Early-Life Outcomes in Relation to Social Determinants of Health for Children Born Extremely Preterm - 22/08/23
Doi : 10.1016/j.jpeds.2023.113443
Jane E. Brumbaugh, MD 1, ⁎ 
, Betty R. Vohr, MD 2, Edward F. Bell, MD 3, Carla M. Bann, PhD 4, Colm P. Travers, MD 5, Elisabeth C. McGowan, MD 2, Heidi M. Harmon, MD, MS 3, Waldemar A. Carlo, MD 5, Andrea F. Duncan, MD, MS 6, Susan R. Hintz, MD, MS Epi 7
for the
, Betty R. Vohr, MD 2, Edward F. Bell, MD 3, Carla M. Bann, PhD 4, Colm P. Travers, MD 5, Elisabeth C. McGowan, MD 2, Heidi M. Harmon, MD, MS 3, Waldemar A. Carlo, MD 5, Andrea F. Duncan, MD, MS 6, Susan R. Hintz, MD, MS Epi 7for the
Eunice Kennedy Shriver NICHD Neonatal Research Network∗
Alan H. Jobe, MD, PhD, Michael S. Caplan, MD, Richard A. Polin, MD, Abbot R. Laptook, MD, Martin Keszler, MD, Angelita M. Hensman, PhD, RNC-NIC, Barbara Alksninis, RNC PNP, Carmena Bishop, Robert T. Burke, MD, MPH, Melinda Caskey, MD, Laurie Hoffman, MD, Katharine Johnson, MD, Mary Lenore Keszler, MD, Andrea M. Knoll, Vita Lamberson, MD, Teresa M. Leach, MEd CAES, Emilee Little, BSN RN, Elisabeth C. McGowan, MD, Bonnie E. Stephens, MD, Elisa Vieira, BSN RN, Lucille St. Pierre, BS, Suzy Ventura, Victoria E. Watson, MS CAS, Anna Maria Hibbs, MD MSCE, Michele C. Walsh, MD, MS, Deanne E. Wilson-Costello, MD, Nancy S. Newman, RN, Monika Bhola, MD, Allison H. Payne, MD, MS, Bonnie S. Siner, RN, Gulgun Yalcinkaya, MD, William E. Truog, MD, Eugenia K. Pallotto, MD, MSCE, Howard W. Kilbride, MD, Cheri Gauldin, RN BS CCRC, Anne Holmes, RN MSN MBA-HCM CCRC, Kathy Johnson, RN CCRC, Allison Scott, RNC-NIC BSN CCRC, Prabhu S. Parimi, MD, Lisa Gaetano, RN MSN, Brenda B. Poindexter, MD, MS, Kurt Schibler, MD, Suhas G. Kallapur, MD, Edward F. Donovan, MD, Stephanie Merhar, MD, MS, Cathy Grisby, BSN CCRC, Kimberly Yolton, PhD, Barbara Alexander, RN, Traci Beiersdorfer, RN BSN, Kate Bridges, MD, Tanya E. Cahill, RN BSN, Juanita Dudley, RN BSN, Estelle E. Fischer, MHSA MBA, Teresa L. Gratton, PA, Devan Hayes, BS, Jody Hessling, RN, Lenora D. Jackson, CRC, Kristin Kirker, CRC, Holly L. Mincey, RN BSN, Greg Muthig, BS, Sara Stacey, BA, Jean J. Steichen, MD, Stacey Tepe, BS, Julia Thompson, RN BSN, Sandra Wuertz, RN BSN CLC, C. Michael Cotten, MD, MHS, Ronald N. Goldberg, MD, Ricki F. Goldstein, MD, William F. Malcolm, MD, Deesha Mago-Shah, MD, Patricia L. Ashley, MD, PhD, Joanne Finkle, RN JD, Kathy J. Auten, MSHS, Kimberley A. Fisher, PhD FNP-BC IBCLC, Sandra Grimes, RN BSN, Kathryn E. Gustafson, PhD, Melody B. Lohmeyer, RN MSN, Matthew M. Laughon, MD, MPH, Carl L. Bose, MD, Janice Bernhardt, MS RN, Gennie Bose, RN, Cindy Clark, RN, Jennifer Talbert, MS RN, Diane Warner, MD, MPH, Andrea