Development of Perinatal Social Determinants of Health Composite Risk Score in Infants Born Preterm

To develop and validate a perinatal social determinants of health (SDoH) risk score for predicting neurodevelopmental outcomes in infants born preterm.

This is a prospective cohort study of 395 infants born at ≤32 weeks' gestation recruited from 5 level III/IV neonatal intensive care units in Greater Cincinnati (2016-2019); 328 (83%) infants with complete data were analyzed. Five prenatal social risk factors-maternal age, education, household income, employment, and family structure-were combined into composite SDoH scores using supervised and unsupervised machine learning. The outcomes were Bayley Scales of Infant and Toddler Development, Third Edition, cognitive, language, and motor composite scores at 2 years corrected age; neurodevelopmental impairment was defined as ≥1 subscale <85.

Among the mothers of 328 infants (median gestational age, 29.6 weeks), 52.1% of mothers had a college degree or higher, 47.3% had low income, and 29.3% were single parents. The supervised ridge model showed R² = 0.19 (SD = 0.13), and the unsupervised multiple correspondence analysis showed R² = 0.20 (SD = 0.14) of cognitive variance. Infants in the highest risk tertile scored 13.1 points lower in cognition than those in the lowest risk tertile, with similar gradients for language (19 points) and motor outcomes (7.8 points). Cross domain consistency was high (r = 0.97-1.00). Temporal validation at the age of 5 (n = 291) showed correlations of 0.33-0.35 with general cognitive ability (all P < .001). Discrimination for impairment was moderate (area under the curve, 0.67-0.68).

This validated perinatal SDoH score quantifies cumulative social disadvantage in infants born preterm and supports early identification, targeted intervention, and standardized case-mix adjustment across neonatal intensive care units.