Social Determinants of Health and Redirection of Care for Infants Born Extremely Preterm
Authors: Jane E. Brumbaugh, Carla M. Bann, Edward F. Bell, Colm P. Travers, Betty R. Vohr, Elisabeth C. McGowan, Heidi M. Harmon, Waldemar A. Carlo, Susan R. Hintz, Andrea F. Duncan, Richard A. Polin, Abbot R. Laptook, Martin Keszler, Julie Mayne, Vita Lamberson, Mary L. Keszler, Angelita M. Hensman, Elisa Vieira, Lucille St. Pierre, Robert T. Burke, Barbara Alksninis, Teresa M. Leach, Victoria E. Watson, Andrea Knoll, Stephanie Moffat, Anna Maria Hibbs, Nancy S. Newman, Deanne E. Wilson-Costello, Bonnie S. Siner, Harriet G. Friedman, William E. Truog, Eugenia K. Pallotto, Howard W. Kilbride, Cheri Gauldin, Anne Holmes, Kathy Johnson, Allison Scott, Prabhu S. Parimi, Lisa Gaetano, Stephanie L. Merhar, Kurt Schibler, Brenda B. Poindexter, Jae Kim, Kimberly Yolton, Tanya E. Cahill, David Russell, Juanita Dudley, Teresa L. Gratton, Cathy Grisby, Lisa Henkes, Kristin Kirker, Sara Stacey, Sandra Wuertz, C. Michael Cotten, Ronald N. Goldberg, Matthew M. Laughon, Ricki F. Goldstein, William F. Malcolm, Patricia L. Ashley, Deesha Mago-Shah, Joanne Finkle, Kimberley A. Fisher, Kathryn E. Gustafson, Carl L. Bose, Janice Bernhardt, Gennie Bose, Cindy Clark, Janice Wereszczak, Diane Warner, Jennifer Talbert, Stephen D. Kicklighter, Alexandra Bentley, Laura Edwards, Ginger Rhodes-Ryan, Donna White, Ravi M. Patel, David P. Carlton, Barbara J. Stoll, Yvonne Loggins, Ira Adams-Chapman (deceased), Elizabeth Sewell, Nathalie Maitre, Diane Bottcher, Sheena L. Carter, Ellen C. Hale, Salathiel Kendrick-Allwood, Judith Laursen, Maureen Mulligan LaRossa, Colleen Mackie, Amy Sanders, Gloria Smikle, Lynn Wineski, Michele C. Walsh, Andrew A. Bremer, Rosemary D. Higgins, Stephanie Wilson Archer, Gregory M. Sokol, Lu-Ann Papile, Dianne E. Herron, Abbey C. Hines, Carolyn Lytle, Lucy Smiley, Leslie Dawn Wilson, Donna Watkins, Susan Gunn, Jeff Joyce (deceased), Jon E. Tyson, Amir M. Khan, Kathleen A. Kennedy, Matthew A. Rysavy, Ricardo A. Mosquera, Elizabeth Eason, Emily Stephens, Nora I. Alaniz, Elizabeth Allain, Julie Arldt-McAlister, Fatima Boricha, Katrina Burson, Allison G. Dempsey, Carmen Garcia, Donna J. Hall, Janice John, Patrick M. Jones, M. Layne Lillie, Carrie M. Mason, Karen Martin, Sara C. Martin, Georgia E. McDavid, Shannon L. McKee, Michelle Poe, Kimberly Rennie, Tina Reddy, Shawna Rodgers, Saba Khan Siddiki, Daniel Sperry, Patti L. Pierce Tate, Michelle White, Sharon L. Wright, Dinorah Zanger, Pablo J. Sánchez, Jonathan L.. Slaughter, Leif D. Nelin, Sudarshan R. Jadcherla, Nathalie L. Maitre, Christopher Timan, Keith O. Yeates, Patricia Luzader, Nancy Batterson, Hallie Baugher, Demi R. Beckford, Stephanie Burkhardt, Helen Carey, Michelle Chao, Courtney Cira, Erna Clark, Brittany DeSantis, Christine A. Fortney, Aubrey Fowler, Julie Gutentag, Jennifer L. Grothause, Cole D. Hague, Sarah A. Keim, Katelyn Levengood, Laura Marzec, Jacqueline McCool, Bethany Miller, Mary Ann Nelin, Julia Newton, Courtney Park, Lindsay Pietruszewski, Jessica Purnell, Ruth Seabrook, Julie C. Shadd, Kristi Small, Melanie Stein, Margaret Sullivan, Rox Ann Sullivan, Kyrstin Warnimont, Lina Yossef-Salameh, Erin