Early-Life Outcomes in Relation to Social Determinants of Health for Children Born Extremely Preterm

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Objective: To characterize the relationships between social determinants of health (SDOH) and outcomes for children born extremely preterm. Study design: This is a cohort study of infants born at 22-26 weeks of gestation in National Institute of Child Health and Human Development Neonatal Research Network centers (2006-2017) who survived to discharge. Infants were classified by 3 maternal SDOH: education, insurance, and race. Outcomes included postmenstrual age (PMA) at discharge, readmission, neurodevelopmental impairment (NDI), and death postdischarge. Regression analyses adjusted for center, perinatal characteristics, neonatal morbidity, ethnicity, and 2 SDOH (eg, group comparisons by education adjusted for insurance and race). Results: Of 7438 children, 5442 (73%) had at least 1 risk-associated SDOH. PMA at discharge was older (adjusted mean difference 0.37 weeks, 95% CL 0.06, 0.68) and readmission more likely (aOR 1.27, 95% CL 1.12, 1.43) for infants whose mothers had public/no insurance vs private. Neither PMA at discharge nor readmission varied by education or race. NDI was twice as likely (aOR 2.36, 95% CL 1.86, 3.00) and death 5 times as likely (aOR 5.22, 95% CL 2.54, 10.73) for infants with 3 risk-associated SDOH compared with those with none. Conclusions: Children born to mothers with public/no insurance were older at discharge and more likely to be readmitted than those born to privately insured mothers. NDI and death postdischarge were more common among children exposed to multiple risk-associated SDOH at birth compared with those not exposed. Addressing disparities due to maternal education, insurance coverage, and systemic racism are potential intervention targets to improve outcomes for children born preterm.

Original languageEnglish
Article number113443
JournalJournal of Pediatrics
StateAccepted/In press - 2023

Bibliographical note

Funding Information:
The National Institutes of Health , the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Center for Research Resources , and the National Center for Advancing Translational Sciences provided grant support for the Neonatal Research Network’s Generic Database and Follow-up Studies through cooperative agreements. Individual site grant numbers listed in the Appendix ; available at www.jpeds.com . NICHD staff had input into the design and conduct of the study, interpretation of the data, and decision to submit the manuscript for publication. Data were collected by participating centers. Data were managed and analyzed by RTI staff. The manuscript was prepared by the authors then reviewed and approved by NICHD staff.

Publisher Copyright:
© 2023 Elsevier Inc.


  • discharge
  • education
  • insurance
  • neurodevelopment
  • premature
  • race

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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