488 - Child Opportunity Index and early childhood outcomes in a prospective preterm cohort

Poster Number: 488
Publication Number: 488.1577

Background: Preterm infants are at risk of brain injury and adverse neurodevelopmental outcomes. Examining the Child Opportunity Index (COI) in early childhood may allow identification of specific interventions to improve health in this population. The COI is comprised of 29 neighborhood characteristics in three subdomains: education, health/environment, and social/economic.

Objective: To evaluate the associations between COI and 2.5-year neurodevelopmental outcomes in preterm infants < 32 weeks gestational age (wGA).

Design/Methods: This is a secondary analysis on a prospective single-center cohort of preterm infants < 32 wGA born in 2011-2017 and imaged in the neonatal period with 3T MRI. Severe brain injury (SBI) was defined as intraventricular hemorrhage (grades 3 or 4) and/or moderate-severe white matter injury. The COI, a scale between 1-100 with a median of 50, ranks neighborhood resources and conditions nationally, with 1 representing least opportunity. Zip code in the first year of life were used to determine overall COI and COI subdomains. The relationship between COI and Bayley-III scores at 2.5 years of age was evaluated using linear regression adjusted for maternal and neonatal factors.

Results: In this cohort of 108 infants, 101 had at least one neonatal MRI and 3 died prior to follow-up. 2.5-year outcomes were available for 62/98 (62%) infants but for one child zip code was unknown, leaving 61 subjects for analysis. Distribution of COI is shown in Figure 1. The median GA was 27.7w (IQR 25.7-30.3w) and median birthweight was 1000 g (IQR 730-1190). 61 infants had a first MRI at a median postmenstrual age (PMA) of 33.4w (IQR 31.8-35) and 32 infants had a second MRI at a median PMA of 35.8w (IQR 35.1-36.8). 8 infants had SBI identified in at least one MRI scan. Proportion of children with above median COI did not significantly differ between those who did or did not attend 2.5-year follow-up (p=0.47). In multivariate regression models, overall COI was independently associated with Bayley cognitive scores but not motor nor language scores (Figure 2, Table 2). The COI education subdomain was independently associated with cognitive scores while the environment and economic domains were not.

Conclusion(s): Neighborhood opportunity level in the first year of life is more strongly associated with cognitive scores in early childhood independent of severe brain injury in this cohort of preterm infants. Education opportunities appear to drive this association, highlighting the potential for targeted interventions to improve health equity in this high-risk population.