Impact of systematic screening for social determinants of health in a level IV neonatal intensive care unit

Impact of systematic screening for social determinants of health in a level IV neonatal intensive care unit | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Impact of systematic screening for social determinants of health in a level IV neonatal intensive care unit Joanne Lagatta, Caitlin Hoffman, Melissa Harris, Krishna Acharya, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4656439/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Sep, 2024 Read the published version in Journal of Perinatology → Version 1 posted 7 You are reading this latest preprint version Abstract Objective : To determine whether screening for social determinants of health (SDoH) in a level IV neonatal intensive care unit (NICU) could uncover additional family needs. Methods : Secondary analysis of a prospective study in a level IV NICU. Participants filled out the Protocol for Responding to and Assessing Patients’ Assets, Risks and Experiences (PRAPARE) tool, which includes economic, housing, transportation, and safety questions. Questionnaires were completed via secure tablet; the research team notified social workers of reported needs. Illness and demographic characteristics were compared between families who did and did not report resource needs. Manual chart review assessed subsequent response to reported SDoH needs. Results : Of 319 respondents, 61(19%) reported resource needs. Of 61 families, 88% received repeat social work encounter to re-assess for resources; 59% received new resource referrals. Conclusions : Systematic SDoH screening can identify needs throughout the NICU stay, even among families already connected to social work support. Health sciences/Risk factors Health sciences/Health care/Health services Health sciences/Health care/Paediatrics social determinants of health prematurity neonatal intensive care Figures Figure 1 Background Social determinants of health (SDoH) are associated with preterm birth and its complications. SDoH, as defined by the World Health Organization, encompass a variety of non-medical factors that affect a person’s health and include education, income, basic needs such as access to healthy foods and safe housing, and social support networks. 1–3 For infants requiring care in a neonatal intensive care unit (NICU), SDoH have been found to increase risk of prematurity, low birth weight, and complications related to prematurity. 4–14 For parents of infants in the NICU, SDoH are associated with less ability to spend time in the NICU as well as higher rates of maternal mental health diagnoses. 15,16 A recent statement by the American Academy of Pediatrics endorsed the need to address SDoH in the NICU. 17 as a strategy to improve the quality of healthcare delivered in this high-risk patient population. Systematic screening tools to identify SDoH needs have been developed for use in healthcare settings, aiming to allow healthcare staff and providers to identify a broader array of needs than would typically be covered in a usual clinic or hospital visit. Using these tools in the inpatient setting has advantages and disadvantages. In a study conducted in an emergency department, staff reported concerns with time constraints, while patients reported concerns with vulnerability given rapid turnover of the emergency room. 18 In the NICU, where patients often experience a prolonged stay, staff may have more opportunities to establish rapport with families; thus the NICU setting may be ideally poised to conduct such screenings. In one NICU that conducted SDoH screening, over 80 percent of families screened had at least one unmet need, and 98% of those screens resulted in referrals to meet those needs. 19 Nonetheless, only one in four NICUs currently uses a screening tool to identify SDoH related needs. 20 While healthcare professionals including those in NICU settings have been found to be in support of universal SDoH screening, many also share hesitation related to implementation barriers, current level of knowledge with screening, lack of resources to respond to uncovered needs, barriers in translating resources from inpatient to outpatient settings, and preference to establish individual rapport rather than relying on screening tools. 21–25 In a setting like the NICU which may have more resources or existing processes to screen and refer to needed resources, it is unknown how a systematic screening protocol would integrate into existing supports. The objective of this study was to determine whether systematic screening for SDoH in a single NICU, in addition to existing social work and psychologist support, would uncover additional social needs for families, and whether screening could facilitate addressing any newly identified needs. Methods This was a secondary analysis of a prospective study conducted from September 2018 – March 2020, which received approval from the Children’s Wisconsin Institutional Review Board. 25,26 It was a single-center study conducted in a level IV 70-single-bed NICU with a fetal consult coordinating center and connected to a delivery hospital. The NICU does not designate any beds as lower or higher acuity. Infants and families had access to 3 social workers, a dedicated psychologist for NICU families, case management, and a March of Dimes family support coordinator. Infant-parent dyads were eligible for the prospective study if the infant had a length of stay of at least 14 days and was anticipating discharge home with their parent. Parents who participated in the study were asked to fill out a demographic questionnaire as well as questions from the Protocol for Responding to and Assessing Patients’ Assets, Risks and Experiences (PRAPARE) tool. The PRAPARE questionnaire includes national core measures and community priorities, including race and ethnicity, resource needs (food, utilities, clothing, transportation, and housing status), safety (neighborhood and domestic violence), mental health (including presence of emotional distress disorder and stress level), social support (number of adults living at home, amount of weekly social interaction, and number of adults nearby to help care for the infant), education level, employment and household income level, insurance status, and language preference. 27 These questionnaires were completed at the bedside on a digital tablet. For any identified concrete needs, which included worry about housing, financial limitations, lack of transportation, or safety, the research coordinator immediately notified the social work team of that need. Housing need was defined as answering “yes” to the question “Are you worried about losing your housing?” or answering, “I don’t have housing” in response to the question “What is your housing situation?”. Safety need was defined as answering “no” to the question “Do you feel physically and emotionally safe where you currently live?” or answering yes to the question “In the past year, have you been afraid of your partner or ex-partner?” Transportation need was defined as answering “yes” to the question “Has a lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?” Financial need was defined as answering “yes” to the question “In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?” with options including food, utilities, clothing, childcare, medicine or health care, phone or other. Infant illness variables were collected by manual chart review. These included day of life at interview, gestational age, birth weight, congenital and chromosomal anomalies, days on a ventilator, vasopressor administration, days of life at discharge, corrected gestational age at discharge, respiratory support at discharge, feeding support at discharge, total number of medications at discharge. Post-discharge variables included readmissions to the hospital and emergency department visits within 3 months of discharge, consistent with previously collected study data. Demographic variables were collected by parent report at enrollment and included parent age, race/ethnicity, insurance type, education level, transportation method (own car, rides from friend or family, public transportation), distance from home to hospital, number of adults living at home, income level, and childcare plan (parent or family, daycare or nanny, or unknown plan). After discharge, a manual chart review of the electronic health record assessed what had been done to address needs identified by parents on the PRAPARE questionnaire, which included concerns regarding housing, finances, transportation, or safety. Social work and nursing documentation were reviewed manually to determine whether new referrals were placed, or resources were provided to address the identified needs. Documentation was categorized into three categories. Screened and referred was defined as documentation that the social work team had screened a family in response to identified needs on or after the date of the PRAPARE questionnaire, and referred to new resources, with no prior notes that already addressed that specific need. Screened was defined as documentation that the social work team had screened a family in response to the identified need, but did not refer to new resources above what had already been provided prior to the date of the study questionnaire. No screen was defined when no documentation of encounter followed the PRAPARE questionnaire. It was expected that for resource needs including transportation, housing, and financial concerns there would be explicit social work documentation of how the specific need was addressed. Based on discussion with the social work team it was understood that responses to safety concerns would be confidential and are typically not documented explicitly in the patient chart. For these concerns we relied on notes taken by the research coordinator about their follow-up with the social work team during the study period and social work