The smallest, sickest babies born to low-income parents appear to get substandard follow-up care once they leave the neonatal intensive-care unit, said the lead researcher on a study in Monday’s issue of the journal Pediatrics.

Dr. C. Jason Wang, assistant professor of pediatrics and public health at Boston Medical Center, led a team that looked at medical records of more than 2,100 babies born in South Carolina between 1996 and 1998. All of them were on Medicaid.

What they found was appalling and should serve as a call to all states to look at the care provided to the nation’s preemies, Wang said.

The study focused on two things. The first was follow-up care for the 241 babies who had been diagnosed with a hearing impairment before they left the hospital. The second was eye exams for babies between their first and second birthdays.

One of five babies had hearing rehabilitation by the 6-month birthday. About one in four had an eye exam between the first and second birthdays.

“You have to be able to hear and see to learn; these are very basic needs,” Wang said.

Researchers evaluated the records of babies who weighed less than 1,500 grams, or about 3 pounds, 5 ounces. Each year, about 60,000 babies born in the United States fall into this category and almost all of them are premature.

Little is known about what happens to these babies after they leave neonatal intensive-care units.

Wang said he chose South Carolina because the state had strong databases that he could link to evaluate the quality and frequency of follow-up care.

“Having insurance doesn’t mean you can actually get the care. What if I don’t have transportation? What if I speak a different language and I don’t understand what the issues are? And what if nobody ever told me how important it was to follow through with these things?”

Families need to be supported and government and the medical community must be vigilant in helping, he said.

“It would be unfair to try to save very, very small babies and then kind of drop the ball.”

Dr. Stephen Welty, medical director of Nationwide Children’s Hospital's neonatal intensive-care unit, said the Columbus hospital works hard to make sure babies that leave there get the appropriate care.

“The hidden cost of not providing good follow-up has not been well studied and is probably far greater than we think,” he said.

The hospital has two follow-up clinics, a neurodevelopment clinic and a clinic for babies who have a scarring lung disease called bronchopulmonary dysplasia.

“We bird-dog them; we work very hard to get them to come back.”

Many communities struggle more than Columbus to assure that children get appropriate follow-up, said Dr. Peter Giannone, associate medical director of the neonatal intensive-care unit at Ohio State University Medical Center. He sees it as a key responsibility of physicians to continue to remind parents of the importance of regular exams.

The sooner a developmental issue is caught, the better, but screening is only as good as the follow-up care that a child gets, said John Ladd, state director of program services for the March of Dimes.

The March of Dimes is working with the Ohio legislature to look at a variety of prematurity issues and the frequency of follow-up care may be something that is evaluated in this state, he said.

mcrane@dispatch.com