264 - Neurodevelopmental Outcomes of Neonates with Hypoxic-Ischemic Encephalopathy: The Role of Neighborhood Disadvantage

Poster Number: 264
Publication Number: 264.2170

Background: Despite the improved neurodevelopmental outcomes in high-risk NICU graduates associated with receipt of services at high-risk infant clinics following NICU discharge, follow-up rates are low for several reasons. Individual and family-level factors have been shown to impact follow-up care of neonates surviving hypoxic-ischemic encephalopathy (HIE). However, there is a lack of literature examining how neighborhood characteristics affect neurodevelopmental outcomes of children with a history of neonatal HIE.

Objective: Our aim was to elucidate the relationship between neighborhood disadvantage and neurodevelopmental outcomes of neonates who survived HIE.

Design/Methods: 57 infants with moderate to severe HIE who underwent therapeutic hypothermia (TH) were enrolled between 2010 and 2015. Using electronic medical records, we obtained clinical and sociodemographic characteristics including birth anthropometrics, gestational age, sex, cord pH, base deficit, Apgar scores at 1 and 5 minutes, brain MRI NICHD scores, peak creatinine and alanine transaminase levels. To quantify neighborhood disadvantage, we used the Area Deprivation Index (ADI), a well-validated metric including domains of income, education, employment and housing quality. We used Capute and Mullen scores, and Gross Motor Function Classification System to assess cognitive and motor outcomes respectively at 24 months. Logistic regressions were performed to assess differences in cognitive outcomes and overall neurodevelopment by ADI quartiles adjusted for MRI grade.

Results: Among infants with HIE treated with TH, ADI scores were associated with cognitive outcomes at 24 months and ADI scores. Infants residing in areas with the highest ADI scores (reflecting the greatest neighborhood disadvantage) had significantly greater odds of moderate and severe cognitive disability compared to those with the lowest ADI scores (reflecting the least neighborhood disadvantage), when compared to national and state rankings (OR 29.43, p = 0.013 and OR 16.03, p = 0.043 respectively), after adjusting for MRI NICHD grade. There were significantly higher odds of combined cognitive and motor disability in infants living in areas with higher ADI scores, even after adjusting for severity of MRI grade.

Conclusion(s): For the first time, we show that neighborhood disadvantage has a detrimental impact on neurodevelopmental outcomes of infants surviving HIE. Further research elucidating the role of contributory factors will allow for identification of populations most at risk and aid the development of evidence-based, targeted interventions to improve long-term outcomes.