461 - The Impact of Neighborhood Disadvantage on High-Risk Infant Follow-Up Attendance and Early Developmental Outcomes

Publication Number: 4452.461

Jamie M. Klapp, University of California, San Diego School of Medicine, San Diego, CA, United States; Nana Matoba, University of California, San Diego School of Medicine, San Diego, CA, United States; Carolyn Sawyer, University of California, San Diego School of Medicine, San Diego, CA, United States

Background: High-risk infant follow-up (HRIF) clinics are important for developmental monitoring and optimizing outcomes after NICU discharge, yet attendance rates remain low, particularly among socioeconomically disadvantaged families. Prior studies suggest that socioeconomic disparities may contribute to poorer developmental outcomes at follow-up.

Objective: We aimed to: (1) examine the effect of neighborhood socioeconomic disadvantage on attendance at follow-up, and (2) assess the relationship between socioeconomic disadvantage and developmental outcomes at the first follow-up visit.

Design/Methods: We conducted a retrospective cohort study of all infants referred to our NICU follow-up clinic at University of California San Diego from 2014–2022. We excluded patients who did not have address data available. Maternal and infant demographics and NICU clinical variables were collected. Socioeconomic disadvantage was assessed with Childhood Opportunity Index (COI). Primary outcome was attendance at the first follow-up visit. Secondary outcomes included attendance at subsequent visits, and developmental outcomes at the first visit, assessed using the Bayley III Screening Test. Scores were dichotomized as “competent” or “at risk for delay” across all developmental domains. Demographics were compared between attendees and non-attendees using Chi-square test, and outcomes by disadvantage were compared using Kruskal-Wallis test.

Results: Of 729 infants referred to NICU follow-up clinic, 391 (53.6%) attended at least one visit. A total of 180 (24.6%) attended a second visit, and 58 (7.9%) attended all 3 recommended visits. Attendees had significantly lower gestational age (p < 0.05) and lower birth weight (p < 0.001). Attendance differed by race, primary language, and insurance status (p < 0.001 for all). Non-attendees had significantly lower COI scores across all domains (p < 0.001). Bayley III Screening Test cognitive risk category varied significantly across COI groups (p < 0.05), while there was no difference in motor or language risk categories based on neighborhood disadvantage.

Conclusion(s): Neighborhood socioeconomic disadvantage was strongly associated with non-attendance at NICU follow-up. At initial follow-up visit, risk for cognitive delay, but not language or motor delay, varied by neighborhood disadvantage. These findings suggest the need to identify specific neighborhood-level factors that could inform targeted interventions. Further research is needed to understand the impact of neighborhood disadvantage on long-term developmental outcomes.

Table 1
9286A8D7-A0BA-460C-A86A-9B879A7D3984.jpegComparing clinical and demographic characteristics among those who did and did not attend first NICU follow-up clinic appointment. COI=childhood opportunity index.

Table 2
BA1A12A4-631A-4D15-A3AA-FE84C5FBE07D.jpegAge and developmental outcomes at first follow-up visit across levels of childhood opportunity (COI).