi.org/10.1038/s41390-025-04709-3 #### IMPACT: The future of such comprehensive programs lies in expanding access to comprehensive, integrated care offering services that extend into adolescence and adulthood that supports NICU graduates throughout their lifespan, ensuring optimal health and developmental outcomes #### INTRODUCTION Extensive epidemiological and physiological research in both humans and animal models supports the developmental origins of health and disease (DOHaD) hypothesis, which posits that adverse events during the fetal to neonatal periods influence disease development in adulthood. ^1–5 Critical stages of brain development occur in utero and throughout the first year of life, and injuries during these stages can lead to lifelong disabilities, including age-related neurologic decline and vascular diseases. ³ Numerous publications have emphasized the need for neonatal brain comprehensive programs. ^1–5 Of the 3,591,328 live births recorded in the US in one single year, an estimated 15% are admitted to neonatal intensive care units (NICUs).¹ Of these, up to 25% require neurologic consultations and follow-up because they are at risk for neurodevelopmental disabilities.² Despite recent updates to clinical practice, adverse outcomes for newborns remain alarmingly high. For example, newborns with hypoxic–ischemic encephalopathy (HIE) or intraventricular hemorrhage who survive frequently face neurodevelopmental disorders in childhood. Over the past decade, more than 25,000 peer-reviewed research articles and over 5000 NIH-funded grants have focused on the developing brain, leading to advancements in understanding the pathobiological mechanisms underlying various neurological conditions. Care of a NICU graduate does not start on admission to the NICU, and it does not end at discharge. During the prenatal period and following NICU discharge, providers have a responsibility to follow through for families and support them. Our patients have different needs based on where they live, their level of education, their income and other factors. By developing strategies to address at multiple levels we can find solutions and improve the healthcare for our premature and sick babies. We propose with "Fetus to Five" a continuum of personalized care for this vulnerable population to ensure each moment in their medical path is nurtured. When this happens, not only will the most vulnerable benefit, but society at large will benefit. In this review we describe the benefit of a comprehensive program spanning from before birth, NeuroNICU and following NICU discharge. We describe (1) Types of follow up care after NICU discharge, (2) "Fetus to Five" integrated follow-up care across multiple disciplines, (3) clinical and research benefits of comprehensive programs. The overall goal is to provide a framework that can be adapted to other networks. $^1$ UT Southwestern, Parkland and Childrens Health, Dallas, TX, USA. $^{\boxtimes}$ email: Lina.chalak@utsouthwestern.edu Received: 11 June 2025 Accepted: 16 July 2025 Published online: 03 January 2026 ![](https://assets.reachrx.ai/images/10.1038%E2%98%8Ds41390-025-04709-3/_page_1_Picture_2.jpeg) Fig. 1 Growth of fetal and neuronicu patient numbers. #### TYPES OF FOLLOW-UP CARE After Neonatal Intensive Care Unit (NICU) discharge, vulnerable babies often require specialized follow-up care to monitor their development and address any potential issues. Typically, this includes multiple appointments to various combinations of the following types clinics and services: #### **Neonatal Follow-up Clinics (NFC)** These clinics are focused on monitoring the overall growth, development, and neurological health of infants discharged from the NICU. They typically involve a team of specialists, including neonatologists, pediatricians, and therapists, to track developmental milestones and early impairment. #### **Developmental pediatrics clinics** These clinics specialize in monitoring the developmental progress of infants, particularly those at risk for delays due to prematurity or brain injury. Developmental pediatricians assess cognitive, motor, language, and social development, and offer interventions as needed. #### **Neurology clinics** These clinics focus on diagnosing and treating conditions like cerebral palsy, epilepsy, or other disorders resulting from brain injury. #### Early intervention services These programs are designed to provide support for babies at risk of developmental delays, offering therapy services such as physical, occupational, and speech therapy. #### Ophthalmology and ENT/audiology clinics These clinics focus on early identification and management of vision and auditory