Neighborhood Disadvantage and Early Respiratory Outcomes in Very Preterm Infants with Bronchopulmonary Dysplasia.

Abstract

OBJECTIVE\nTo investigate the impact of neighborhood conditions on respiratory-related hospital admissions in the first year after discharge from the neonatal unit in a population of infants born very preterm with bronchopulmonary dysplasia (BPD).\n\n\nSTUDY DESIGN\nVery preterm infants (gestational age (GA) <33 weeks) who had BPD at 36 weeks post-conceptional age and who received follow-up in a French regional medical network were included. Socioeconomic context was estimated using a neighborhood-based socioeconomic deprivation index. Poisson regression analysis was used to identify risk factors associated with rehospitalization.\n\n\nRESULTS\nThe study included 423 infants with a mean (SD) GA of 27±2 weeks and birth weight of 941±277 g; 51% of the population lived in disadvantaged areas. The hospital admission rates increased from 8.8% to 24% in infants living in affluent and disadvantaged areas, respectively (p < 0.01), and reached 30% in extremely preterm infants from disadvantaged areas. After adjusting for perinatal characteristics, home oxygen therapy and season of birth, the respiratory-related hospitalization rate was almost 3-fold higher in infants living in disadvantaged areas, with an adjusted incidence rate ratio (95% confidence interval) of 2.79 (95% CI, 1.29 - 6.09; P < .01).\n\n\nCONCLUSIONS\nDisadvantaged neighborhoods adversely impact early respiratory outcomes in infants born very preterm with BPD. The social context should be considered in routine follow-up care of children born preterm. Further studies investigating the underlying mechanisms are warranted for implementing preventive strategies.