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Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Perinatal outcomes in neonates referred to social services in a tertiary neonatal intensive care unit from a
Nazan Neslihan Dogan Kocabıyık1, Ozgul Salihoglu1
1Bakırkoy Dr. Sadi Konuk Training Research Center, Department of Pediatrics, Division of Neonatology, University of Health Sciences, Istanbul, Türkiye.
Insights
Neonatal intensive care unit (NICU) infants needing social services often have mothers with poor antenatal care, anemia, and substance use. Early screening and collaboration can improve outcomes for these vulnerable newborns.
Area of Science:
- Neonatalogy
- Social Determinants of Health
- Public Health
Background:
- Social vulnerability and determinants of health significantly impact perinatal and neonatal outcomes.
- Limited data exist on integrated maternal, neonatal, and social risk factors for infants requiring social services in the NICU, particularly in resource-limited settings.
Purpose of the Study:
- To investigate maternal, neonatal, and social risk factors associated with social-service referral in neonates hospitalized in the NICU.
- To identify predictors of social-service referral among a vulnerable NICU population.
Main Methods:
- Retrospective cohort study of neonates referred to social services versus a comparison group.
- Data extracted from electronic medical records and social-service notes, including maternal, neonatal, and social variables.
- Logistic regression analysis to identify independent predictors of referral.
Main Results:
- Referred infants had mothers with higher rates of adolescent pregnancy, unmarried status, inadequate antenatal care, anemia, and substance use.
- Referred infants experienced lower APGAR scores, higher rates of low birth weight, neurological diagnoses, bronchopulmonary dysplasia, hearing impairment, and prolonged hospitalization.
- Lack of legal marriage, absence of antenatal care, lower maternal hemoglobin, lower neonatal TSH, and longer hospitalization were independent predictors of referral.
Conclusions:
- NICU infants referred to social services represent a vulnerable population with identifiable maternal and neonatal risk factors.
- Early social-risk screening during antenatal care and enhanced multidisciplinary collaboration are crucial for improving outcomes in high-risk families.
Background:
Beyond medical complexity, social determinants of health and social vulnerability have emerged as factors shaping perinatal and neonatal outcomes among socially vulnerable families in neonatal intensive care units. However, data integrating maternal, neonatal, and social risk factors among infants requiring social-service referral during neonatal intensive care unit (NICU) hospitalization remain limited, especially in resource-limited settings.
Study Design:
A retrospective cohort study was conducted including all neonates who received a formal social-service consultation between January 2020 and December 2024, and a comparison group of infants hospitalized without referral.
Methods:
Data were extracted from electronic medical records and social-service notes. Maternal variables included age, marital status, antenatal visit frequency, prenatal testing, smoking or substance use, hematologic parameters, and antenatal corticosteroid administration. Neonatal variables included birth weight, gestational age, APGAR scores, NICU diagnoses, prematurity-related morbidities, respiratory support, thyroid function tests, hearing-screening results, and hospitalization duration. Social-service notifications were categorized as legal/judicial reasons, parental psychosocial or functional challenges, parental care risks, and socioeconomic vulnerabilities. Group comparisons used t-tests, Mann-Whitney U tests, and χ 2/Fisher's exact tests. Logistic regression identified independent predictors of referral.
Results:
A total of 193 neonates were assessed. Referred infants (n = 96) were born to younger mothers with significantly higher rates of adolescent pregnancy, unmarried status, inadequate antenatal care, lower maternal hemoglobin levels, and higher smoking/substance use. Referred infants had lower 5-min APGAR scores and higher rates of low birth weight, neurological diagnoses, bronchopulmonary dysplasia, abnormal thyroid function, prolonged hospitalization, and bilateral or unilateral hearing-screen failure. Mortality was significantly higher in the referred group. In multivariate analysis, lack of legal marriage (OR: 0.05), absence of antenatal care (OR: 0.12), lower maternal hemoglobin (OR: 0.41), lower neonatal TSH levels (OR: 0.75), and longer hospitalization (OR: 1.07) remained independent predictors of social-service referral. Non-Turkish nationality was significant in univariate analysis but not in the adjusted model.
Conclusion:
Infants referred to social services in the NICU represent a distinctly vulnerable population characterized by inadequate maternal antenatal care, unmarried status, maternal anemia, and substance exposure. Integrating early social-risk screening into routine antenatal care and strengthening multidisciplinary perinatal-social collaboration may improve outcomes in high-risk families.
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