impairments. #### **Genetics clinics** Genetic testing and counseling may be part of follow-up or separate. #### Other specialty clinics These provide additional expertise for management of more complex chronic problems, e.g., Pulmonary for management of ventilators, Gastroenterology for management of TPN dependence, Neurosurgery for VP shunts, Surgery for gastrostomy tube placement, Endocrinology for congenital hypothyroidism, Cardiology for congenital heart disease, Physical Medicine Rehab for CP. Each of these clinics plays a crucial role in ensuring early detection ![](https://assets.reachrx.ai/images/10.1038%E2%98%8Ds41390-025-04709-3/_page_1_Figure_20.jpeg) Fig. 2 Highlights the growth of the program over the last 10 years. and intervention for babies at risk of brain injury, helping to optimize long-term outcomes. #### PARADIGM SHIFT TO INTEGRATED "FETUS TO FIVE" CARE Our group boasts a clinical comprehensive program spanning from "Fetus to Five" as well as an accredited NNCC neonatal neurocritical care fellowship. Our goal is to review this comprehensive program "Fetus to Five" starting from (1) FETAL Program, (2) NeuroNICU, (3) THRIVE Program into early childhood. (Fig. 1). #### 2A. ENVIRONMENT AND SUPPORTING HOSPITAL NETWORK Our neonatal division currently serves 5 integrated hospitals across Dallas – Parkland, Clements University Hospital, Children's Medical Center, and Texas Health Dallas and Frisco - accounting for 20,000 births each year, the largest delivery program in Texas. Figs. 2–4. Our obstetric service is highly integrated within the health care delivery services of targeted communities of Dallas, assuring a continued source of diverse patients. #### Parkland Hospital and Health Systems (PHHS) Parkland Health first opened its doors in 1894 and is now one of the largest public hospital systems in the country. Licensed for 983 beds, Parkland is Dallas County's only public hospital. Parkland delivers more than 250,000 emergency visits, 14,000 births per year. SPRINGER NATURE Pediatric Research # Distribution by service Neonataology (40%) GI (8%) Nephrology (1%) Neurology (6%) NSG (2%) Palliative care (14%) Surgery (10%) **Fig. 3** Summarizes the types of specialties involved with (1) majority of General neonatology consults occurring in 40%, followed by other subspecialists consults as follows: (2) urology in 18%, (3) palliative teams in 14%, 4) surgery in 10%, (5) neurology in 10%, 6) other specialties for rare conditions as neurosurgery 2%, genetics 1% and nephrology 1%. ![](https://assets.reachrx.ai/images/10.1038%E2%98%8Ds41390-025-04709-3/_page_2_Figure_4.jpeg) **Fig. 4** Highlights the interdisciplinary nature of the teams helping patients needs in THRIVE program. #### Children's Health Systems of Texas Children's Health Systems of Texas (Children's) is private, not-forprofit, and is the seventh largest pediatric healthcare provider in the nation. As the only academic healthcare facility in North Texas dedicated exclusively to the comprehensive care of children from birth to age 18, Children's provides patient care ranging from simple eye exams to specialized treatment in areas such as NICU and follow up. The Children's system is licensed for 562 beds and the NICU expanded to 60 beds in 2025. Clements University Hospital. includes 30 private NICU rooms, giving each baby his or her own space that easily accommodates hospital staff and parents designed to keep NICU babies and their parents together as much as possible. Parents can sleep in the room overnight with their newborns and do bedside rounds with the medical team – enabling them to focus on their infant and build bonds that will help the baby grow stronger. #### **Texas Health Resources (THR)** Texas Health Resources, established in 1997, is one of the largest nonprofit health care delivery systems in the United States and the largest in North Texas. Through Southwestern Health Resources (SWHR), a clinically integrated network formed in partnership with UT Southwestern, collaboration integrates clinical care, data infrastructure, and population health management to support value based care including 50 beds NICU, Neuronicu program and integrated follow-up. # 2B. THE FETAL EVALUATION AND TREATMENT ALLIANCE (FETAL) PROGRAM FETAL started in 2013 with the aim of providing exceptional antenatal/fetal care for parents whose fetus has been diagnosed with a congenital anomaly or condition warranting treatment either in-utero or in the neonatal period. It has grown exponentially in the last 10 years from 90 cases in 2013 to 490 completed consults in 2024. Patients can access fetal MRI imaging and perinatal genetic counseling. The program has grown to