Neighborhood deprivation and association with 18-month neurodevelopmental impairment of preterm infants born in a dense urban setting.

Abstract

Background: Neighborhood adversity's impact on 18-month neurodevelopmental impairment (NDI) is not well-described. The aim of our study was to determine whether area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, at birth is associated with 18-month NDI of preterm infants born in dense urban setting.

Methods: A retrospective case-cohort study was performed in infants born at 23-32 weeks gestational age (GA) with birth weight (BW) ≤1250 g between 2013 and 2017 and evaluated for NDI at 18-month corrected age (CA). Socioeconomic deprivation was computed geospatially using subject addresses that were mapped to national ADI rankings. Subjects were categorized as low (<26^th percentile) or high (26-100^th percentile) ADI neighborhoods and with/without NDI if any of Bayley-III cognition, language, or motor composite scores were <70. The relationship between ADI and NDI was analyzed using logistic regression adjusted for GA and BW and group comparisons were made.

Results: Data were available in 119 patients (GA = 27.2 ± 2.2 weeks, BW = 870 ± 246 g). Children with NDI at 18-month CA were born at an earlier GA (p < .001) with lower BW (p < .03) and to mothers living in high ADI neighborhoods (p < .02). Patients from lower ADI neighborhoods at birth had higher Bayley-III cognition (p < .0001), language (p < .005), and motor (p = .03) composite scores at 18-month CA. Cognition (p < .01), language (p < .003) and motor (p < .03) composite scores decreased with increasing ADI percentiles.

Conclusions: Among infants born 23-32 weeks GA in a dense urban setting, ADI at birth is associated with NDI at 18 months with lower cognitive, language, and motor scores in preterm infants from higher ADI neighborhoods.