notes documented over the course of the hospitalization. Statistical Analysis Infant illness characteristics and parent demographics were compared between those families who reported a resource need and those families who did not report resource needs. Chi-squared or Fisher’s exact tests were used to compare differences in proportions; Kruskal-Wallis tests were used to compare differences in medians. For families who reported a resource need, we used descriptive statistics to illustrate the details of what types of resources were provided, or any context we were able to determine for families who did not receive new resources. STATA version 16.1 (College Station, TX) was used for analyses. Results A total of 319 parents enrolled in the study, and 19% (61/319) reported at least one resource need. Tables 1 and 2 show infant illness and parent demographic characteristics of those who did versus did not identify resource needs on the PRAPARE questionnaire. Infants whose parents reported resource needs were more likely to be born extremely preterm, to require surgery and vasopressors in the NICU, and to experience a longer NICU length of stay. After discharge, they were more likely to be seen in the emergency room. Parents who reported resource needs were more likely to report Black race and/or Hispanic ethnicity, less education, public insurance, lower income and less social support. Table 1 Infant clinical characteristics of families screening for resource needs. Variable Category All Indicated need? p No Yes NICU ILLNESS Day of life on date of questionnaire, median (IQR) 21 ( 17 – 30 ) 19.5 ( 16 – 28 ) 27 (20–37) < 0.001 Gestational age <=28 weeks 71 (22%) 49 (19%) 22 (36%) 0.016 29–33 weeks 113 (35%) 95 (37%) 18 (30%) 37 + weeks 135 (42%) 114 (44%) 21 (34%) Birth weight in kilograms, median (IQR) 1820 (1130–2624) 1930 (1220–2700) 1560 (860–2270) 0.007 Surgery No 180 (56%) 153 (59%) 27 (44%) 0.033 Yes 139 (44%) 105 (41%) 34 (56%) Postnatal steroids No 248 (78%) 205 (79%) 43 (70%) 0.130 Yes 71 (22%) 53 (21%) 18 (30%) Ventilator days 0 days 140 (44%) 118 (46%) 22 (36%) 0.088 1–7 days 90 (28%) 76 (29%) 14 (23%) 8–30 days 38 (12%) 28 (11%) 10 (16%) > 30 days 51 (16%) 36 (14%) 15 (25%) Vasopressors used No 246 (77%) 206 (80%) 40 (66%) 0.017 Yes 73 (23%) 52 (20%) 21 (34%) Number of consultants involved <=1 consultant 107 (34%) 92 (36%) 15 (25%) 0.100 2 + consultants 212 (66%) 166 (64%) 46 (75%) Days of life at discharge, median (IQR) 42 (28–85) 40 (26–77) 57 (35–102) 0.005 Respiratory support at discharge Room air 221 (69%) 182 (71%) 39 (64%) 0.102 Home oxygen 76 (24%) 62 (24%) 14 (23%) Tracheostomy 22 (7%) 14 (5%) 8 (13%) Feeding support at discharge All oral 219 (69%) 175 (68%) 44 (72%) 0.088 Nasogastric tube 35 (11%) 33 (13%) 2 (3%) Gastrostomy tube 65 (20%) 50 (19%) 15 (25%) Total number of medications at discharge 0 medications 159 (50%) 134 (52%) 25 (41%) 0.066 1–2 medications 86 (27%) 71 (28%) 15 (25%) 3 + medications 74 (23%) 53 (21%) 21 (34%) Number of appointments scheduled post-discharge <=1 68 (21%) 57 (22%) 11 (18%) 0.142 2–3 109 (34%) 93 (36%) 16 (26%) 4+ 142 (45%) 108 (42%) 34 (56%) POST-NICU ACUTE HEALTHCARE UTILIZATION Number of readmissions 0 readmissions 236 (74%) 186 (72%) 50 (82%) 0.104 1 readmission 62 (19%) 56 (22%) 6 (10%) 2 + readmissions 21 (7%) 16 (6%) 5 (8%) Number of emergency department visits 0 visits 221 (69%) 187 (72%) 34 (56%) 0.007 1 visit 64 (20%) 43 (17%) 21 (34%) 2 + visits 34 (11%) 28 (11%) 6 (10%) Infant clinical characteristics of families who indicated a resource need based on screening, defined as a positive response to transportation, housing, economic, or safety concerns on the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) tool. Included characteristics on the table were different between parents who did and did not indicate needs on screening with a p value < 0.2; bold p values highlight those with p values < 0.05. Table 2 Parent demographic characteristics of families screening for resource needs. Variable Category All Indicated need? p No Yes DEMOGRAPHICS Parent age, median (IQR) 30 (26–34) 31 (26–34) 27 (23–34) 0.023 Race/ethnicity Black 71 (22%) 47 (18%) 24 (39%) < 0.001 White 202 (63%) 183 (71%) 10 (31%) Asian 8 (3%) 5 (2%) 3 (5%) Other 4 (1%) 3 (1%) 1 (2%) Hispanic 34 (11%) 20 (8%) 14 (23%) Insurance type Public 174 (55%) 122 (47%) 52 (85%) < 0.001 Private 145 (45%) 136 (53%) 9 (15%) Education level < High school 22 (7%) 8 (3%) 14 (23%) < 0.001 High school 62 (19%) 46 (18%) 16 (26%) Some college 235 (74%) 204 (79%) 31 (51%) Transportation method Own car 259 (81%) 226 (88%) 33 (54%) < 0.001 Rides from friend 48 (15%) 27 (10%) 21 (34%) Public transportation 12 (4%) 5 (2%) 7 (11%) Number of adults who live at home Single parent 32 (10%) 22 (9%) 10 (16%) 0.142 Parent + 1 261 (82%) 216 (84%) 45 (74%) > 2 adults 26 (8%) 20 (8%) 6 (10%) Number of adults who live nearby No adults nearby 38 (12%) 31 (12%) 7 (11%) 0.171 1–2 adults 99 (31%) 74 (29%) 99 (31%) > 2 adults 181 (57%) 152 (52%) 181 (57%) Income level < $ 20,000 64 (20%) 38 (15%) 26 (43%) $ 40,000 162 (51%) 151 (59%) 11 (18%) Prefer not to answer 33 (10%) 23 (9%) 10 (16%) Childcare Parent or relative 248 (78%) 196 (76%) 52 (85%) 0.030 Daycare or nanny 64 (20%) 58 (22%) 6 (10%) Unknown 7 (2%) 4 (2%) 3 (5%) How often do you see or talk to people that you care about and feel close to? =3x week 267 (85%) 223 (87%) 44 (75%) Stress is when someone feels tense, nervous, anxious, or can’t sleep at night because their mind is troubled. How stressed are you? Not at all-moderate 237 (75%) 197 (77%) 40 (68%) 0.157 Quite a bit-very much 79 (25%) 60 (23%) 19 (32%) Self-reported characteristics of families who indicated a resource need based on screening, defined as a positive response to transportation, housing, economic, or safety concerns on the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) tool. Questions about social and emotional health are drawn from the PRAPARE tool and are included verbatim. Included characteristics on the table were different between parents who did and did not indicate needs on screening with a p value < 0.2; bold p values highlight those with p values < 0.05. Of the 61 parents who identified needs, 24 identified transportation needs, 5 identified housing needs, 12 identified safety needs, and 20 identified other economic needs (Fig. 1 ). Most parents identified only one need (51/61, 84%), with 10 identifying multiple needs. Figure 1 shows the documented response by type of identified need. Additional resource referrals were documented for 56% of positive transportation screens, 80% of positive housing screens, 20% of positive safety screens, and 79% of positive economic screens. Of the 61 families who identified needs, 36 (59%) resulted in documentation of a new resource referral. Table 3 documents details of the responses to identified needs on screening. For those with transportation needs, most families were referred to a medical transportation company for assistance; one family was given resources on local bus routes. For families with housing needs, most were referred to the Ronald McDonald House and one family was given transportation resources. Those with economic needs received a mix of resources; some received Ronald McDonald House or medical transportation referrals and others were given resources for food, finances, employment, and housing. For the 12 safety concerns, several families were already in close contact with social work at the time of the screening, and all but 2 families who were not already in contact with social work were screened immediately after the survey. Table 3 also shows details of documented responses to families whose screen indicated a need who received a social work screening encounter but no new referrals. Most of these concerns were related to transportation to the NICU itself, and the families had arranged transportation by the time of the encounter. Housing questions that did not result in new referrals were often issues related to delays in getting temporary housing close to the hospital. Some safety referrals had documentation that the issue was related to an ex-partner or a former housing situation that was no longer a concern. Table 3 Response details after screening. Screen and subsequent referral Transportation need referrals (n = 13) Medical transportation company referral for rides, bus tickets or mileage reimbursement (n = 13) Review of bus routes with social worker (n = 1) Housing need referrals (n = 4) Ronald McDonald House (n = 4) Medical transportation company referrals (n = 1) Economic need referrals (n = 13 which were not duplicated from transportation and housing) Food, financial, employment, and/or housing resources provided (n = 6) Medical transportation company referrals (n = 5) Ronald McDonald House (n = 4) Screen but no referral Transportation Arranged alternative transportation in the interim Housing Most notes indicate that parents lived locally and had vehicle Safety Majority denied safety concerns; one safety response was already in process Economic Had already received resources at referring hospital Details of documented encounters for parents who indicated a resource need based on screening, defined as a positive response to transportation, housing, economic or safety concerns on the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) tool. Notes reflect manual chart review of nursing, case management and social work encounters documented after the date of positive screening. There were 14 families for whom additional screening by social work was not noted after families reported a need via PRAPARE screening. Of these families, 6 had no social work documentation and were discharged within 72 hours of the screen; another 6 had previous documentation from social work about referrals to resources. For 2 families, research coordinator notes confirm that social work was notified, but we were not able to find documentation of subsequent conversation in the chart or research team notes. Discussion We took advantage of an opportunity embedded in a prospective study of parent experiences related to infant health in and after NICU discharge to understand the potential impact of systematic SDoH screening in a level IV NICU. More than half of needs reported on study screening resulted in a new resource referral, even in a well-resourced NICU with social work, case management, and psychology support. Some positive screens ultimately identified issues that were no longer relevant by the time of encounter, which offers insight into design considerations for SDoH screening in inpatient settings like the NICU. SDoH influence a wide range of health, individual and family level functioning; 27 inequities in SDoH are one of the root causes of health disparities. 