include multiple pediatric medical and surgical specialties who participate in antenatal counseling, usually in conjunction with each other, to deliver personalized multi-disciplinary care. Due to the increase in referrals and the complexity of patient cases, the program now offers antenatal consultations with all pediatric medical and surgical subspecialists. The FETAL team collaborates with different specialists to coordinate "blocked" times dedicated for fetal consults and communicates directly with providers regarding complex cases that warrant multi-disciplinary development of treatment plans. Specific working groups (i.e., the EXIT delivery working group) have solidified practices in response to the increasing complexity of patients referred to the FETAL Center. Furthermore, the team has developed a model for full-time Monday-Friday neonatology consultant role and has successfully implemented billing for these consultations performed via a telemedicine platform in 2024. Monthly conferences, co-led by a neonatologist and maternal-fetal-medicine physician, are now CME-accredited, and comprise teaching for trainees as well as detailed discussions between providers for individualized care for complex patients. On a larger scale, the FETAL team participates in research initiatives as part of the Children's Hospital Neonatal Consortium (CHNC) and North American Fetal Therapy Network (NAFNet) #### 2.C. NEURONICU The Neonatal Neurology team is consulted for any concerns of seizures, HIE, IVH as well as any preterm infant under 32 weeks gestation with published neuroimaging, follow-up protocols and guidelines.^7–13 The Neonatal Neurology team continues to follow these neonates periodically throughout their NICU admission to monitor the neurological exam, to monitor for seizures, and to continue to communicate with the families regarding neurodevelopmental prognosis. 14 The neonatal NeuroNICU program has a proven track record where initial consult starts in NICU and then Follow-up of study infants is integrated within the infant's medical home at Children's Medical Center (CMC). The fetal neonatal neurology fellowship program incorporates specific education and exposure to updating protocols and adherence to provide better care. The neonatal intensive care unit database is unique in its years of existence, its size for a single-site database and the implementation of periodic documentation of its validity. The division database was established in 1977 and has been maintained for >46 years. Thus, it predates the establishment of most multicenter neonatal databases, including the NICHD NRN GDB in 1986, VON in 1988, KPNMD in 1992, the Pediatrix Baby Steps Clinical Data Warehouse in 1996 and the California Perinatal Quality Care Collaborative (CPQCC) in 1997. 15 ### Table 1. Example Active Research Trials (2-year Follow-up rates exceeding 90%) [Follow-up](http://www.clinicaltrials.gov/ct2/show/NCT00009633) (1993 - ongoing) Follow-up of infants born less than or equal to 26 completed weeks gestational age at 22–26 months corrected age. NIH-NICHD [Generic Database](http://www.clinicaltrials.gov/ct2/show/NCT00063063) (1987 - ongoing) The Generic Data Base Study (GDB): Survey of Morbidity and Mortality in Very Low Birth Weight (VLBW) Infants. NIH-NICHD [HYBRiD](https://clinicaltrials.gov/ct2/show/NCT01353313) (2017 - ongoing) Follow-up of infants enrolled in the Hydrocortisone for BPD Trial at 5–6 years corrected age to assess functional developmental and respiratory outcomes at early school age. NIH-NICHD [TOP5](https://clinicaltrials.gov/study/NCT01702805?PARAMS=xik_3uQbRyWB4RowsexwLdZ7LFMHUCt3sZV4SKcb54Ks3NG26EBd3Vdj2x4ZDmT3E8hD11) (2019 – ongoing) Follow-up of infants enrolled in the TOP Trial at 5–6 years corrected age to assess neurological and functional outcomes at early school age based on neonatal transfusion threshold. NIH-NICHD [NeoPlaTT](https://clinicaltrials.gov/study/NCT06676904) (2025 - ongoing) Neonatal Platelet Transfusion Threshold Trial (NeoPlaTT) NIH-NICHD [DARBE](https://clinicaltrials.gov/study/NCT03169881?PARAMS=xik_7JraL6nQ3du71tK35rkjQqBSB12Bojh9XSvygj24CTYqS1qx7W3tqk7n8spzK4Pesh) Kids (2024 – ongoing) Follow-up of infants enrolled in the DARBE Trial at 4–5 and 6–7 years corrected age to assess neurological and functional outcomes at school age based on treatment with darbepoetin versus placebo. NIH-NICHD [MIDAS](https://clinicaltrials.gov/study/NCT06679855) (2025 - ongoing) Milrinone for Prevention of Postligation Cardiac Syndrome Trial. NIH-NICHD COOL PRIME (7/01/2022 – 6/30/2028) COOL PRIME: Comparative Effectiveness for Cooling Mild HIE-Patient-Centered Outcomes Research Inst (PCORI) CAN HEAL (7/2023- 