Research In Practice Blog

Intro
Bronchopulmonary dysplasia (BPD) is a very serious chronic lung condition disease which can result when respiratory support is provided for newborns whose lungs are underdeveloped at birth. BPD is associated with high rates of morbidity and mortality, and babies with BPD require increased care and health services. It is known that inequities in both prevalence and outcomes of BPD exist, and our pediatric researchers wanted to know more about how racial disparities and social vulnerability affected health outcomes among infants with BPD. The research team used the CDCs demographics-driven Social Vulnerability Index (SVI) to measure infant’s social vulnerability. 

Study design & findings
Researchers analyzed 378 infants born at <32 weeks gestation who were diagnosed with BPD and who lived in the metropolitan Philadelphia region. The mean SVI of the cohort was 0.59 (0=least vulnerable; 1=most vulnerable) and 62% of the cohort was publicly insured. In the year after NICU discharge, 46% of the infants experienced an inpatient readmission or ED visit. While infants identified as non-Hispanic Black in the electronic health record comprised 50% of the cohort, they comprised 63% of those who experienced an inpatient readmission or ED visit in the year after NICU discharge. The authors determined that a significant proportion of racial disparity in ED visits for acute respiratory illness may be explained by racial differences in SVI.

Implications 
This study exposed significant racial disparities in acute respiratory illness and highlights the potential role of macroenvironmental factors in outcomes and inequities among preterm infants with BPD. SVI significantly mediated 31% of the Black-White disparity in ED visit rates. With knowledge of contributing factors to readmission risk, preventive and protective interventions can be developed for patients and families who are most likely to be affected.

Information & Resources:
CHOP Newborn & Infant Chronic Lung Disease Program

Clinical Futures authors: Scott A Lorch, MD, MSCE; Nicolas A Bamat, MD, MSCE; Heather H Burris, MD, MPH

Additional study authors from Children’s Hospital of Philadelphia: Timothy D Nelin, MD; Joshua Radack, MS; Sara B DeMauro, MD, MSCE; Erik A Jensen, MD, MSCE; and Kathleen Gibbs, MD

Nelin TD, Yang N, Radack J, et al. Associations of neighborhood social vulnerability with emergency department visits and readmissions among infants with bronchopulmonary dysplasia [published online ahead of print, 2023 Jul 25]. J Perinatol. 2023;10.1038/s41372-023-01735-z. doi:10.1038/s41372-023-01735-z