28 SDoH are known to be associated with a higher risk of preterm birth, and infants born preterm or with chronic conditions are at higher risk for morbidity and mortality in the NICU. Unaddressed SDoH needs can place vulnerable populations at even higher risk. Consistent with these data, we found that infants whose parents identified resource needs on screening were more likely to be born extremely preterm, to require more intensive care unit interventions, and to have a longer NICU stay. Our findings endorse that screening for SDoH in the NICU presents an opportunity to better address the needs of our highest-risk patients and families. It is also important to note the context for our finding that 19% of families identified resource needs. In this study cohort, almost half were privately insured, most owned cars, lived in a 2-parent household, and had some college education. Our NICU has multiple staff members dedicated to providing family support already. The proportion of families identifying resource needs may be higher in NICUs serving a different patient population or with fewer staff resources already in place. We found that more than half of positive screens led to additional resource referrals, even with existing family support processes in place. The NICU in some ways presents an ideal opportunity for health care teams to understand and address the needs of their patients and families over time, due to the length of time often required before discharge home. Nurses and social workers are trained to establish rapport and build trust and identify ways to support families through those relationships. Unfortunately, families with fewer financial resources, other children at home, less ability to take time off work, or other competing issues may have less ability to be present at the bedside to form those relationships. We also found that some families’ circumstances changed over the course of their child’s stay in the NICU and they found themselves needing resources that were not needed earlier during the admission. Using an electronic tablet-based method of screening in this study was advantageous as it allowed parents to fill out a survey when they were available and then social workers were promptly notified of resource needs so that they could address these needs with families. We also found that many positive screens did not result in additional resource referrals. One issue with adapting a questionnaire such as PRAPARE to an inpatient setting is that a family’s circumstances may be very different in their daily life compared to what they face in the NICU. In the NICU or other inpatient settings, it would likely be beneficial to specify whether needs are temporary and related to the hospital stay or whether they are more long-term needs, as depending on the temporality of the need, different resources may be provided. This was especially evident when it came to screening for housing and transportation needs; some families required temporary housing closer to the hospital as they lived too far away to reasonably commute and some also required transportation to and from the hospital during the NICU stay. Other families indicated the same needs, but they were more long-term as they were experiencing housing instability or did not own a personal vehicle for transportation. Our screening approach was embedded within an ongoing research study and not administered by clinical staff; therefore, some screens identified resource needs that had already been addressed, and others were identified close to discharge such that repeat encounters may have been less feasible. Implementation of systematic screening approaches in the real world should leverage the benefit of clinical context. This could also include establishing a method to communicate SDoH screening information to outpatient partners, as we observed that some families who were receiving transportation resources in the NICU went on to miss outpatient follow-up appointments due to transportation needs that were not continued after discharge. In children’s hospital NICUs, 63% of neonatal follow-up clinics now screen for SDoH in the outpatient setting. 31 Since the completion of this study, our neonatal follow-up clinic team has adapted a process to assess for SDoH needs prior to discharge in order to identify resources that could help improve the transition home. Strengths of this study include the opportunity to test a systematic screen for SDoH in addition to existing family support services, manual chart review of responses, and the broad clinical and demographic representation in this study cohort. There are several limitations. We do not know whether some responses were already in process by the time of the screen, or whether some responses occurred but were not documented, as might especially be expected with safety concerns. We only obtained parent report from those who agreed to participate in the original study; although we enrolled 84% of eligible infant-parent dyads, we do not have parent-reported resource need information from parents who did not participate. The results of this study highlight that systematic screening for SDoH in a NICU has the potential to identify needs throughout the NICU stay, even among those who are already connected to social work and have previously received support. Inpatient settings with a long stay and especially with families far from home may require more consideration of adapting settings to reflect both acute needs related to hospitalization and longer-term resource needs. Abbreviations NICU neonatal intensive care unit SDoH social determinants of health PRAPARE Protocol for Responding to and Assessing Patients’ Assets, Risks and Experiences Declarations Conflicts of interest/Disclosures : The authors declare no conflicts of interest. Funding : This project is funded in part by the National Institutes of Health K23HL136525 (JL). The content is solely the responsibility of the author(s) and does not necessarily represent the official views of the NIH. Author contributions : C. Hoffman: conceptualization, data collection, formal analysis, writing – original draft, visualization M. Harris: conceptualization, formal analysis, writing – review and editing K.K. Acharya: conceptualization, investigation, writing – review and editing M. Malnory: investigation, writing – review and editing, project administration S. Cohen: conceptualization, investigation, writing – review and editing J. Lagatta: conceptualization, methodology, formal analysis, writing – review and editing, visualization, supervision, funding acquisition Acknowledgements: The authors acknowledge Jill Winkler MSW, Megan Sheble, and Jonathan Leuthner for their contributions to this work. Data availability statement: The datasets generated and analyzed are available from the corresponding author on reasonable request. References World Health Organization. (n.d.). Social Determinants of Health . World Health Organization. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1 Chow S, Chow R, Popovic M, et al. A Selected Review of the Mortality Rates of Neonatal Intensive Care Units. Front Public Heal. 2015;3(October). doi: 10.3389/fpubh.2015.00225 Talisman S, Guedalia J, Farkash R, Avitan T, Srebnik N, Kasirer Y. Neonatal intensive care admission for term neonates and subsequent childhood mortality: a retrospective linkage study. BMC Med. 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National Prevalence of Social Determinants of Health Screening Among US Neonatal Care Units. Hosp Pediatr. 2022;12(12):1040–1047. doi: 10.1542/hpeds.2022-006767 Parker MG, Garg A, Brochier A, et al. Approaches to addressing social determinants of health in the NICU: a mixed methods study. J Perinatol. 2021;41(8):1983–1991. doi: 10.1038/s41372-020-00867-w Kostelanetz S, Pettapiece-Phillips M, Weems J, et al. Health Care Professionals' Perspectives on Universal Screening of Social Determinants of Health: A Mixed-Methods Study. Popul Health Manag. 2022;25(3):367–374. doi: 10.1089/pop.2021.0176 Leary JC, Rijhwani L, Bettez NM, et al. Clinical Stakeholder Perspectives on Pediatric Inpatient Screening for Social Needs. Acad Pediatr. 2022;22(3):470–477. doi: 10.1016/j.acap.2021.09.015 Byhoff E, Garg A, Pellicer M, et al. Provider and Staff Feedback on Screening for Social and Behavioral Determinants of Health for Pediatric Patients. J Am Board Fam Med. 2019;32(3):297–306. doi: 10.3122/jabfm.2019.03.180276 Harris M, Cusatis R, Malnory M, Dawson S, Konduri GG, Lagatta J. Identifying barriers and facilitators to care for infants with bronchopulmonary dysplasia after NICU discharge: a prospective study of parents and clinical stakeholders. J Perinatol. Published online January 26, 2024. doi: 10.1038/s41372-024-01880-z Lagatta JM, Uhing M, Acharya K, et al. Actual and potential impact of a home nasogastric tube feeding program for infants whose neonatal intensive care unit discharge is affected by delayed oral feedings. The Journal of Pediatrics. 2021;234. doi: 10.1016/j.jpeds.2021.03.046 Malin KJ, Johnson TS, Brown RL, et al. Uncertainty and perinatal post-traumatic stress disorder in the neonatal intensive care unit. Research in Nursing & Health. 