6/30/2029) A Novel Wavelet Neurovascular Bundle for Real Time Detection of Injury. NIH-NINDS [BiB](https://clinicaltrials.gov/study/NCT04545866?PARAMS=xik_7AHxx7AX98SQY1bggjeqGvpHBgqbXRPb7WAX2kFx4zng9J7dh6biGuS8AUUixtbKQ4) (2021- ongoing) The Budesonide in Babies Trial. NIH-NICHD [PDA](https://clinicaltrials.gov/study/NCT03456336?PARAMS=xik_7JraL6nQ3du71tK35rkjQqNex49FdLE2kGhhhWGQzFYQ7F3LPLoTvqCrY48BzvCck3) (2019 – ongoing) Management of the Patent Ductus Arteriosus in Premature Infants Trial NIH-NICHD COPE (2023 – 2028). Cardiac Growth Trajectories after Preterm Birth NIH, NHLBI Interdisciplinary team meets with trainees and faculty throughout the year: - Developmental Brain Science Annual Symposium (1 day, 8 h course offered annually). Brain-focused conference providing state-of-the-art, evidence-based teaching on common neonatal neurologic pathologies with topics spanning fetal neurologic concerns to childhood neurodevelopmental outcomes of neonatal neurologic conditions. - Neuroradiology NICU Rounds (weekly). The basic principles underlying the clinical applications of neuroimaging and the strengths and limitations of specific neuroimaging modalities are discussed, with a focus on MRI, reviewing the role played by neuroimaging in diagnosis, monitoring of disease progression. - NeuroNICU Multidisciplinary Case Conference (twice/ month). Case-based review of basic principles of neonatal neurologic pathologies, including congenital and acquired brain injury, neuromuscular diseases, neurologic manifestations of metabolic disorders, and neurologic complications of other disease states. - NeuroNICU Journal Club (monthly). Fellow-led discussion and review of both landmark research in neonatal neurology and contemporary publications meant to both inform understanding of pathophysiology and improve management of neonates with neurologic pathologies #### 2.D. THE THRIVE PROGRAM: A COMPREHENSIVE NICU FOLLOW-UP MEDICAL HOME The THRIVE Program is a unique, comprehensive outpatient follow-up program that provides primary care and neurodevelopmental services for high-risk infants from birth to five years of age. Distinct among NICU follow-up models, THRIVE functions as a full medical home—offering routine well-childcare, acute and chronic illness management, after-hours support (via phone or pager), and coordinated neurodevelopmental assessments. Referral criteria include very low birth weight (<1500 g), severe intraventricular hemorrhage or periventricular leukomalacia, hypoxic-ischemic encephalopathy (HIE), bronchopulmonary dysplasia, surgical necrotizing enterocolitis, complex nutritional needs, and infants enrolled in research studies requiring neurodevelopmental tracking with active trials in Table 1. Table 2. THRIVE Program Visit Statistics reflecting 45 years of growth | | New Patients
(avg. per yr.) | Primary Care (avg.
per yr.) | |------------------------|--------------------------------|--------------------------------| | 1979–1999 | 2275 (110) | 14,650 (730) | | 2000–2009 | 1430 (143) | 31,650 (3165) | | 2010–2019 | 2627 (262) | 44,059 (4406) | | 2020–2024 | 1660 (332) | 22,149 (4430) | | Cumulative 45
years | 7992 | 112,508 | THRIVE' s patient population reflects the local community, comprising 61% Hispanic, 36% Black, 2% White, and 1% other. The majority are insured through Medicaid (50% managed, 42% traditional), with additional coverage through CHIP and other public or private sources. This patient population representation is important as it is often not included or studied in research trials. Since its inception over 45 years ago, THRIVE has followed approximately 8000 newborns, delivering more than 112,000 primary care visits and countless allied health consultations, including nutrition, developmental, and behavioral services. Currently, the clinic serves over 1400 unique patients annually, including 400 new enrollees, with approximately 5000 primary care visits and 2500 allied health visits each year. The program continues to expand, now supporting referrals from five hospitals within our healthcare network as described in Table 2. Each child is assigned a dedicated mid-level pediatric provider for vaccines and primary care needs (nurse practitioner or physician assistant), with clinic hours from 8 AM to 5 PM, Monday through Friday, and 24/7 telephone access for urgent concerns. Providers coordinate care with physician supervisors and emergency services outside clinic hours. In addition to comprehensive primary care, the clinic addresses growth, nutrition, psychosocial and behavioral challenges, and connects families to subspecialty care in audiology, ENT, ophthalmology, and other medical and surgical subspecialities