Trembath, MD, MPH, T. Michael O'Shea, MD, MPH, Janice Wereszczak, CPNP-AC/PC, Stephen D. Kicklighter, MD, Ginger Rhodes-Ryan, ARNP MSN NNP-BC, Donna White, BSN RN-BC, Ravi M. Patel, MD, MSc, David P. Carlton, MD, Barbara J. Stoll, MD, Ellen C. Hale, RN BS CCRC, Yvonne C. Loggins, RN BSN, Ira Adams-Chapman, MD MPH : deceased, Ann Blackwelder, RN MN, Diane I. Bottcher, RN MSN, Sheena L. Carter, PhD, Salathiel Kendrick-Allwood, MD, Judith Laursen, RN, Maureen Mulligan LaRossa, RN, Colleen Mackie, BS RT, Amy Sanders, PsyD, Irma Seabrook, RRT, Gloria Smikle, PNP MSN, Lynn C. Wineski, RN MS, Rosemary D. Higgins, MD, Andrew A. Bremer, MD PhD, Stephanie Wilson Archer, MA, Gregory M. Sokol, MD, Brenda B. Poindexter, MD, MS, Anna M. Dusick, MD FAAP : deceased, Lu Ann Papile, MD, Susan Gunn, NNP CCRC, Faithe Hamer, BS, Heidi M. Harmon, MD, MS, Dianne E. Herron, RN CCRC, Abbey C. Hines, PsyD, Carolyn Lytle, MD, MPH, Lucy C. Miller, RN BSN CCRC, Heike M. Minnich, PsyD HSPP, Leslie Richard, RN, Lucy Smiley, CCRC, Leslie Dawn Wilson, BSN CCRC, Jon E. Tyson, MD, MPH, Kathleen A. Kennedy, MD, MPH, Amir M. Khan, MD, Barbara J. Stoll, MD, Andrea Duncan, MD, MS, Ricardo Mosquera, MD, Emily K. Stephens, BSN RNC-NIC, Georgia E. McDavid, RN, Nora I. Alaniz, BS, Elizabeth Allain, MS, Julie Arldt-McAlister, RN BSN, Katrina Burson, RN BSN, Allison G. Dempsey, PhD, Elizabeth Eason, MD, Patricia W. Evans, MD, Carmen Garcia, RN CCRP, Charles Green, PhD, Donna Hall, RN, Beverly Foley Harris, RN BSN, Margarita Jiminez, MD, MPH, Janice John, CPNP, Patrick M. Jones, MD, MA, M. Layne Lillie, RN BSN, Anna E. Lis, RN BSN, Karen Martin, RN, Sara C. Martin, RN BSN, Carrie M. Mason, MA LPA, Shannon McKee, EdS, Brenda H. Morris, MD, Kimberly Rennie, PhD, Shawna Rodgers, RN BSN, Saba Khan Siddiki, MD, Maegan C. Simmons, RN, Daniel Sperry, RN, Patti L. Pierce Tate, RCP, Sharon L. Wright, MT (ASCP), Pablo J. Sánchez, MD, Leif D. Nelin, MD, Sudarshan R. Jadcherla, MD, Jonathan L. Slaughter, MD, MPH, Keith O. Yeates, PhD, ABPP/CN, Sarah Keim, PhD, MA, MS, Nathalie L. Maitre, MD, PhD, Christopher J. Timan, MD, Patricia Luzader, RN, Erna Clark, BA, Christine A. Fortney, PhD RN, Julie Gutentag, RN, Courtney Park, RN, Julie Shadd, BS, RD, LD, Margaret Sullivan, BA, Melanie Stein, BBA RRT, Mary Ann Nelin, MD, Julia Newton, MPH, Kristi Small, BS, Stephanie Burkhardt, BS, MPH, Jessica Purnell, BS, CCRC, Lindsay Pietruszewski, PT, DPT, Katelyn Levengood, PT, DPT, Nancy Batterson, OT/L, SCFES, CLC, Pamela Morehead, CRC, Helen Carey, PT, DHSc, Lina Yoseff-Salameh, MD, Rox Ann Sullivan, RN, BSN, Cole Hague, BA, MS, Jennifer Grothause, RN, BSN, Erin Fearns, Aubrey Fowler, BS, Jennifer Notestine, RN, Jill