483 - Social determinants of health, discharge characteristics, and outcomes for children born extremely preterm

Poster Number: 483
Publication Number: 483.129

Jane E. Brumbaugh, Mayo Clinic, Rochester, MN, United States; Betty R. Vohr, Women & Infants Hospital of Rhode Island; Alpert Medical School of Brown University, Providence, SD, United States; Edward F. Bell, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, United States; Carla Bann, RTI International, Research Triangle Park, NC, United States; Colm P. Travers, University of Alabama at Birmingham, Birmingham, AL, United States; Elisabeth McGowan, Women & Infants Hospital of Rhode Island, Providence, RI, United States; Heidi Harmon, University of Iowa, Iowa City, IA, United States; Waldemar A. Carlo, University of Alabama at Birmingham, Birmingham, AL, United States; Andrea F. Duncan, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Susan R. Hintz, Stanford University School of Medicine, Palo Alto, CA, United States; NICHD Neonatal Research Network, NICHD, Bethesda, MD, United States

Background: Social and structural determinants of health (SDH) are associated with health outcomes. Children born extremely preterm have higher rates of adverse SDH than full term peers. The relationship between SDH and outcomes of children born extremely preterm merits investigation to eliminate disparities by non-biological constructs.

Objective: To characterize the relationships between SDH and discharge characteristics, readmission, and neurodevelopmental impairment (NDI) or death post-discharge for children born extremely preterm.

Design/Methods: This is a secondary analysis of inborn infants 22-26 weeks’ gestation and cared for at NICHD Neonatal Research Network centers from 2006-2017 who survived to discharge. Available SDH were classified as binary variables: maternal education (less than high school graduate or high school graduate), insurance status (public/none or private), and race (non-white or white). The primary outcome was postmenstrual age (PMA) at discharge. Secondary outcomes included discharge with oxygen, readmission post-discharge, and NDI at 18-26 months’ corrected age or death post-discharge. Demographic, perinatal, and discharge characteristics and 18-26 months’ corrected age outcomes were compared between SDH groups using chi-square tests for categorical variables and t-tests for continuous variables. Regression analyses comparing the SDH groups adjusted for center, perinatal characteristics, and neonatal morbidity.

Results: Of the 8136 children who met inclusion criteria, 6082 (75%) had at least one SDH risk exposure (Fig. 1). Mothers with any SDH risk were younger at delivery and less likely to have received antenatal steroids (both p < 0.001). PMA at discharge did not vary by SDH risk (education p=0.651, insurance p=0.138, race p=0.490) (Table 1). Infants with any SDH risk were less likely to be discharged with oxygen than those without SDH risk (aOR 0.87, 95% CI 0.76-0.99) (Table 2). Readmission was more common among infants with any SDH risk compared to those without (aOR1.25, 95% CI 1.11-1.40). NDI or death after discharge was more common among children with any SDH risk (aOR 1.85, 95% CI 1.63-2.10) than those without SDH risk. Among survivors, cognitive scores were lower for those exposed to SDH risk compared to those unexposed (all p < 0.001).Conclusion(s): PMA at discharge did not differ by SDH. However, readmission and NDI or death post-discharge were more common among children exposed to maternal SDH risk compared to those unexposed. Maternal education, insurance status, and systemic racism are potential intervention targets to optimize outcomes for children born extremely preterm.
Figure 1
Table 1