as needed. Collaborations include a developing parent-infant mental health model with the Department of Child Psychiatry and Psychology. To ensure continuity, the program employs multiple strategies: introducing THRIVE to families before discharge, scheduling early post-discharge visits, assisting with Medicaid Pediatric Research enrollment, collecting, and updating contact details, and following up on missed appointments. THRIVE' s integrated, family-centered model ensures high-quality, continuous care for vulnerable infants during their critical early years. This has also resulted in follow-up rates among the highest in the country, especially for research studies (e.g., above 90% for Neonatal Research Network subjects through early school age). ## COMPREHENSIVE THRIVE PUBLISHED RANDOMIZED TRIALS LEVEL 1 EVIDENCE #### Clinical care cost analysis Inner-city high-risk infants often receive limited and fragmented care, a problem that may increase serious illness. A study was conducted in JAMA over 20 years ago to assess whether access to comprehensive care in a follow-up clinic is cost-effective in reducing life-threatening illnesses among high-risk, inner-city infants. 16,17 A total of 887 very-low-birth-weight infants born in our county hospital between January 1988 and March 1996 were followed up in a children's hospital clinic. Infants were randomly assigned to receive routine follow-up care (well-baby care and care for chronic illnesses; n = 441) or comprehensive care (which included the components of routine care plus care for acute illnesses, with 24-h access to a primary caregiver; n = 446). Main Outcome Measures included Life-threatening illnesses (i.e., causing death or hospital admission for pediatric intensive care) occurring between nursery discharge and age 1 year, assessed by blinded evaluators from inpatient charts and state Medicaid and vital statistics records; and hospital costs (estimated from department-specific cost-to-charge ratios). We reported that Comprehensive care resulted in a mean of 3.1 more clinic visits and 6.7 more telephone conversations with clinic staff (P < 0.001 for both). The comprehensive-care group had 48% fewer life-threatening illnesses (33 vs 63; P < 0.001), 57% fewer intensive care admissions (23 vs 53; P = 0.003), and 42% fewer intensive care days (254 vs 440; P = 0.003). Comprehensive care did not increase the mean estimated cost per infant for all care (\$6265 with comprehensive care and \$9913 with routine care). Comprehensive follow-up care was highly effective in reducing life-threatening illness without increasing costs among high-risk inner-city infants. Clinical Benefits of comprehensive care Fetus to Fifty are summarized below $^{18-22}$ : - Coordinated Care: By having specialists from different fields (neurology, developmental pediatrics, physical therapy, etc.) work together, families benefit from a more seamless experience. Instead of navigating multiple appointments with separate providers, parents can attend one location where all their baby's needs are addressed, which helps ensure no aspect of their care is overlooked. - Early Identification of Issues: With experts from various disciplines working together, the risk of missing important developmental concerns is reduced. For example, a neurologist might notice subtle signs of brain injury, while a developmental pediatrician could assess the baby's motor skills. The combined expertise helps identify problems earlier, leading to more timely interventions that can positively affect the baby's long-term development. - Comprehensive Monitoring: A multi-disciplinary approach allows for holistic tracking of a baby's growth and development. Physical, cognitive, sensory, and emotional health are all monitored in tandem, so specialists can adjust care plans or therapies quickly as new issues arise. This integrated monitoring supports the child's overall development, ensuring no single area is neglected. - Personalized Care Plans: By combining insights from various specialists, a more individualized and tailored care plan can be - created for the child. Each specialist contributes unique expertise, leading to a comprehensive approach that addresses the child's specific needs across all developmental domains—brain health, motor skills, language development, and more. - Family Support and Education: Social Work, Child Life, Nutrition, Child Psych, and Developmental Specialist. Families benefit from the unified expertise of multiple professionals, which provides reassurance and education. Parents receive guidance on how to support their child's development at home, understand how different aspects of care interrelate, and