26 - Can maternal Social Determinants of Health predict missed developmental testing at two year of age for premature infants discharged from the NICU?

Publication Number: 4025.26

Alyson N. Brown, Cleveland Clinic Children's, Cleveland Heights, OH, United States; Maitri Shah, Cleveland Clinic Children's, Cleveland, OH, United States; Emman Dabaja, Cleveland Clinic Children's, Cleveland, OH, United States; HANY ALY, Cleveland Clinic Children's Hospital, Cleveland, OH, United States; Anirudha Das, Cleveland Clinic Children's, Lakewood, OH, United States

Background: Developmental testing at 18-24 months of age is essential for early identification and diagnosis of developmental delays or impairments across multiple domains, which is crucial for initiating timely and targeted interventions. It is known that Social Determinants of Health (SDOH), such as race, socioeconomic status, and access to transportation, influence follow-up after NICU discharge. Understanding how these factors are associated with missed developmental testing can help guide targeted strategies to improve retention and promote equitable outcomes for high-risk infants.

Objective: To assess SDOH factors that predict missed Bayley Scales of Infant and Toddler Development (BSID IV) at 18-24 months of age in very premature infants.

Design/Methods: In this retrospective cohort study, infants of gestational age of < 32 weeks (very preterm) discharged from a large tertiary care NICU were divided into two groups: mother/infant dyads compliant with 2-year Bayley testing appointments (Group A) and dyads who did not attend the 2-year Bayley testing (Group B). Analyses were conducted using JMP Student Edition 18, using Chi square tests for categorical data, Wilcoxon rank-sum tests for continuous nonparametric data, and logistic regression for predictive modeling.

Results: Out of the 432 mother/baby dyads assessed in a single large tertiary healthcare system, only 195 (45.1%) very preterm infants completed the developmental testing at 18-24 months of age. Infants of mothers who were not married and of Black race were significantly associated with a lower rate of completion of the two-year BSID-IV developmental testing. No significant differences were found between the groups in terms of gestational age, birth weight, maternal age, maternal smoking, or positive drug screen results.
After adjusting for gestational age, the mean 2-year Bayley cognitive score was significantly higher in infants of mothers of White race (100.5±15.29) compared to those of Black race (95.83±15.83) (p=0.042). The mean 2-year BSID-IV language score was also significantly higher in infants of maternal White race compared to Black (99.33±12.04 vs 93.06±15.69, p< 0.030) and similarly for Bayley motor score (100.1±11.57 in White vs 94.5±15.25 in Blacks, p< 0.0423).

Conclusion(s): In terms of SDOH factors in very preterm infants discharged from the NICU, unmarried mother and Black race were predictive of a significantly lower rate of completion of the 18-24 month Bayley Developmental testing. The cognitive, language, and motor scores on the BSID IV scale were significantly higher in infants of White race after adjusting for gestational age.

Table 1
Demographic differences between Group A (subjects completed the Bayley testing at 18-24 months) and Group B (did not complete the developmental testing)