High-risk neighbourhoods and behaviour outcomes in children born extremely preterm

Ogochukwu Y Nwanne; Michelle L Rogers; Elisabeth C McGowan; Richard Tucker; Patrick M Vivier; Betty R Vohr

doi:10.1111/apa.17236

High-risk neighbourhoods and behaviour outcomes in children born extremely preterm

Acta Paediatr. 2024 Apr 10. doi: 10.1111/apa.17236. Online ahead of print.

Authors

Ogochukwu Y Nwanne^{1

2

3}, Michelle L Rogers⁴, Elisabeth C McGowan^{1

2}, Richard Tucker², Patrick M Vivier⁵, Betty R Vohr^{1

2}

Affiliations

¹ Division of Neonatal Medicine, Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
² Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island, USA.
³ Department of Pediatrics, St Mary's Hospital Athens, Athens, Georgia, USA.
⁴ Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA.
⁵ College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA.

PMID: 38597231
DOI: 10.1111/apa.17236

Abstract

Aim: Study the association between neighbourhood risk and behaviour in extreme preterm (EPT) children. We hypothesised that EPT children living in high-risk neighbourhoods have increased risk of clinical range behaviour problems at age 30-36 months.

Methods: Retrospective analyses of Child Behavior Checklist (CBCL)scores for 739 EPTs born 2005-2016. Addresses were geocoded to identify census block groups and create high versus low-risk groups. Regression analyses assessed the impact of neighbourhood risk on behaviour.

Results: Children from high-risk (N = 272, 39%) and low-risk (N = 417, 61%) neighbourhoods were compared. In adjusted analyses, odds of clinical range scores remained greater in high-risk neighbourhoods for Emotionally Reactive (OR: 4.32, CI: 1.13, 16.51), Somatic Complaints (2.30, CI 1.11,4.79), Withdrawn (OR: 2.56, CI: 1.21, 5,42), Aggressive Behaviour (OR: 4.12, CI: 1.45, 11.68), Internalising (OR: 1.96, CI: 1.17, 3.28), and Total score (OR: 1.86, OR: CI: 1.13, 3.07). Cognitive delay was higher in high-risk neighbourhoods and a risk factor for Attention Problems (2.10,1.08, 4.09). Breast milk was protective for Emotionally Reactive (OR: 0.22, CI: 0.06, 0.85) and Sleep Problems (OR: 0.47, CI:0.24, 0.94).

Conclusion: Neighbourhood risk provided an independent contribution to preterm adverse behaviour outcomes with cognitive delay an additional independent risk factor. Breast milk at discharge was protective.

Keywords: behaviour; extreme preterm; high‐risk neighbourhood; outcomes.