gain clarity about their child's progress. The combined effort also strengthens the support network available to parents, reducing stress and uncertainty. - Efficient Resource Use: Combining multiple services during a single appointment block can reduce the time and effort families spend accessing care. This increases the efficiency of healthcare delivery while reducing the logistical challenges of managing multiple separate appointments and specialists. - Holistic Family-Centered Care: A comprehensive follow-up clinic offers a family-centered approach where the family is actively involved in decisions about their child's care. Families receive guidance, emotional support, and education to empower them to advocate for their child's needs, improving both the child's health and the family's well-being. This includes Long-Term Support and Monitoring. This helps ensure that any new issues that arise, even later in life, are caught early and managed appropriately, ensuring long-term developmental success. The comprehensive care model has facilitated for follow-up rates above 90% for all most NICHD Neonatal Research Network trials and many other trials over the last 45 years. This model provides a "gold mine" for research, in addition to providing comprehensive care. - This model has also been a rich learning environment for a wide spectrum of trainees, ranging from Neonatal-Perinatal and NeuroNICU Fellows to Pediatric Residents to Advanced Practice Trainees and medical and allied health students, providing relevant exposure to the breadth and depth of medical and psychosocial issues that the NICU graduates and their families have to deal with and to the broad spectrum of neurodevelopmental and other chronic outcomes that we observe, which preclude scientific and ethical reduction to oversimplified categories. - The THRIVE comprehensive follow-up analysis done decades ago at inception of the program demonstrated that comprehensive-care group had 47% fewer infants who developed life threatening illnesses and 56% fewer infants who received pediatric intensive care than did the routinecare group. The reduction in life-threatening illnesses was achieved without a substantial increase in outpatient visits²². #### **CONCLUSION** In summary, findings demonstrate that comprehensive follow-up care provided by experienced caregivers can be highly effective in reducing life-threatening illnesses without increasing the overall costs of care for high-risk inner-city infants. Development of a comprehensive Fetus to Five Program highlight a cohesive, multi-disciplinary follow-up system, that maximizes the potential for optimal care. It creates an environment where specialists can collaborate closely, ensuring that each child's needs are met efficiently and comprehensively. The algorithm of follow-up care we provide should be individually considered in the context of the hospital setup and facilities. The "Fetus to Five " UT Southwestern NICU program has developed a comprehensive, longitudinal approach for supporting Pediatric Research high-risk infants and their families from the earliest stages of life through early childhood. Beginning in the NICU, the program emphasizes family-centered care, preparing parents for discharge with structured education, individualized support, and coordinated transition planning. Post-discharge, multidisciplinary followup clinics provide ongoing assessments and interventions, addressing medical, developmental, and psychosocial needs up to school age and beyond. The future of such programs lies in expanding access to comprehensive, integrated care offering services that extend into adolescence and adulthood that supports NICU graduates throughout their lifespan, ensuring optimal health and developmental outcomes with the hope in the future to move from 'Fetus to Five' to 'Fetus to Fifty.' #### SUMMARY What's Known on this Subject and This Study Adds: - After Neonatal Intensive Care Unit (NICU) discharge, vulnerable babies often require specialized follow-up care to monitor their development which typically includes multiple appointments to follow-up clinics and specialties. - We review a comprehensive clinical program "Fetus to Five" starting from (1) FETAL Program, (2)NeuroNICU, (3) THRIVE into early childhood. - Our integrated follow-up model at inception of the program demonstrated that comprehensive-care group had 47% fewer infants who developed life threatening illnesses and 56% fewer infants who received pediatric intensive care than did the routine-care group. - Research trials benefited from the integrated follow up listing more than 90% follow up rates. #### DATA AVAILABILITY Requests for data should be directed to the corresponding author shared per data protection and confidentiality guidelines. #### REFERENCES - 1. Kuroda, Y. et al. Neurocritical care update. J. Intensive Care 4, 36 (2016). - 2. Bonifacio, S. L., Glass, H. C., Peloquin, S. & Ferriero, D. M. A new neurological focus in neonatal intensive care. Nat. Rev. Neurol. 