NICU to neighborhood: structural drivers shape health inequities for preterm infants

Bastos Reinaldo, J. et al. Neighborhood socioeconomic disadvantage and early overweight of very preterm-born children: a cohort study in France. Pediatr. Res . https://doi.org/10.1038/s41390-026-04956-y .(2026). Halfon, N. 2025.Licence: CC BY-NC-SA 3.0 IGO Phillips, R. L. et al. How Other Countries Use Deprivation Indices—And Why The United States Desperately Needs One. Health Aff. (Millwood) 35 , 1991–1998 (2016). Article PubMed Google Scholar Zelenina, A., Shalnova, S., Maksimov, S. & Drapkina, O. Classification of Deprivation Indices That Applied to Detect Health Inequality: A Scoping Review. Int. J. Environ. Res. Public. Health 19 , 10063 (2022). Article PubMed PubMed Central Google Scholar Rey, G., Jougla, E., Fouillet, A. & Hémon, D. Ecological association between a deprivation index and mortality in France over the period 1997 - 2001: variations with spatial scale, degree of urbanicity, age, gender and cause of death. BMC Public Health 9 , 33 (2009). Article PubMed PubMed Central Google Scholar European Commission. Directorate General for Justice and Consumers. Analysis and Comparative Review of Equality Data Collection Practices in the European Union: Data Collection in the Field of Ethnicity . (Publications Office, LU, 2017). https://doi.org/10.2838/447194 . Trinidad, S. et al. Use of area-based socioeconomic deprivation indices: a scoping review and qualitative analysis: study examines socioeconomic deprivation indices. Health Aff. (Millwood) 41 , 1804–1811 (2022). Article PubMed Google Scholar Noelke, C. et al. (2025) ChildOpportunity Index 3.0 Technical Documentation (July 24, 2025). diversitydatakids.org, Boston University.Retrieved from diversitydatakids.org/research-library/coi-30-technical-documentation. Aris, I. M. et al. Neighborhood food access in early life and trajectories of child body mass index and obesity. JAMA Pediatr. 178 , 1172 (2024). Article PubMed PubMed Central Google Scholar Jia, P. et al. Green space access in the neighbourhood and childhood obesity. Obes. Rev. 22 , e13100 (2021). Article PubMed Google Scholar Ferry, F., McDowell, R., Rosato, M., Murphy, J. & Leavey, G. Does change in area-level deprivation, change health outcomes? A latent class growth analysis of population data. SSM - Popul. Health 31 , 101826 (2025). Article PubMed PubMed Central Google Scholar Sullivan, B. A. et al. Neighborhood deprivation and association with neonatal intensive care unit mortality and morbidity for extremely premature infants. JAMA Netw. Open 6 , e2311761 (2023). Article PubMed PubMed Central Google Scholar Sahni, P. V., Kim, F., Isler, J. R. & Sahni, R. Neighborhood deprivation and association with 18-month neurodevelopmental impairment of preterm infants born in a dense urban setting. J. Neonatal-Perinat. Med. 17 , 829–837 (2024). Article Google Scholar Nwanne, O. Y. et al. High-risk neighborhoods and neurodevelopmental outcomes in infants born preterm. J. Pediatr. 245 , 65–71 (2022). Article CAS PubMed Google Scholar Yeo, E. N. et al. High-risk infant developmental outcome is associated with medical complexity and neighborhood opportunity. J. Pediatr. 279 , 114433 (2025). Article PubMed Google Scholar Laugier, O. et al. Influence of socioeconomic context on the rehospitalization rates of infants born preterm. J. Pediatr. 190 , 174–179.e1 (2017). Article PubMed Google Scholar Banwell, E. et al. Area deprivation and respiratory morbidities in children with bronchopulmonary dysplasia. Pediatr. Pulmonol. 57 , 2053–2059 (2022). Article PubMed PubMed Central Google Scholar Szeto, J. J. et al. Associations of community material neighborhood deprivation with the diagnosis of asthma among infants with Bronchopulmonary Dysplasia (BPD). Pediatr. Pulmonol. 