Caregiver social needs and outpatient respiratory outcomes in a cohort of children with bronchopulmonary dysplasia

OBJECTIVE: Bronchopulmonary dysplasia (BPD) is the most common cause of chronic lung disease in infancy. Caregivers often experience significant challenges in caring for these medically complex children. The purpose of this study was to determine feasibility of administering an electronic social determinants of health (SDoH) screening tool and to determine if caregiver social needs correlate with respiratory outcomes in children with BPD. 

STUDY DESIGN: An SDoH screening tool was completed by caregivers of children seen in BPD pulmonary clinics at the Children's Hospital of Philadelphia (2022-2025). Subject characteristics and respiratory health outcomes were obtained by chart review and questionnaires. 

RESULTS: Approximately 1/3 of caregivers (34.7%) endorsed a social need, with difficulty paying utility bills the most expressed need. Children of caregivers who endorsed at least one social need were more likely to have lower birth weights, earlier gestational ages, and caregivers who self-report as Nonwhite. For every social need identified, there was a 32% increased risk of an emergency department visit and a 38% increased risk of rehospitalization (unadjusted). When analyzed by self-reported race, children of White but not Nonwhite caregivers, had twice the likelihood of an ED visit/rehospitalization with each social need endorsed. 

CONCLUSION: Social need endorsement is high in caregivers of children with BPD. An association between social need endorsement and ED visits/re-hospitalizations was found in children of self-reported White but not Nonwhite caregivers, suggesting that other systemic issues not identified by the SDoH tool account for the high acute care events in children of Nonwhite caregivers.