Division of Neonatal Medicine, Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Women and Infants Hospital, Providence, RI.
Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI.
J Pediatr. 2022 Jun;245:65-71. doi: 10.1016/j.jpeds.2022.01.042. Epub 2022 Feb 2.
To study the association between neighborhood risk and moderate to severe neurodevelopmental impairment (NDI) at 22-26 months corrected age in children born at <34 weeks of gestation. We hypothesized that infants born preterm living in high-risk neighborhoods would have a greater risk of NDI and cognitive, motor, and language delays.
We studied a retrospective cohort of 1291 infants born preterm between 2005 and 2016, excluding infants with congenital anomalies. NDI was defined as any one of the following: a Bayley Scales of Infant and Toddler Development-III Cognitive or Motor composite score <85, bilateral blindness, bilateral hearing impairment, or moderate-severe cerebral palsy. Maternal addresses were geocoded to identify census block groups and create high-risk versus low-risk neighborhood groups. Bivariate and regression analyses were run to assess the impact of neighborhood risk on outcomes.
Infants from high-risk (n = 538; 42%) and low-risk (n = 753; 58%) neighborhoods were compared. In bivariate analyses, the risk of NDI and cognitive, motor, and language delays was greater in high-risk neighborhoods. In adjusted regression models, the risks of NDI (OR, 1.43; 95% CI, 1.04-1.98), cognitive delay (OR, 1.62; 95% CI, 1.15-2.28), and language delay (OR, 1.58; 95% CI, 1.15-2.16) were greater in high-risk neighborhoods. Breast milk at discharge was more common in low-risk neighborhoods and was protective of NDI in regression analysis.
High neighborhood risk provides an independent contribution to preterm adverse NDI, cognitive, and language outcomes. In addition, breast milk at discharge was protective. Knowledge of neighborhood risk may inform the targeted implementation of programs for socially disadvantaged infants.
研究 34 周以下早产儿在 22-26 个月校正年龄时，邻里风险与中重度神经发育障碍（NDI）之间的关系。我们假设，居住在高风险社区的早产儿婴儿发生 NDI 及认知、运动和语言发育迟缓的风险更大。
我们对 2005 年至 2016 年间出生的 1291 名早产儿进行了回顾性队列研究，排除了患有先天性异常的婴儿。NDI 定义为以下任何一种情况：贝利婴幼儿发育量表-III 认知或运动综合评分<85、双侧失明、双侧听力障碍或中重度脑瘫。将母亲的地址进行地理编码，以确定普查区组，并创建高风险和低风险邻里组。进行了双变量和回归分析，以评估邻里风险对结局的影响。
比较了来自高风险（n=538；42%）和低风险（n=753；58%）社区的婴儿。在双变量分析中，高风险社区的 NDI 及认知、运动和语言发育迟缓的风险更大。在调整后的回归模型中，NDI（OR，1.43；95% CI，1.04-1.98）、认知障碍（OR，1.62；95% CI，1.15-2.28）和语言发育迟缓（OR，1.58；95% CI，1.15-2.16）的风险在高风险社区更高。出院时母乳喂养在低风险社区更常见，且在回归分析中对 NDI 具有保护作用。
高邻里风险对早产儿不良 NDI、认知和语言结局有独立影响。此外，出院时母乳喂养具有保护作用。邻里风险的相关知识可能有助于针对社会弱势群体婴儿实施相关项目。