61 , e71462 (2026). Article PubMed PubMed Central Google Scholar Ravi, K., Young, A., Beattie, R. M. & Johnson, M. J. Socioeconomic disparities in the postnatal growth of preterm infants: a systematic review. Pediatr. Res. 97 , 532–557 (2025). Article PubMed Google Scholar Belanoff, C., Black, A., Ncube, C. N., Acevedo-Garcia, D. & Almeida, J. Neighborhood child opportunity and preterm birth rates by race and ethnicity. JAMA Netw. Open 7 , e2432766 (2024). Article PubMed PubMed Central Google Scholar Burridge, J. V., Baer, R. J. & Chambers, C. D. Association between census-tract Social Vulnerability Index and preterm birth rates. Pregnancy 1 , e70142 (2025). Article Google Scholar Vos, A. A., Posthumus, A. G., Bonsel, G. J., Steegers, E. A. P. & Denktaş, S. Deprived neighborhoods and adverse perinatal outcome: a systematic review and meta-analysis. Acta Obstet. Gynecol. Scand. 93 , 727–740 (2014). Article PubMed Google Scholar Flynn, E. F., Kenyon, C. C. & Vasan, A. Cash transfer programs for child health—elucidating pathways and optimizing program design. JAMA Pediatr. 177 , 661 (2023). Article PubMed PubMed Central Google Scholar Mcconnell, M. et al. Prescription for Cash? Cash support to low-income families in maternal and pediatric health care settings. Milbank Q 102 , 64–82 (2024). Article PubMed Google Scholar Bouchelle, Z., Nelin, T. D., Salazar, E., Duncan, A. F. & Parker, M. G. Unconditional cash transfers for preterm neonates: evidence, policy implications, and next steps for research. Matern. Health Neonatol. Perinatol. 10 , 2 (2024). Article PubMed PubMed Central Google Scholar Glassman, A. et al. Impact of conditional cash transfers on maternal and newborn health. J. Health Popul. Nutr. 31 , 48–66 (2013). PubMed Google Scholar Agarwal, S. et al. Perinatal cash transfers and birth outcomes: a population-based, quasi-experimental study of the Rx kids unconditional cash prescription during pregnancy and infancy. Preprint at https://doi.org/10.2139/ssrn.5459276 (2025). Enns, J. E. et al. An unconditional prenatal income supplement is associated with improved birth and early childhood outcomes among First Nations children in Manitoba, Canada: a population-based cohort study. BMC Pregnancy Childbirth 21 , 312 (2021). Article PubMed PubMed Central Google Scholar Bouchelle, Z. M. et al. Unconditional cash transfers to low-income preterm infants and their families: a pilot randomized controlled trial. J. Perinatol. 45 , 1233–1239 (2025). Article PubMed Google Scholar McConnell, M. et al. CuddleCard: Protocol for a randomized controlled trial evaluating the effect of providing financial support to low-income mothers of preterm infants on parental caregiving in the neonatal intensive care unit (NICU). BMC Pediatr. 25 , 383 (2025). Article PubMed PubMed Central Google Scholar Nandi, A. et al. The Impact of parental and medical leave policies on socioeconomic and health outcomes in OECD countries: a systematic review of the empirical literature. Milbank Q 96 , 434–471 (2018). Article PubMed PubMed Central Google Scholar Wells, W. M. et al. Effects of US state paid family leave policies on perinatal and postpartum health: a quasi-experimental analysis. Am. J. Epidemiol. 195 , 246–254 (2026). Article PubMed PubMed Central Google Scholar Jiang, X. et al. Longitudinal studies on breastfeeding among preterm infants: a scoping review. BMC Pregnancy Childbirth 25 , 738 (2025). Article PubMed PubMed Central Google Scholar Committee on the Review of Federal Policies that Contribute to Racial and Ethnic Health Inequities, Board on Population Health and Public Health Practice, Health and Medicine Division, & National Academies of Sciences, Engineering, and Medicine. Federal Policy to Advance Racial, Ethnic, and Tribal Health Equity . 26834 (National Academies Press, Washington, D.C., 2023). https://doi.org/10.17226/26834 . Download references