2022;45(6):717–732. doi: 10.1002/nur.22261 What is PRAPARE? Prapare. Accessed February 8, 2024. https://prapare.org/what-is-prapare/ . Healthy People 2030. Social Determinants of Health. 2020. https://health.gov/healthypeople/objectives-and-data/social-determinants-health Centers for Disease Control and Prevention (CDC). NCHHSTP Social Determinants of Health Frequently Asked Questions. Published 2019. https://www.cdc.gov/nchhstp/socialdeterminants/faq.html#:~ :text=Social determinants of health such,lives by reducing health inequities. Quinones Cardona V, Cohen SC, Cook N, et al. The Current State of Neonatal Neurodevelopmental Follow-Up Programs in North America: A Children’s Hospitals Neonatal Consortium Report. Amer J Perinatol. 2024; doi: 10.1055/a-2283-8843 . Additional Declarations There is NO conflict of interest to disclose. Cite Share Download PDF Status: Published Journal Publication published 07 Sep, 2024 Read the published version in Journal of Perinatology → Version 1 posted Editorial decision: revise 02 Aug, 2024 Review # 1 received at journal 02 Jul, 2024 Reviewer # 1 agreed at journal 01 Jul, 2024 Reviewers invited by journal 01 Jul, 2024 Submission checks completed at journal 01 Jul, 2024 Editor assigned by journal 28 Jun, 2024 First submitted to journal 28 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4656439","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":321453813,"identity":"fc084e02-255c-4774-b2e1-4a7461867231","order_by":0,"name":"Joanne Lagatta","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAw0lEQVRIiWNgGAWjYBACxnYogx9CMROhpRlEJhgwSDYQqwWiBqjF4ACxWpibmR+/+Pnjj7zxtcPPJBgqrBMbCDuMzcyyJ8HAcNvtNDMJhjPpxGhhMDPgSTBg3HY7h+0GY9thYrSwfzP8k2Bgv3k2SMs/orTwGD8G2pK4QRqkpYE4LWXMMmnGyTNup5n/SDiWbkxQi2F7++aPb2zkbPtnJz82+FBjLUtYSwMDmwScl0BIOQjIA6PmAzEKR8EoGAWjYAQDAEMmPUR+YpDmAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-5147-2396","institution":"Medical College of Wisconsin","correspondingAuthor":true,"prefix":"","firstName":"Joanne","middleName":"","lastName":"Lagatta","suffix":""},{"id":321453814,"identity":"d4339cc7-d7c9-4440-a548-14d377985c77","order_by":1,"name":"Caitlin Hoffman","email":"","orcid":"","institution":"Medical College of Wisconsin","correspondingAuthor":false,"prefix":"","firstName":"Caitlin","middleName":"","lastName":"Hoffman","suffix":""},{"id":321453815,"identity":"5488d1ba-1314-4e6d-8479-ac1b8476e8bf","order_by":2,"name":"Melissa Harris","email":"","orcid":"","institution":"Medical College of Wisconsin","correspondingAuthor":false,"prefix":"","firstName":"Melissa","middleName":"","lastName":"Harris","suffix":""},{"id":321453816,"identity":"2502b1e7-644a-474d-b5fc-18986235140b","order_by":3,"name":"Krishna Acharya","email":"","orcid":"https://orcid.org/0000-0002-6073-4669","institution":"Medical College of Wisconsin","correspondingAuthor":false,"prefix":"","firstName":"Krishna","middleName":"","lastName":"Acharya","suffix":""},{"id":321453817,"identity":"799f783e-01cb-4f8b-ba31-ac70210a33cb","order_by":4,"name":"Margaret Malnory","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Margaret","middleName":"","lastName":"Malnory","suffix":""},{"id":321453818,"identity":"4cf9e9ea-81e4-462d-8abf-13e53c431b20","order_by":5,"name":"Susan Cohen","email":"","orcid":"https://orcid.org/0000-0003-4444-2145","institution":"Medical College of Wisconsin","correspondingAuthor":false,"prefix":"","firstName":"Susan","middleName":"","lastName":"Cohen","suffix":""}],"badges":[],"createdAt":"2024-06-28 18:55:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4656439/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4656439/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41372-024-02096-x","type":"published","date":"2024-09-07T04:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":61176320,"identity":"26e2cec9-b731-4eb5-916c-4d471d28abbe","added_by":"auto","created_at":"2024-07-26 15:43:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":24688,"visible":true,"origin":"","legend":"\u003cp\u003eDocumented responses to parent reported needs on screening.\u003c/p\u003e\n\u003cp\u003eFigure 1 shows counts of responses to parents’ report of SDoH needs on the Protocol for Responding to and Assessing Patients’ Assets, Risks and Experiences (PRAPARE) tool. \u003cem\u003eScreened and referred\u003c/em\u003e was defined as documentation that the social work team had screened a family in response to identified needs on or after the date of the PRAPARE questionnaire, and referred to new resources, with no prior notes that already addressed that specific need. \u003cem\u003eScreened \u003c/em\u003ewas defined as documentation that the social work team had screened a family in response to the identified need, but did not refer to new resources above what had already been provided prior to the date of the study questionnaire. \u003cem\u003eNo screen \u003c/em\u003ewas defined when no documentation of encounter followed the PRAPARE questionnaire.\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-4656439/v1/d5f833c3f2edd0fb8027bbdb.png"},{"id":64129653,"identity":"b0b78f3e-2c5e-41b9-9f6d-7abf1118d97e","added_by":"auto","created_at":"2024-09-08 07:05:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":921862,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4656439/v1/3a64b5ea-3361-46a8-8f5d-b36ed3f7add2.pdf"}],"financialInterests":"There is \u003cb\u003eNO\u003c/b\u003e conflict of interest to disclose.","formattedTitle":"Impact of systematic screening for social determinants of health in a level IV neonatal intensive care unit","fulltext":[{"header":"Background","content":"\u003cp\u003eSocial determinants of health (SDoH) are associated with preterm birth and its complications. SDoH, as defined by the World Health Organization, encompass a variety of non-medical factors that affect a person\u0026rsquo;s health and include education, income, basic needs such as access to healthy foods and safe housing, and social support networks.\u003csup\u003e1\u0026ndash;3\u003c/sup\u003e For infants requiring care in a neonatal intensive care unit (NICU), SDoH have been found to increase risk of prematurity, low birth weight, and complications related to prematurity.\u003csup\u003e4\u0026ndash;14\u003c/sup\u003e For parents of infants in the NICU, SDoH are associated with less ability to spend time in the NICU as well as higher rates of maternal mental health diagnoses.\u003csup\u003e15,16\u003c/sup\u003e A recent statement by the American Academy of Pediatrics endorsed the need to address SDoH in the NICU.\u003csup\u003e17\u003c/sup\u003e as a strategy to improve the quality of healthcare delivered in this high-risk patient population.\u003c/p\u003e \u003cp\u003eSystematic screening tools to identify SDoH needs have been developed for use in healthcare settings, aiming to allow healthcare staff and providers to identify a broader array of needs than would typically be covered in a usual clinic or hospital visit. Using these tools in the inpatient setting has advantages and disadvantages. In a study conducted in an emergency department, staff reported concerns with time constraints, while patients reported concerns with vulnerability given rapid turnover of the emergency room.\u003csup\u003e18\u003c/sup\u003e In the NICU, where patients often experience a prolonged stay, staff may have more opportunities to establish rapport with families; thus the NICU setting may be ideally poised to conduct such screenings. In one NICU that conducted SDoH screening, over 80 percent of families screened had at least one unmet need, and 98% of those screens resulted in referrals to meet those needs.\u003csup\u003e19\u003c/sup\u003e Nonetheless, only one in four NICUs currently uses a screening tool to identify SDoH related needs.\u003csup\u003e20\u003c/sup\u003e While healthcare professionals including those in NICU settings have been found to be in support of universal SDoH screening, many also share hesitation related to implementation barriers, current level of knowledge with screening, lack of resources to respond to uncovered needs, barriers in translating resources from inpatient to outpatient settings, and preference to establish individual rapport rather than relying on screening tools.\u003csup\u003e21\u0026ndash;25\u003c/sup\u003e In a setting like the NICU which may have more resources or existing processes to screen and refer to needed resources, it is unknown how a systematic screening protocol would integrate into existing supports.\u003c/p\u003e \u003cp\u003eThe objective of this study was to determine whether systematic screening for SDoH in a single NICU, in addition to existing social work and psychologist support, would uncover additional social needs for families, and whether screening could facilitate addressing any newly identified needs.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis was a secondary analysis of a prospective study conducted from September 2018 \u0026ndash; March 2020, which received approval from the Children\u0026rsquo;s Wisconsin Institutional Review Board.\u003csup\u003e25,26\u003c/sup\u003e It was a single-center study conducted in a level IV 70-single-bed NICU with a fetal consult coordinating center and connected to a delivery hospital. The NICU does not designate any beds as lower or higher acuity. Infants and families had access to 3 social workers, a dedicated psychologist for NICU families, case management, and a March of Dimes family support coordinator. Infant-parent dyads were eligible for the prospective study if the infant had a length of stay of at least 14 days and was anticipating discharge home with their parent.