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Published on: January 12, 2018
Neighborhood Opportunity and Early Life Indicators of Respiratory Health in Children Born Very Preterm
Ella M Whitman1,2, Marissa Hauptman3,4,5, Lystra P Hayden4,6
1Boston College Global Observatory on Planetary Health, Chestnut Hill, Massachusetts, USA.
Insights
Children in lower opportunity neighborhoods face greater risks for prematurity complications and longer mechanical ventilation (MV) durations. Addressing these disparities is crucial for improving long-term respiratory health in preterm infants.
Area of Science:
- Neonatal and developmental pediatrics
- Public health and epidemiology
- Respiratory medicine
Background:
- Bronchopulmonary dysplasia (BPD) is a primary complication of prematurity with lifelong respiratory consequences.
- The influence of childhood opportunity on BPD risk and post-discharge respiratory health is not well understood.
- Understanding these factors is critical for improving long-term outcomes in preterm infants.
Purpose of the Study:
- To investigate the association between childhood opportunity and the risk of developing BPD.
- To examine the impact of childhood opportunity on post-discharge respiratory health in very preterm infants.
- To identify potential racial disparities in respiratory outcomes related to neighborhood opportunity.
Main Methods:
- An observational cohort study included 845 infants born very preterm (≤32 weeks).
- Childhood Opportunity Index (COI) was derived from census tract data.
- Linear regression analyzed COI's impact on neonatal and childhood respiratory outcomes, with secondary analyses of racial differences.
Main Results:
- Lower COI was linked to smaller birth weight, earlier gestation, and longer mechanical ventilation (MV) in the NICU.
- No direct link was found between COI and long-term respiratory outcomes.
- Racial disparities in birth outcomes were amplified at higher COI levels.
- Prolonged MV correlated with increased hospital readmissions and reduced childhood lung function (FEV1, FVC).
Conclusions:
- Low childhood opportunity is associated with prolonged NICU mechanical ventilation, increasing healthcare use and impairing respiratory function.
- Significant racial disparities in birth outcomes persist across neighborhood opportunity levels.
- Targeted interventions are essential to promote health equity for vulnerable preterm infants.
Background:
Bronchopulmonary dysplasia (BPD) is the most common complication of prematurity, contributing to long term adverse respiratory outcomes that persist across the life course. However, it remains unclear how childhood opportunity impacts the underlying risk for developing BPD and post-discharge respiratory health, both of which may impact long term outcomes.
Methods:
Observational cohort of 845 children born very preterm (≤32 weeks), followed for post-prematurity respiratory disease. We derived childhood opportunity index (COI) from the census tract corresponding to each subject's address. Linear regression was used to identify the impact of COI on neonatal and childhood respiratory outcomes. In a secondary analysis, we examined differences in outcomes between races (White, non-White), across quartiles of COI.
Results:
Children residing in neighborhoods with lower COI were born at a significantly smaller birth weight, earlier gestation, and spent longer duration on mechanical ventilation (MV) in the NICU. No direct association was observed between COI and longer-term respiratory outcomes. Racial disparities in birth outcomes within COI quartiles became more pronounced at higher levels of opportunity. Longer duration of MV in the NICU was significantly associated with longer-term outcomes including increased hospital readmissions in early life and lower FEV1 and FVC % predicted in childhood.
Conclusion:
Low COI is associated with longer duration of MV in the NICU, which itself is associated with increased healthcare utilization and reduced functional respiratory outcomes. Racial disparities in birth outcomes within similar neighborhood contexts demonstrate the need for targeted interventions to advance health equity in this population of vulnerable infants.
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