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

Objective To develop and validate a perinatal social determinant of health (SDoH) risk score for predicting neurodevelopmental outcomes in infants born preterm. Study design Prospective cohort study of 395 infants born at ≤32 weeks' gestation recruited from 5 level III/IV NICUs in Greater Cincinnati (2016–2019); 328 (83%) 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. Outcomes were Bayley-III cognitive, language, and motor composite scores at 2 years corrected age; neurodevelopmental impairment was defined as ≥1 subscale <85. Results Among 328 infants (median gestational age 29.6 weeks), 52.1% of mothers had a college degree or higher, 47.3% were low income, and 29.3% were single parents. The supervised ridge model explained R 2 =0.19 (SD 0.13) and the unsupervised multiple correspondence analysis (MCA) explained R 2 =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 age 5 (n=291) showed correlations of 0.33–0.35 with general cognitive ability (all p<.001). Discrimination for impairment was moderate (AUC 0.67–0.68). Conclusions 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 NICUs.