Tonneman, OTR/L, BCP, Krystal Hay, DPT, Margaret Sullivan, BS, Michelle Chao, BS, Kyrstin Warnimont, BS, Laura Marzec, MD, Bethany Miller, RN, BSN, Demi R. Beckford, MHS, Hallie Baugher, BS, MSN, Brittany DeSantis, BS, Cory Hanlon, BS, Jacqueline McCool, Abhik Das, PhD, Marie G. Gantz, PhD, Carla M. Bann, PhD, Dennis Wallace, PhD, Margaret M. Crawford, BS CCRP, Jenna Gabrio, MPH CCRP, David Leblond, BS, Jamie E. Newman, PhD, MPH, Carolyn M. Petrie Huitema, MS CCRP, Jeanette O'Donnell Auman, BS, W. Kenneth Poole, PhD : deceased, Kristin M. Zaterka-Baxter, RN BSN CCRP, Krisa P. Van Meurs, MD, Valerie Y. Chock, MD MS Epi, David K. Stevenson, MD, Marian M. Adams, MD, M. Bethany Ball, BS CCRC, Barbara Bentley, PhD, Elizabeth Bruno, PhD, Alexis S. Davis, MD MS Epi, Maria Elena DeAnda, PhD, Anne M. DeBattista, RN PNP-C PhD, Lynne C. Huffman, MD, Magdy Ismael, MD, MPH, Jean G. Kohn, MD, MPH, Casey Krueger, PhD, Janice Lowe, MD, Ryan E. Lucash, PhD, Andrew W. Palmquist, RN BSN, Jessica Patel, PhD, Melinda S. Proud, RCP, Elizabeth N. Reichert, MA CCRC, Nicholas H. St. John, PhD, Dharshi Sivakumar, MD, Heather L. Taylor, PhD, Natalie Wager, PsyD, R. Jordan Williams, BA, Hali Weiss, MD, Ivan D. Frantz, MD, John M. Fiascone, MD, Elisabeth C. McGowan, MD, Brenda L. MacKinnon, RNC, Anne Furey, MPH, Ellen Nylen, RN BSN, Paige T. Church, MD, Cecelia E. Sibley, MHA PT, Ana K. Brussa, MS OTR/L, Waldemar A. Carlo, MD, Namasivayam Ambalavanan, MD, Myriam Peralta-Carcelen, MD, MPH, Kathleen G. Nelson, MD, Kirstin J. Bailey, PhD, Fred J. Biasini, PhD : deceased, Stephanie A. Chopko, PhD, Monica V. Collins, RN BSN MaEd, Shirley S. Cosby, RN BSN, Kristen C. Johnston, MSN CRNP, Mary Beth Moses, PT MS PCS, Cryshelle S. Patterson, PhD, Vivien A. Phillips, RN BSN, Julie Preskitt, MSOT MPH, Richard V. Rector, PhD, Sally Whitley, MA OTR-L FAOTA, Uday Devaskar, MD, Meena Garg, MD, Isabell B. Purdy, PhD CPNP, Teresa Chanlaw, MPH, Rachel Geller, RN BSN, Neil N. Finer, MD, Yvonne E. Vaucher, MD, MPH, David Kaegi, MD, Maynard R. Rasmussen, MD, Kathy Arnell, RNC, Clarence Demetrio, RN, Martha G. Fuller, PhD RN MSN, Wade Rich, BSHS RRT, Edward F. Bell, MD, Tarah T. Colaizy, MD, MPH, John A. Widness, MD, Heidi M. Harmon, MD, MS, Jane E. Brumbaugh, MD, Michael J. Acarregui, MD, MBA, Karen J. Johnson, RN BSN, Diane L. Eastman, RN CPNP MA, Claire A. Goeke, RN, Mendi L. Schmelzel, MSN RN, Jacky R. Walker, RN, Michelle L. Baack, MD, Laurie A. Hogden, MD, Megan Broadbent, RN BSN, Chelsey Elenkiwich, RN BSN, Megan M. Henning, RN, Sarah Van Muyden, BSN RN, Dan L. Ellsbury, MD, Donia B. Campbell, RNC-NIC, Tracy L. Tud, RN, Shahnaz Duara, MD, Charles R. Bauer, MD, Ruth Everett-Thomas, RN MSN, Sylvia Fajardo-Hiriart, MD, Arielle