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The following is a summary of “Addressing Health Inequities: Understanding the Relationship between Social Determinants of Health and Necrotizing Enterocolitis,” published in the February 2025 issue of Pediatrics by Young et al.

Necrotizing enterocolitis (NEC) is a life-threatening condition in neonates, characterized by significant morbidity and mortality. While prematurity and neonatal stress are well-established risk factors, the role of maternal and socioeconomic factors remains underexplored. This study aimed to identify parental and patient-related factors associated with NEC and evaluate their impact on clinical outcomes, particularly mortality.

Using data from the Pediatric Health Information System database (2012–2022), researchers analyzed infants under one year old diagnosed with NEC. The Childhood Opportunity Index was employed to quantify family educational, environmental, and socioeconomic conditions, stratified into low, middle, and high levels. Associations between COI, patient demographics, and mortality were assessed using multivariable regression, adjusted for gestational age, gender, race, primary payer, urbanicity, and geographic region.

A total of 10,768 infants with a median gestational age of 29 weeks (IQR: 25–34) and a median birth weight of 1,010 g (IQR: 660–1,880 g) were included. The cohort was predominantly male (57%) and White (46%), with an overall mortality rate of 18%. Infants from low-COI households experienced significantly longer hospital stays (56 vs. 53 days) and higher mortality rates (19% vs. 15%) compared to those from high-COI households. 

Adjusted analysis revealed that high COI was associated with a reduced likelihood of in-hospital mortality (OR 0.75, 95% CI 0.65–0.86, P<0.001) when compared to low COI.

These findings highlight the disproportionate burden of NEC on socially disadvantaged infants and emphasize the critical role of social determinants of health in influencing disease outcomes. The association between lower COI and increased mortality underscores the need for targeted interventions to mitigate risk factors linked to socioeconomic disadvantage. Future strategies should focus on enhanced prenatal care, improved access to resources, and tailored risk assessments for socially vulnerable populations. Addressing these disparities is essential to reducing NEC-related mortality and promoting equitable neonatal health outcomes.

Source: sciencedirect.com/science/article/abs/pii/S0022346825000211