Fearns, Abhik Das, Marie G. Gantz, Laura Elizabeth Wiener, Dennis Wallace, Jeanette O’Donnell Auman, Margaret Crawford, Jenna Gabrio, Jamie E. Newman, Lindsay Parlberg, Carolyn M. Petrie Huitema, Kristin M. Zaterka-Baxter, Krisa P. Van Meurs, Valerie Y. Chock, David K. Stevenson, M. Bethany Ball, Dona Bahmani, Marian M. Adams, Barbara Bentley, Maria Elena DeAnda, Anne M. DeBattista, Beth Earhart, Lynne C. Huffman, Casey E. Krueger, Ryan E. Lucash, Melinda S. Proud, Elizabeth N. Reichert, Heather Taylor, Hali E. Weiss, R. Jordan Williams, Namasivayam Ambalavanan, Myriam Peralta-Carcelen, Monica V. Collins, Shirley S. Cosby, Kirstin J. Bailey, Fred J. Biasini, Stephanie A. Chopko, Kristy A. Domnanovich, Chantel J. Jno-Finn, Morissa Ladinsky, Mary Beth Moses, Cindie Buie, Tara E. McNair, Vivien A. Phillips, Julie Preskitt, Richard V. Rector, Kimberlly Stringer, Sally Whitley, Sheree York Chapman, Uday Devaskar, Meena Garg, Isabell B. Purdy, Teresa Chanlaw, Rachel Geller, Tarah T. Colaizy, John A. Widness, Karen J. Johnson, Diane L. Eastman, Jacky R. Walker, Claire A. Goeke, Mendi L. Schmelzel, Sarah E. Faruqui, Brenda J. Coulter, Bailey M. Schrimper, Sydney S. Jellison, Laura K. Knosp, Sandra J. Arnold, Haley A. Andrews, Dan L. Ellsbury, Donia B. Bass, Tracy L. Tud, Michelle L. Baack, Laurie A. Richards, Megan M. Henning, Chelsey Elenkiwich, Megan Broadbent, Sarah Van Muyden, Aimee T. Brodkorb, Kristi L. Watterberg, Janell Fuller, Robin K. Ohls, Conra Backstrom Lacy, Carol Hartenberger, Sandra Sundquist Beauman, Mary Hanson, Jean R. Lowe, Elizabeth Kuan, Sara B. DeMauro, Eric C. Eichenwald, Barbara Schmidt, Haresh Kirpalani, Soraya Abbasi, Aasma S. Chaudhary, Toni Mancini, Dara M. Cucinotta, Judy C. Bernbaum, Marsha Gerdes, Savin Ghavam, Hallam Hurt, Jonathan Snyder, Kristina Ziolkowski, Megan Dhawan, Lauren Booth, Christine Catts, Carl T. D'Angio, Ronnie Guillet, Gary J. Myers, Anne Marie Reynolds, Satyan Lakshminrusimha, Holly I.M. Wadkins, Michael G. Sacilowski, Rosemary L. Jensen, Joan Merzbach, William Zorn, Osman Farooq, Dee Maffett, Ashley Williams, Julianne Hunn, Stephanie Guilford, Kelley Yost, Mary Rowan, Diane Prinzing, Melissa Bowman, Linda J. Reubens, Ann Marie Scorsone, Michelle Harley-McAndrew, Caitlin Fallone, Kyle Binion, Constance Orme, Premini Sabaratnam, Alison Kent, Rachel Jones, Elizabeth Boylin, Daisy Rochez, Emily Li, Jennifer Kachelmeyer, Kimberly G. McKee, Kelly R. Coleman, Melissa Moreland, Brenna Cavanaugh, Myra H. Wyckoff, Luc P. Brion, Roy J. Heyne, Diana M. Vasil, Sally S. Adams, Lijun Chen, Maria M. De Leon, JoAnne Duran, Frances Eubanks, Rebecca McDougald, Lara Pavageau, Pollieanna Sepulveda, Alicia Guzman, Michelle Harrod, Elizabeth Heyne, Linda A. Madden, Lizette E. Lee, Anna Puentez, Kristine Tolentino-Plata, Cathy Twell Boatman, Azucena Vera, Jillian Waterbury, Bradley A. Yoder, Mariana Baserga, Roger G. Faix, Stephen D. Minton, Mark J. Sheffield, Carrie A. Rau, Shawna Baker, Jill Burnett, Susan Christensen, Laura Cole Bledsoe, Sean D. Cunningham, Brandy Davis, Jennifer O. Elmont, Becky Hall, Erika R. Jensen, Manndi C. Loertscher, Trisha Marchant, Earl Maxson, Kandace M. McGrath, Hena G. Mickelsen, Galina