Rigaud, MD, Maria Calejo, MS, Silvia M. Frade Eguaras, MA, Michelle Harwood Berkowits, PhD, Andrea Garcia, MS, Helina Pierre, BA, Alexandra Stoerger, BA, Kristi L. Watterberg, MD, Janell Fuller, MD, Robin K. Ohls, MD, Sandra Sundquist Beauman, MSN RNC-NIC, Conra Backstrom Lacy, RN, Andrea F. Duncan, MD MScr, Mary Hanson, RN BSN, Carol Hartenberger, MPH RN, Elizabeth Kuan, RN BSN, Jean R. Lowe, PhD, Rebecca A. Thomson, RN BSN, Sara B. DeMauro, MD MSCE, Eric C. Eichenwald, MD, Barbara Schmidt, MD MSc, Haresh Kirpalani, MB MSc, Aasma S. Chaudhary, BS RRT, Soraya Abbasi, MD, Toni Mancini, RN BSN CCRC, Christine Catts, CRNP, Noah Cook, MD, Dara M. Cucinotta, RN, Judy C. Bernbaum, MD, Marsha Gerdes, PhD, Sarvin Ghavam, MD, Hallam Hurt, MD, Jonathan Snyder, RN BSN RN, Saritha Vangala, RN MSN, Kristina Ziolkowski, CMA(AAMA) CCRP, Carl T. D'Angio, MD, Dale L. Phelps, MD, Ronnie Guillet, MD, PhD, Gary J. Myers, MD, Michelle Andrews-Hartley, MD, Julie Babish Johnson, MSW, Kyle Binion, BS, Melissa Bowman, RN NP, Elizabeth Boylin, BA, Erica Burnell, RN, Kelly R. Coleman, PsyD, Cait Fallone, MA, Osman Farooq, MD, Julianne Hunn, BS, Diane Hust, MS RN CS, Rosemary L. Jensen, Rachel Jones, Jennifer Kachelmeyer, BS, Emily Kushner, MA, Deanna Maffett, RN, Kimberly G. McKee, MPH, Joan Merzbach, LMSW, Gary J. Myers, MD, Constance Orme, Diane Prinzing, Linda J. Reubens, RN CCRC, Daisy Rochez, BS MHA, Mary Rowan, RN, Premini Sabaratnam, MPH, Ann Marie Scorsone, MS CCRC, Holly I.M. Wadkins, MA, Kelley Yost, PhD, Lauren Zwetsch, RN MS PNP, Satyan Lakshminrusimha, MD, Anne Marie Reynolds, MD MPH, Michael G. Sacilowski, MAT CCRC, Stephanie Guilford, BS, Emily Li, BA, Ashley Williams, MSEd, William A. Zorn, PhD, Myra H. Wyckoff, MD, Luc P. Brion, MD, Pablo J. Sánchez, MD, Walid A. Salhab, MD, Charles R. Rosenfeld, MD, Roy J. Heyne, MD, Diana M. Vasil, MSN BSN RNC-NIC, Sally S. Adams, MS RN CPNP, Lijun Chen, PhD RN, Maria M. De Leon, RN BSN, Francis Eubanks, RN BSN, Alicia Guzman, Gaynelle Hensley, RN, Elizabeth T. Heyne, MS MA PA-C PsyD, Lizette E. Lee, RN, Melissa H. Leps, RN, Linda A. Madden, BSN RN CPNP, E. Rebecca McDougald, MSN APRN CPNP-PC/AC, Nancy A. Miller, RN, Janet S. Morgan, RN, Lara Pavageau, MD, Pollieanna Sepulveda, RN, Kristine Tolentino-Plata, MS, Cathy Twell Boatman, MS CIMI, Azucena Vera, AS, Jillian Waterbury, DNP RN CPAP-PC, Bradley A. Yoder, MD, Mariana Baserga, MD MSCI, Roger G. Faix, MD, Sarah Winter, MD, Stephen D. Minton, MD, Mark J. Sheffield, MD, Carrie A. Rau, RN BSN CCRC, Shawna Baker, RN, Karie Bird, RN BSN, Jill Burnett, RNC BSN, Susan Christensen, RNC BSN, Laura Cole-Bledsoe, RN, Brandy Davis, RN BSN, Jennifer O. Elmont, RN BSN, Jennifer