7, 485–494 (2011). - 3. Van Meurs, K. P., Yan, E. S. & Randall, K. S. Development of a neuroNICU with a broader focus on all newborns at risk of brain injury: the first 2 years. Am. J. Perinatol. 35, 1197–1205 (2018). - 4. Glass, H. C., Bonifacio, S. L., Shimotake, T. & Ferriero, D. M. Neurocritical care for neonates. Curr. Treat. Options Neurol. 13, 574–589 (2011). - 5. Egawa, S., Hifumi, T. & Kawakita, K. Impact of neurointensivist-managed intensive care unit implementation on patient outcomes after aneurysmal subarachnoid hemorrhage. J. Crit. Care 32, 52–55 (2016). - 6. Horbar, J.D., Edwards, E.M. & Ogbolu, Y. Our responsibility to follow through for NICU infants and their families. Pediatrics 146, e20200360 (2020). - 7. Pazandak, C. C. et al. Timing of initiation of therapeutic hypothermia in neonates with hypoxic ischemic encephalopathy born at a high-volume urban safety net hospital. Early Hum. Dev. 204, 106249 (2025). - 8. Bitar, L., Leon, R. L., Liu, Y. L., Kota, S., Chalak, L. F. Multi-organ dysfunction across the neonatal encephalopathy spectrum. Pediatr. Res. [https://doi.org/10.1038/](https://doi.org/10.1038/s41390-025-03978-2) [s41390-025-03978-2](https://doi.org/10.1038/s41390-025-03978-2) (2025). - 9. Kota, S., Liu, Y. L., Bitar, L. & Chalak, L. EEG spectral power and neurovascular coupling as early predictors of neurodevelopmental outcome in neonatal hypoxic-ischemic encephalopathy. In Annual International Conference of the IEEE Engineering in Medicine and Biology Society (IEEE, 2024). - 10. Chalak, L. F., Bitar, L. & Kota, S. Perinatal hypoxic-ischemic encephalopathy among a large public hospital population. JAMA Netw. Open 7, e2444448 (2024). - 11. Mashat, S. et al. Placental inflammatory response and association with the severity of neonatal hypoxic ischemic encephalopathy. Early Hum. Dev. 201, 106179 (2025). - 12. Babata, K. et al. Subgaleal hemorrhage in neonates: a comprehensive review and summary recommendations. J. Perinatol. 45, 167–179 (2025). - 13. Alayli, Y. et al. Neurodevelopmental outcomes in extremely preterm infants with placental pathologic evidence of fetal inflammatroy response. Pediatr. Res. (2024). - 14. Ibrahim, J., Mir, I. & Chalak, L. Brain imaging in preterm infants <32 weeks gestation: a clinical review and algorithm for the use of cranial ultrasound and qualitative brain MRI. Pediatr. Res. 84, 799–806 (2018). - 15. Babata, K. et al. A validated NICU database: recounting 50 years of clinical growth, quality improvement and research. Pediatr. Res. 97, 2224–2234 (2025). - 16. Broyles, R. S. et al. Comprehensive follow-up care and life-threatening illnesses among high-risk infants: a randomized controlled trial. JAMA. 284, 2070–2076 (2000). - 17. Lasky, R. E. et al. Disappointing follow-up findings for indigent high-risk newborns. Am. J. Dis. Child. 141, 100–105 (1987). - 18. Ornstein, M., Ohlsson, A., Edmonds, J. & Asztalos, E. Neonatal follow-up of very low birthweight/extremely low birthweight infants to school age. Acta Paediatr. Scand. 80, 741–748 (1991). - 19. Stevenson, D. K. et al. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1993 through December 1994. Am. J. Obstet. Gynecol. 179, 1632–1639 (1998). - 20. Hack, M. & Fanaroff, A. A. Outcomes of children of extremely low birthweight and gestational age in the 1990's. Early Hum. Dev. 53, 193–218 (1999). - 21. Lorenz, J. M., Wooliever, D. E., Jetton, J. R. & Paneth, N. A quantitative review of mortality and developmental disability in extremely premature newborns. Arch. Pediatr. Adolesc. Med.152, 425–435 (1998). - 22. Lewit, E. M., Baker, L. S., Corman, H. & Shiono, P. H. The direct cost of low birth weight. Future Child 5, 35–56 (1995). #### COMPETING INTERESTS The authors declare no competing interests. #### ADDITIONAL INFORMATION Correspondence and requests for materials should be addressed to Lina Chalak. Reprints and permission information is available at [http://www.nature.com/](http://www.nature.com/reprints) [reprints](http://www.nature.com/reprints) Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. ![](https://assets.reachrx.ai/images/10.1038%E2%98%8Ds41390-025-04709-3/_page_5_Picture_40.jpeg) Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://](http://creativecommons.org/licenses/by-nc-nd/4.0/) [creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/). © The Author(s) 2026