Morshedzadeh, D. Melody Parry, Brixen A. Reich, Susan T. Schaefer, Kelly Stout, Ashley L. Stuart, Kimberlee Weaver-Lewis, Sarah Winter, Kathryn D. Woodbury, Karen Osborne, Karie Bird, Kathleen Coleman, Barbara L. Francom, Jamie Jordan, Mike Steffen, Katherine Tice, Seetha Shankaran, Girija Natarajan, Athina Pappas, Beena G. Sood, Monika Bajaj, Melissa February, Prashant Agarwal, Sanjay Chawla, Rebecca Bara, Kirsten Childs, Eunice Woldt, Laura Goldston, Stephanie A. Wiggins, Mary K. Christensen, Martha Carlson, John Barks, Diane F. White
Journal: JAMA Pediatrics (2024)

Importance Redirection of care refers to withdrawal, withholding, or limiting escalation of treatment. Whether maternal social determinants of health are associated with redirection of care discussions merits understanding. Objective To examine associations between maternal social determinants of health and redirection of care discussions for infants born extremely preterm. Design, Setting, and Participants This is a retrospective analysis of a prospective cohort of infants born at less than 29 weeks’ gestation between April 2011 and December 2020 at 19 National Institute of Child Health and Human Development Neonatal Research Network centers in the US. Follow-up occurred between January 2013 and October 2023. Included infants received active treatment at birth and had mothers who identified as Black or White. Race was limited to Black and White based on service disparities between these groups and limited sample size for other races. Maternal social determinant of health exposures were education level (high school nongraduate or graduate), insurance type (public/none or private), race (Black or White), and ethnicity (Hispanic or non-Hispanic). Main Outcomes and Measures The primary outcome was documented discussion about redirection of infant care. Secondary outcomes included subsequent redirection of care occurrence and, for those born at less than 27 weeks’ gestation, death and neurodevelopmental impairment at 22 to 26 months’ corrected age. Results Of the 15 629 infants (mean [SD] gestational age, 26 [2] weeks; 7961 [51%] male) from 13 643 mothers, 2324 (15%) had documented redirection of care discussions. In unadjusted comparisons, there was no significant difference in the percentage of infants with redirection of care discussions by race (Black, 1004/6793 [15%]; White, 1320/8836 [15%]) or ethnicity (Hispanic, 291/2105 [14%]; non-Hispanic, 2020/13 408 [15%]). However, after controlling for maternal and neonatal factors, infants whose mothers identified as Black or as Hispanic were less likely to have documented redirection of care discussions than infants whose mothers identified as White (Black vs White adjusted odds ratio [aOR], 0.84; 95% CI, 0.75-0.96) or as non-Hispanic (Hispanic vs non-Hispanic aOR, 0.72; 95% CI, 0.60-0.87). Redirection of care discussion occurrence did not differ by maternal education level or insurance type. Conclusions and Relevance For infants born extremely preterm, redirection of care discussions occurred less often for Black and Hispanic infants than for White and non-Hispanic infants. It is important to explore the possible reasons underlying these differences.