\u003c/p\u003e \u003cp\u003eParents who participated in the study were asked to fill out a demographic questionnaire as well as questions from the Protocol for Responding to and Assessing Patients\u0026rsquo; Assets, Risks and Experiences (PRAPARE) tool. The PRAPARE questionnaire includes national core measures and community priorities, including race and ethnicity, resource needs (food, utilities, clothing, transportation, and housing status), safety (neighborhood and domestic violence), mental health (including presence of emotional distress disorder and stress level), social support (number of adults living at home, amount of weekly social interaction, and number of adults nearby to help care for the infant), education level, employment and household income level, insurance status, and language preference.\u003csup\u003e27\u003c/sup\u003e These questionnaires were completed at the bedside on a digital tablet. For any identified concrete needs, which included worry about housing, financial limitations, lack of transportation, or safety, the research coordinator immediately notified the social work team of that need. \u003cem\u003eHousing need\u003c/em\u003e was defined as answering \u0026ldquo;yes\u0026rdquo; to the question \u0026ldquo;Are you worried about losing your housing?\u0026rdquo; or answering, \u0026ldquo;I don\u0026rsquo;t have housing\u0026rdquo; in response to the question \u0026ldquo;What is your housing situation?\u0026rdquo;. \u003cem\u003eSafety need\u003c/em\u003e was defined as answering \u0026ldquo;no\u0026rdquo; to the question \u0026ldquo;Do you feel physically and emotionally safe where you currently live?\u0026rdquo; or answering yes to the question \u0026ldquo;In the past year, have you been afraid of your partner or ex-partner?\u0026rdquo; \u003cem\u003eTransportation need\u003c/em\u003e was defined as answering \u0026ldquo;yes\u0026rdquo; to the question \u0026ldquo;Has a lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?\u0026rdquo; \u003cem\u003eFinancial need\u003c/em\u003e was defined as answering \u0026ldquo;yes\u0026rdquo; to the question \u0026ldquo;In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?\u0026rdquo; with options including food, utilities, clothing, childcare, medicine or health care, phone or other.\u003c/p\u003e \u003cp\u003eInfant illness variables were collected by manual chart review. These included day of life at interview, gestational age, birth weight, congenital and chromosomal anomalies, days on a ventilator, vasopressor administration, days of life at discharge, corrected gestational age at discharge, respiratory support at discharge, feeding support at discharge, total number of medications at discharge. Post-discharge variables included readmissions to the hospital and emergency department visits within 3 months of discharge, consistent with previously collected study data. Demographic variables were collected by parent report at enrollment and included parent age, race/ethnicity, insurance type, education level, transportation method (own car, rides from friend or family, public transportation), distance from home to hospital, number of adults living at home, income level, and childcare plan (parent or family, daycare or nanny, or unknown plan).\u003c/p\u003e \u003cp\u003eAfter discharge, a manual chart review of the electronic health record assessed what had been done to address needs identified by parents on the PRAPARE questionnaire, which included concerns regarding housing, finances, transportation, or safety. Social work and nursing documentation were reviewed manually to determine whether new referrals were placed, or resources were provided to address the identified needs. Documentation was categorized into three categories. \u003cem\u003eScreened and referred\u003c/em\u003e was defined as documentation that the social work team had screened a family in response to identified needs on or after the date of the PRAPARE questionnaire, and referred to new resources, with no prior notes that already addressed that specific need. \u003cem\u003eScreened\u003c/em\u003e was defined as documentation that the social work team had screened a family in response to the identified need, but did not refer to new resources above what had already been provided prior to the date of the study questionnaire. \u003cem\u003eNo screen\u003c/em\u003e was defined when no documentation of encounter followed the PRAPARE questionnaire.\u003c/p\u003e \u003cp\u003eIt was expected that for resource needs including transportation, housing, and financial concerns there would be explicit social work documentation of how the specific need was addressed. Based on discussion with the social work team it was understood that responses to safety concerns would be confidential and are typically not documented explicitly in the patient chart. For these concerns we relied on notes taken by the research coordinator about their follow-up with the social work team during the study period and social work notes documented over the course of the hospitalization.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eInfant illness characteristics and parent demographics were compared between those families who reported a resource need and those families who did not report resource needs. Chi-squared or Fisher\u0026rsquo;s exact tests were used to compare differences in proportions; Kruskal-Wallis tests were used to compare differences in medians. For families who reported a resource need, we used descriptive statistics to illustrate the details of what types of resources were provided, or any context we were able to determine for families who did not receive new resources. STATA version 16.1 (College Station, TX) was used for analyses.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 319 parents enrolled in the study, and 19% (61/319) reported at least one resource need. Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e show infant illness and parent demographic characteristics of those who did versus did not identify resource needs on the PRAPARE questionnaire. Infants whose parents reported resource needs were more likely to be born extremely preterm, to require surgery and vasopressors in the NICU, and to experience a longer NICU length of stay. After discharge, they were more likely to be seen in the emergency room. Parents who reported resource needs were more likely to report Black race and/or Hispanic ethnicity, less education, public insurance, lower income and less social support.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInfant clinical characteristics of families screening for resource needs.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eIndicated need?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eNICU ILLNESS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDay of life on date of questionnaire, median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (\u003cspan additionalcitationids=\"CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.5 (\u003cspan additionalcitationids=\"CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27 (20\u0026ndash;37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGestational age\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;=28 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.016\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u0026ndash;33 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113 (35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95 (37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u0026thinsp;+\u0026thinsp;weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135 (42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBirth weight in kilograms, median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1820 (1130\u0026ndash;2624)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1930 (1220\u0026ndash;2700)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1560 (860\u0026ndash;2270)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e180 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e153 (59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.033\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e105 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostnatal steroids\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e248 (78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e205 (79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43 (70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVentilator days\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e118 (46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u0026ndash;30 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVasopressors used\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e246 (77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e206 (80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.017\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of consultants involved\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;=1 consultant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026thinsp;+\u0026thinsp;consultants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e212 (66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e166 (64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDays of life at discharge, median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (28\u0026ndash;85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (26\u0026ndash;77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57 (35\u0026ndash;102)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRespiratory support at discharge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRoom air\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e221 (69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e182 (71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHome oxygen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTracheostomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFeeding support at discharge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll oral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e219 (69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e175 (68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44 (72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNasogastric tube\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGastrostomy tube\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal number of medications at discharge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e159 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e134 (52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2 medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86 (27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026thinsp;+\u0026thinsp;medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of appointments scheduled post-discharge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;=1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e142 (45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108 (42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePOST-NICU ACUTE HEALTHCARE UTILIZATION\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of readmissions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 readmissions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e236 (74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e186 (72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50 (82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.104\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 readmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026thinsp;+\u0026thinsp;readmissions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of emergency department visits\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 visits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e221 (69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e187 (72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 visit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026thinsp;+\u0026thinsp;visits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eInfant clinical characteristics of families who indicated a resource need based on screening, defined as a positive response to transportation, housing, economic, or safety concerns on the Protocol for Responding to and Assessing Patients\u0026rsquo; Assets, Risks, and Experiences (PRAPARE) tool. Included characteristics on the table were different between parents who did and did not indicate needs on screening with a p value\u0026thinsp;\u0026lt;\u0026thinsp;0.2; bold p values highlight those with p values\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParent demographic characteristics of families screening for resource needs.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eIndicated need?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eDEMOGRAPHICS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParent age, median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (26\u0026ndash;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (26\u0026ndash;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27 (23\u0026ndash;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.023\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace/ethnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24 (39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e202 (63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e183 (71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInsurance type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e174 (55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e122 (47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52 (85%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e145 (45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136 (53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; High school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSome college\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e235 (74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e204 (79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31 (51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTransportation method\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOwn car\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e259 (81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e226 (88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33 (54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRides from friend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublic transportation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of adults who live at home\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle parent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParent\u0026thinsp;+\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e261 (82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e216 (84%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45 (74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2 adults\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of adults who live nearby\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo adults nearby\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2 adults\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e99 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2 adults\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e181 (57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e152 (52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e181 (57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIncome level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u003cspan\u003e$\u003c/span\u003e20,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 (43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e20,000-\u003cspan\u003e$\u003c/span\u003e40,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u003cspan\u003e$\u003c/span\u003e40,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e162 (51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e151 (59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrefer not to answer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChildcare\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParent or relative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e248 (78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e196 (76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52 (85%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.030\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaycare or nanny\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHow often do you see or talk to people that you care about and feel close to?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;=2x week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.020\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;=3x week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e267 (85%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e223 (87%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eStress is when someone feels tense, nervous, anxious, or can\u0026rsquo;t sleep at night because their mind is troubled. How stressed are you?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot at all-moderate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e237 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e197 (77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuite a bit-very much\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eSelf-reported characteristics of families who indicated a resource need based on screening, defined as a positive response to transportation, housing, economic, or safety concerns on the Protocol for Responding to and Assessing Patients\u0026rsquo; Assets, Risks, and Experiences (PRAPARE) tool. Questions about social and emotional health are drawn from the PRAPARE tool and are included verbatim. Included characteristics on the table were different between parents who did and did not indicate needs on screening with a p value\u0026thinsp;\u0026lt;\u0026thinsp;0.2; bold p values highlight those with p values\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOf the 61 parents who identified needs, 24 identified transportation needs, 5 identified housing needs, 12 identified safety needs, and 20 identified other economic needs (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Most parents identified only one need (51/61, 84%), with 10 identifying multiple needs. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the documented response by type of identified need. Additional resource referrals were documented for 56% of positive transportation screens, 80% of positive housing screens, 20% of positive safety screens, and 79% of positive economic screens. Of the 61 families who identified needs, 36 (59%) resulted in documentation of a new resource referral.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e documents details of the responses to identified needs on screening. For those with transportation needs, most families were referred to a medical transportation company for assistance; one family was given resources on local bus routes. For families with housing needs, most were referred to the Ronald McDonald House and one family was given transportation resources. Those with economic needs received a mix of resources; some received Ronald McDonald House or medical transportation referrals and others were given resources for food, finances, employment, and housing. For the 12 safety concerns, several families were already in close contact with social work at the time of the screening, and all but 2 families who were not already in contact with social work were screened immediately after the survey. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e also shows details of documented responses to families whose screen indicated a need who received a social work screening encounter but no new referrals. Most of these concerns were related to transportation to the NICU itself, and the families had arranged transportation by the time of the encounter. Housing questions that did not result in new referrals were often issues related to delays in getting temporary housing close to the hospital. Some safety referrals had documentation that the issue was related to an ex-partner or a former housing situation that was no longer a concern.