High-Risk Infant Developmental Outcome Is Associated with Medical Complexity and Neighborhood Opportunity.

Objective: To assess how medical complexity and neighborhood opportunity jointly affect cognitive, motor, and language Bayley's Scales of Infant Development. Secondary objectives involved identifying the factors contributing to developmental disparities across diverse racial and ethnic groups.

Study design: Electronic health records from a Southern California high-risk infant follow-up clinic were analyzed for 440 infants from 2014 through 2023 who had either had neonatal intensive care unit stays, prematurity, very low birthweight, or developmental delay risk. Medical complexity was categorized using the Pediatric Medical Complexity Algorithm (PMCA) into complex chronic (CC), noncomplex chronic (NCC), or non-chronic (NC). Neighborhood opportunity was assessed using the Child Opportunity Index 2.0 (COI). Developmental progress was tracked from ages 4 to 35.6 months.

Results: Of the cohort, 56% were male, and 67% were born prematurely, with 143 NC, 115 NCC, and 182 CC cases. Developmental scores showed a progressive decline with increased medical complexity. CC infants had lower cognitive (β= -15.20, p<0.001, 95% CI: -18.75, -11.7), motor (β= -20.50, p<0.001, 95% CI: -24.25, -16.8), and language scores (β=-11.88, p<0.001, 95% CI = -15.13 to -8.6) compared with NC infants. Lower COI was linked with decreased language scores (β= -0.07, p = 0.005, 95% CI: 0.01, 0.12) but not cognitive or motor scores.

Conclusions: In high-risk infants, the adverse effects of medical complexities on developmental outcomes exceeded those of prematurity and additionally varied according to child neighborhood opportunity.