Social determinants of health screening and interventions in neonatal care pathways (NICU to follow-up): a scoping review.

Social determinants of health (SDOH) influence families' ability to engage with neonatal care and may contribute to inequities in outcomes. Whilst the neonatal period presents a unique opportunity to address SDOH, it is unclear how screening and related responses are implemented across the neonatal care pathway. This review aimed to (i)o map and characterise existing screening tools and interventions used in the neonatal period to address SDOH and (ii) identify gaps in effectiveness and equity impacts. We conducted a scoping review (PRISMA-ScR) of studies from high-income countries reporting SDOH screening tools and/or interventions delivered in neonatal inpatient settings, discharge/postnatal pathways, neonatal follow-up services, or early infancy primary care. We report setting, tool content and delivery, downstream actions (referral/navigation), outcomes reported, and whether measurement properties were reported. Eight studies were included (predominantly from the USA/Canada) from 3764 studies screened. Most evidence related to implementation of screening and referral workflows rather than evaluation of downstream clinical outcomes. Screening approaches identified high levels of reported social need and commonly triggered social work involvement and referrals; only one study reported a defined "connection with resources" outcome beyond referral. Two studies evaluated equity-relevant interventions beyond screening: a digital participation intervention to support attendance at family-centred rounds and a follow-up intervention addressing structural barriers through coordinated support. Across included neonatal applications, psychometric properties of instruments were not reported, and tools were commonly adapted from other settings or locally developed. Outcomes were heterogeneous and most frequently process-focused (uptake, referrals), limiting comparability.

conclusionEvidence describing SDOH screening and responses across neonatal care pathways remains limited and largely descriptive. Future work should define a core set of SDOH domains with context-specific modules, use standardised outcome reporting, and apply a minimum reporting set for neonatal SDOH screening/intervention studies. WHAT IS KNOWN: • Studies mainly report screening/referral processes; neonatal-context psychometric evidence and standardised downstream outcomes are lacking. WHAT IS NEW: • We propose a minimum reporting set to improve how future neonatal SDOH screening/intervention studies are reported and evaluated.