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResponse details after screening.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eScreen and subsequent referral\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTransportation need referrals (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical transportation company referral for rides, bus tickets or mileage reimbursement (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReview of bus routes with social worker (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHousing need referrals (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRonald McDonald House (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical transportation company referrals (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEconomic need referrals (n\u0026thinsp;=\u0026thinsp;13 which were not duplicated from transportation and housing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFood, financial, employment, and/or housing resources provided (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical transportation company referrals (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRonald McDonald House (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eScreen but no referral\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransportation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArranged alternative transportation in the interim\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMost notes indicate that parents lived locally and had vehicle\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSafety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMajority denied safety concerns; one safety response was already in process\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEconomic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHad already received resources at referring hospital\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eDetails of documented encounters for parents who indicated a resource need based on screening, defined as a positive response to transportation, housing, economic or safety concerns on the Protocol for Responding to and Assessing Patients\u0026rsquo; Assets, Risks, and Experiences (PRAPARE) tool. Notes reflect manual chart review of nursing, case management and social work encounters documented after the date of positive screening.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere were 14 families for whom additional screening by social work was not noted after families reported a need via PRAPARE screening. Of these families, 6 had no social work documentation and were discharged within 72 hours of the screen; another 6 had previous documentation from social work about referrals to resources. For 2 families, research coordinator notes confirm that social work was notified, but we were not able to find documentation of subsequent conversation in the chart or research team notes.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe took advantage of an opportunity embedded in a prospective study of parent experiences related to infant health in and after NICU discharge to understand the potential impact of systematic SDoH screening in a level IV NICU. More than half of needs reported on study screening resulted in a new resource referral, even in a well-resourced NICU with social work, case management, and psychology support. Some positive screens ultimately identified issues that were no longer relevant by the time of encounter, which offers insight into design considerations for SDoH screening in inpatient settings like the NICU.\u003c/p\u003e \u003cp\u003eSDoH influence a wide range of health, individual and family level functioning;\u003csup\u003e27\u003c/sup\u003e inequities in SDoH are one of the root causes of health disparities.\u003csup\u003e28\u003c/sup\u003e SDoH are known to be associated with a higher risk of preterm birth, and infants born preterm or with chronic conditions are at higher risk for morbidity and mortality in the NICU. Unaddressed SDoH needs can place vulnerable populations at even higher risk. Consistent with these data, we found that infants whose parents identified resource needs on screening were more likely to be born extremely preterm, to require more intensive care unit interventions, and to have a longer NICU stay. Our findings endorse that screening for SDoH in the NICU presents an opportunity to better address the needs of our highest-risk patients and families. It is also important to note the context for our finding that 19% of families identified resource needs. In this study cohort, almost half were privately insured, most owned cars, lived in a 2-parent household, and had some college education. Our NICU has multiple staff members dedicated to providing family support already. The proportion of families identifying resource needs may be higher in NICUs serving a different patient population or with fewer staff resources already in place.\u003c/p\u003e \u003cp\u003eWe found that more than half of positive screens led to additional resource referrals, even with existing family support processes in place. The NICU in some ways presents an ideal opportunity for health care teams to understand and address the needs of their patients and families over time, due to the length of time often required before discharge home. Nurses and social workers are trained to establish rapport and build trust and identify ways to support families through those relationships. Unfortunately, families with fewer financial resources, other children at home, less ability to take time off work, or other competing issues may have less ability to be present at the bedside to form those relationships. We also found that some families\u0026rsquo; circumstances changed over the course of their child\u0026rsquo;s stay in the NICU and they found themselves needing resources that were not needed earlier during the admission. Using an electronic tablet-based method of screening in this study was advantageous as it allowed parents to fill out a survey when they were available and then social workers were promptly notified of resource needs so that they could address these needs with families.\u003c/p\u003e \u003cp\u003eWe also found that many positive screens did not result in additional resource referrals. One issue with adapting a questionnaire such as PRAPARE to an inpatient setting is that a family\u0026rsquo;s circumstances may be very different in their daily life compared to what they face in the NICU. In the NICU or other inpatient settings, it would likely be beneficial to specify whether needs are temporary and related to the hospital stay or whether they are more long-term needs, as depending on the temporality of the need, different resources may be provided. This was especially evident when it came to screening for housing and transportation needs; some families required temporary housing closer to the hospital as they lived too far away to reasonably commute and some also required transportation to and from the hospital during the NICU stay. Other families indicated the same needs, but they were more long-term as they were experiencing housing instability or did not own a personal vehicle for transportation. Our screening approach was embedded within an ongoing research study and not administered by clinical staff; therefore, some screens identified resource needs that had already been addressed, and others were identified close to discharge such that repeat encounters may have been less feasible. Implementation of systematic screening approaches in the real world should leverage the benefit of clinical context. This could also include establishing a method to communicate SDoH screening information to outpatient partners, as we observed that some families who were receiving transportation resources in the NICU went on to miss outpatient follow-up appointments due to transportation needs that were not continued after discharge. In children\u0026rsquo;s hospital NICUs, 63% of neonatal follow-up clinics now screen for SDoH in the outpatient setting.\u003csup\u003e31\u003c/sup\u003e Since the completion of this study, our neonatal follow-up clinic team has adapted a process to assess for SDoH needs prior to discharge in order to identify resources that could help improve the transition home.\u003c/p\u003e \u003cp\u003eStrengths of this study include the opportunity to test a systematic screen for SDoH in addition to existing family support services, manual chart review of responses, and the broad clinical and demographic representation in this study cohort. There are several limitations. We do not know whether some responses were already in process by the time of the screen, or whether some responses occurred but were not documented, as might especially be expected with safety concerns. We only obtained parent report from those who agreed to participate in the original study; although we enrolled 84% of eligible infant-parent dyads, we do not have parent-reported resource need information from parents who did not participate.\u003c/p\u003e \u003cp\u003eThe results of this study highlight that systematic screening for SDoH in a NICU has the potential to identify needs throughout the NICU stay, even among those who are already connected to social work and have previously received support. Inpatient settings with a long stay and especially with families far from home may require more consideration of adapting settings to reflect both acute needs related to hospitalization and longer-term resource needs.