P2.H145: Is neighborhood deprivation associated with postnatal neurodevelopmental impairment in extremely preterm infants?

Background: Disparities in healthcare driven by poverty, access to care, and the lasting impact of structural racism affect pregnancy outcomes and child development. Extremely preterm infants (EPT, born < 29 weeks’ gestation) face neurodevelopmental impairment (NDI) as a complication of prematurity, and sociodemographic factors may exacerbate NDI risk. The Area Deprivation Index (ADI) is a validated, national composite measure of neighborhood disadvantage that uses census data on income, education, employment, and housing quality.

Methods: We conducted a retrospective cohort study in 4 level IV NICUs of multiracial EPT infants with Bayley’s Scale of Infant Development exams performed at 18 - 26 months corrected age. We geocoded maternal addresses at birth to census block groups, identified by Federal Information Processing Series (FIPS) codes. Then, we linked NDI outcomes to block group ADI percentiles using open-source data from https://www.neighborhoodatlas.medicine.wisc.edu/ to analyze the relationship between ADI and NDI. NDI was treated as an ordinal variable: using the lowest component score (cognitive, language, or motor). NDI was categorized as none or mild (>85), moderate (70-84), or severe ( < 70). We used a novel, two-stage multivariable regression that simultaneously accounts for missing Bayley scores and models the ordinal NDI outcome. The regression model adjusted for site, sex, birthweight, severe intraventricular hemorrhage (sIVH, grade III-IV), and sepsis (positive blood culture and ≥5 days antibiotics) or necrotizing enterocolitis (NEC, Bell’s stage 2-3). Odds ratios were calculated from model coefficients for each predictor, and a predictor was considered significant if the 95% Credible Intervals excluded 1.0. Continuous predictors were scaled and centered, allowing us to assess the relative importance of predictors by the absolute value of their coefficients.

Results: We studied 1284 EPT infants, of whom 275 had a Bayley exam at 18 - 26 months corrected age. Among infants who survived to NICU discharge, lower birthweight, less sIVH, and inborn status were associated with having a Bayley score. ADI was similar between infants with and without a Bayley score (Table 1). In univariate analysis, higher ADI, lower birthweight, lower gestational age, and male sex were associated with NDI (Table 2).

Conclusion: In a multicenter cohort of preterm infants less than 29 weeks’ gestation, higher neighborhood deprivation, lower birthweight, lower gestational age, and male sex were associated with an increased risk of NDI.