J. Jensen, RN BSN, Manndi C. Loertscher, BS CCRP, Jamie Jordan, RN BSN, Trisha Marchant, RN BSN, Earl Maxson, BSN, Kandace M. McGrath, BS, Karen A. Osborne, RN BSN CCRC, D. Melody Parry, RN BSN, Brixen A. Reich, MSN RNC CCRC, Susan T. Schaefer, RRT RN BSN, Cynthia Spencer, RNC BSN, Michael Steffen, PhD, Katherine Tice, RN BSN, Kimberlee Weaver-Lewis, RN MS, Kathryn D. Woodbury, RN BSN, Karen Zanetti, RN, T. Michael O'Shea, MD MPH, Robert G. Dillard, MD, Lisa K. Washburn, MD, Barbara G. Jackson, RN, BSN, Nancy Peters, RN, Korinne Chiu, MA, Deborah Evans Allred, MA LPA, Donald J. Goldstein, PhD, Raquel Halfond, MA, Carroll Peterson, MA, Ellen L. Waldrep, MS, Cherrie D. Welch, MD MPH, Melissa Whalen Morris, MA, Gail Wiley Hounshell, PhD, Seetha Shankaran, MD, Beena G. Sood, MD MS, Girija Natarajan, MD, Athina Pappas, MD, Katherine Abramczyk, Prashant Agarwal, MD, Monika Bajaj, MD, Rebecca Bara, RN BSN, Elizabeth Billian, RN MBA, Sanjay Chawla, MD, Kirsten Childs, RN BSN, Lilia C. De Jesus, MD, Debra Driscoll, RN BSN, Melissa February, MD, Laura A. Goldston, MA, Mary E. Johnson, RN BSN, Geraldine Muran, RN BSN, Bogdan Panaitescu, MD, Jeannette E. Prentiss, MD, Diane White, RT, Eunice Woldt, RN MSN, John Barks, MD, Stephanie A. Wiggins, MS, Mary K. Christensen, BA RRT, Martha D. Carlson, MD PhD, Richard A. Ehrenkranz, MD, Harris Jacobs, MD, Christine G. Butler, MD, Patricia Cervone, RN, Sheila Greisman, RN, Monica Konstantino, RN BSN, JoAnn Poulsen, RN, Janet Taft, RN BSN, Joanne Williams, RN BSN, Elaine Romano, MSN
1 Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
2 Department of Pediatrics, Women & Infants Hospital of Rhode Island, Warren Albert Medical School of Brown University, Providence, RI
3 Department of Pediatrics, University of Iowa, Iowa City, IA
4 Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
5 Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
6 Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
7 Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA
∗Reprint requests: Jane E. Brumbaugh, MD, Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905Department of Pediatric and Adolescent MedicineMayo Clinic200 First Street SWRochesterMN55905
Abstract |
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.
Le texte complet de cet article est disponible en PDF.Keywords : premature, discharge, neurodevelopment, education, insurance, race
Abbreviations : Bayley-III, BPD, CL, ICH, NDI, NEC, NRN, PMA, ROP, SDOH
Plan
| 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. |
© 2023
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Vol 259
Article 113443- août 2023 Retour au numéro
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