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNICU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eneonatal intensive care unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSDoH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esocial determinants of health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePRAPARE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eProtocol for Responding to and Assessing Patients\u0026rsquo; Assets, Risks and Experiences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflicts of interest/Disclosures\u003c/strong\u003e: The authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This project is funded in part by the National Institutes of Health K23HL136525 (JL). The content is solely the responsibility of the author(s) and does not necessarily represent the official views of the NIH.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eC. Hoffman: conceptualization, data collection, formal analysis, writing \u0026ndash; original draft, visualization\u003c/li\u003e\n \u003cli\u003eM. Harris: conceptualization, formal analysis, writing \u0026ndash; review and editing\u003c/li\u003e\n \u003cli\u003eK.K. Acharya: conceptualization, investigation, writing \u0026ndash; review and editing\u003c/li\u003e\n \u003cli\u003eM. Malnory: investigation, writing \u0026ndash; review and editing, project administration\u003c/li\u003e\n \u003cli\u003eS. Cohen: conceptualization, investigation, writing \u0026ndash; review and editing\u003c/li\u003e\n \u003cli\u003eJ. Lagatta: conceptualization, methodology, formal analysis, writing \u0026ndash; review and editing, visualization, supervision, funding acquisition\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe authors acknowledge Jill Winkler MSW, Megan Sheble, and Jonathan Leuthner for their contributions to this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement:\u0026nbsp;\u003c/strong\u003eThe datasets generated and analyzed are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. (n.d.). \u003cem\u003eSocial Determinants of Health\u003c/em\u003e. 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J Perinatol. 2021;41(2):212\u0026ndash;219. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41372-020-00906-6\u003c/span\u003e\u003cspan address=\"10.1038/s41372-020-00906-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBourque SL, Weikel BW, Palau MA, et al. The Association of Social Factors and Time Spent in the NICU for Mothers of Very Preterm Infants. Hosp Pediatr. 2021;11(9):988\u0026ndash;996. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/hpeds.2021-005861\u003c/span\u003e\u003cspan address=\"10.1542/hpeds.2021-005861\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeck DC, Tabb KM, Tilea A, et al. 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Published 2021 Oct 7. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s43058-021-00212-y\u003c/span\u003e\u003cspan address=\"10.1186/s43058-021-00212-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCordova-Ramos EG, Jain C, Torrice V, et al. Implementing Social Risk Screening and Referral to Resources in the NICU. Pediatrics. 2023;151(4):e2022058975. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/peds.2022-058975\u003c/span\u003e\u003cspan address=\"10.1542/peds.2022-058975\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCordova-Ramos EG, Kerr S, Heeren T, Drainoni ML, Garg A, Parker MG. National Prevalence of Social Determinants of Health Screening Among US Neonatal Care Units. Hosp Pediatr. 2022;12(12):1040\u0026ndash;1047. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/hpeds.2022-006767\u003c/span\u003e\u003cspan address=\"10.1542/hpeds.2022-006767\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParker MG, Garg A, Brochier A, et al. Approaches to addressing social determinants of health in the NICU: a mixed methods study. J Perinatol. 2021;41(8):1983\u0026ndash;1991. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41372-020-00867-w\u003c/span\u003e\u003cspan address=\"10.1038/s41372-020-00867-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKostelanetz S, Pettapiece-Phillips M, Weems J, et al. 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Published online January 26, 2024. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41372-024-01880-z\u003c/span\u003e\u003cspan address=\"10.1038/s41372-024-01880-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLagatta JM, Uhing M, Acharya K, et al. Actual and potential impact of a home nasogastric tube feeding program for infants whose neonatal intensive care unit discharge is affected by delayed oral feedings. The Journal of Pediatrics. 2021;234. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jpeds.2021.03.046\u003c/span\u003e\u003cspan address=\"10.1016/j.jpeds.2021.03.046\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalin KJ, Johnson TS, Brown RL, et al. 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Social Determinants of Health. 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://health.gov/healthypeople/objectives-and-data/social-determinants-health\u003c/span\u003e\u003cspan address=\"https://health.gov/healthypeople/objectives-and-data/social-determinants-health\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCenters for Disease Control and Prevention (CDC). NCHHSTP Social Determinants of Health Frequently Asked Questions. Published 2019. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/nchhstp/socialdeterminants/faq.html#:~\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/nchhstp/socialdeterminants/faq.html#:~\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e:text=Social determinants of health such,lives by reducing health inequities.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuinones Cardona V, Cohen SC, Cook N, et al. The Current State of Neonatal Neurodevelopmental Follow-Up Programs in North America: A Children\u0026rsquo;s Hospitals Neonatal Consortium Report. Amer J Perinatol. 2024; doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1055/a-2283-8843\u003c/span\u003e\u003cspan address=\"10.1055/a-2283-8843\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-perinatology","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"jp","sideBox":"Learn more about [Journal of Perinatology](http://www.nature.com/jp/)","snPcode":"41372","submissionUrl":"https://mts-jper.nature.com/cgi-bin/main.plex","title":"Journal of Perinatology","twitterHandle":"@jperinatology","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"social determinants of health, prematurity, neonatal intensive care","lastPublishedDoi":"10.21203/rs.3.rs-4656439/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4656439/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To determine whether screening for social determinants of health (SDoH) in a level IV neonatal intensive care unit (NICU) could uncover additional family needs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Secondary analysis of a prospective study in a level IV NICU. Participants filled out the Protocol for Responding to and Assessing Patients’ Assets, Risks and Experiences (PRAPARE) tool, which includes economic, housing, transportation, and safety questions. Questionnaires were completed via secure tablet; the research team notified social workers of reported needs. Illness and demographic characteristics were compared between families who did and did not report resource needs. Manual chart review assessed subsequent response to reported SDoH needs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Of 319 respondents, 61(19%) reported resource needs. Of 61 families, 88% received repeat social work encounter to re-assess for resources; 59% received new resource referrals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Systematic SDoH screening can identify needs throughout the NICU stay, even among families already connected to social work support.\u003c/p\u003e","manuscriptTitle":"Impact of systematic screening for social determinants of health in a level IV neonatal intensive care unit","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-26 15:43:49","doi":"10.21203/rs.3.rs-4656439/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2024-08-02T08:47:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2024-07-02T16:16:21+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2024-07-02T03:16:29+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2024-07-02T01:48:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-01T10:39:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-28T18:50:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Perinatology","date":"2024-06-28T18:50:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-perinatology","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"jp","sideBox":"Learn more about [Journal of Perinatology](http://www.nature.com/jp/)","snPcode":"41372","submissionUrl":"https://mts-jper.nature.com/cgi-bin/main.plex","title":"Journal of Perinatology","twitterHandle":"@jperinatology","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"ce00cd3f-b5d0-439b-8ff4-bf068198170d","owner":[],"postedDate":"July 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":33984599,"name":"Health sciences/Risk factors"},{"id":33984600,"name":"Health sciences/Health care/Health services"},{"id":33984601,"name":"Health sciences/Health care/Paediatrics"}],"tags":[],"updatedAt":"2024-09-08T07:05:48+00:00","versionOfRecord":{"articleIdentity":"rs-4656439","link":"https://doi.org/10.1038/s41372-024-02096-x","journal":{"identity":"journal-of-perinatology","isVorOnly":false,"title":"Journal of Perinatology"},"publishedOn":"2024-09-07 04:00:00","publishedOnDateReadable":"September 7th, 2024"},"versionCreatedAt":"2024-07-26 15:43:49","video":"","vorDoi":"10.1038/s41372-024-02096-x","vorDoiUrl":"https://doi.org/10.1038/s41372-024-02096-x","workflowStages":[]},"version":"v1","identity":"rs-4656439","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4656439","identity":"rs-4656439","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}