High-Risk Infant Developmental Outcome Is Associated with Medical Complexity and Neighborhood Opportunity

Emily N Yeo; Nathan D Young; Joseph C Cleveland 3rd; Tamara D Simon; Douglas L Vanderbilt; Juan Espinoza; Christine B Mirzaian; Tanya L Alderete

doi:10.1016/j.jpeds.2024.114433

High-Risk Infant Developmental Outcome Is Associated with Medical Complexity and Neighborhood Opportunity

J Pediatr. 2024 Dec 11:114433. doi: 10.1016/j.jpeds.2024.114433. Online ahead of print.

Authors

Emily N Yeo¹, Nathan D Young², Joseph C Cleveland 3rd³, Tamara D Simon⁴, Douglas L Vanderbilt⁵, Juan Espinoza⁶, Christine B Mirzaian⁷, Tanya L Alderete⁸

Affiliations

¹ Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA.
² Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
³ University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁴ Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, CA, USA; Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, CA.
⁵ Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, CA, USA; Division of Developmental-Behavioral Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USC.
⁶ Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁷ Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, CA, USA; Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA. Electronic address: [email protected].
⁸ Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: [email protected].

PMID: 39672373
DOI: 10.1016/j.jpeds.2024.114433

Abstract

Objective: To assess how medical complexity and neighborhood opportunity jointly affect cognitive, motor, and language Bayley's Scales of Infant Development. Secondary objectives involved identifying the factors contributing to developmental disparities across diverse racial and ethnic groups.

Study design: Electronic health records from a Southern California high-risk infant follow-up clinic were analyzed for 440 infants from 2014 through 2023 who had either had neonatal intensive care unit stays, prematurity, very low birthweight, or developmental delay risk. Medical complexity was categorized using the Pediatric Medical Complexity Algorithm (PMCA) into complex chronic (CC), noncomplex chronic (NCC), or non-chronic (NC). Neighborhood opportunity was assessed using the Child Opportunity Index 2.0 (COI). Developmental progress was tracked from ages 4 to 35.6 months.

Results: Of the cohort, 56% were male, and 67% were born prematurely, with 143 NC, 115 NCC, and 182 CC cases. Developmental scores showed a progressive decline with increased medical complexity. CC infants had lower cognitive (β= -15.20, p<0.001, 95% CI: -18.75, -11.7), motor (β= -20.50, p<0.001, 95% CI: -24.25, -16.8), and language scores (β=-11.88, p<0.001, 95% CI = -15.13 to -8.6) compared with NC infants. Lower COI was linked with decreased language scores (β= -0.07, p = 0.005, 95% CI: 0.01, 0.12) but not cognitive or motor scores.

Conclusions: In high-risk infants, the adverse effects of medical complexities on developmental outcomes exceeded those of prematurity and additionally varied according to child neighborhood opportunity.