In the Journals

Minority preterm infants born more frequently in hospitals with high morbidity, mortality rates

Infants of black or Hispanic race/ethnicity born very prematurely are more likely to be born in hospitals with higher morbidity and mortality rates and, subsequently, have higher rates of adverse outcomes when compared with white infants, according to findings published in JAMA Pediatrics.

“We knew that this was a trend regarding neonatal mortality, but researchers had not looked at serious morbidities,” Elizabeth A. Howell, MD, MPP, director of the Women's Health Institute at the Icahn School of Medicine at Mount Sinai, told Infectious Diseases in Children. “It is interesting because in the last 10 to 20 years, we have made strides in the quality of NICU care, which has really improved overall outcomes. In this setting of improvement, it was interesting to look at whether these old patterns of care are still true today."

To assess the rates of neonatal morbidity and mortality in very preterm infants of non-Hispanic black, Hispanic and non-Hispanic white race/ethnicity, as well as the role of the site of delivery, the researchers conducted a population-based retrospective cohort study born within 39 New York City hospitals. All infants included were born between 2010 and 2014 at 24 to 31 gestational weeks. Howell and colleagues gathered data from linked discharge abstracts and birth certificates.

To compute the risk-adjusted neonatal morbidity and morality rates in this demographic for each hospital, the researchers used mixed-effects logistic regression that included a random hospital-specific intercept. Once this was completed, Howell and colleagues ranked the hospitals and later assessed the disparities between very preterm infants with different racial/ethnic backgrounds.

Additionally, the researchers created a composite of neonatal or in-hospital mortality up to 1 year or severe morbidity in neonates, including bronchopulmonary dysplasia, severe necrotizing enterocolitis, retinopathy of prematurity stage 3 or greater or intraventricular hemorrhage grade 3 or greater.

Of the 7,177 very preterm infants included, 28% experienced morbidity or mortality. The likelihood of morbidity or death was most prevalent in black (32.2%) and Hispanic (28.1%) neonates (2-tailed P = .001). When very preterm infants were born in hospitals with the highest rates of morbidity and mortality, the risk of these conditions were twice as great (0.40; 95% CI, 0.38-0.41) when compared with births within hospitals with the lowest rates of morbidity and mortality (0.16; 95% CI, 0.14-0.18).

White infants were less likely to be born in hospitals with high morbidity and mortality rates (22.9%) when compared with black (43.4%) and Hispanic (34.4%) very preterm infants (2-tailed P <.01; black-white difference, 20%; 95% CI, 18%-23%; Hispanic-white difference, 11%; 95% CI, 9%-14%). Although a significant amount of the observed disparity was contributable to differences in infant health risks among the races/ethnicities included in the study, 40% of the disparity between black and white infants and 30% of the disparity between Hispanic and white infants was supported by birth hospital.

“I think this research raises awareness and reminds us that pregnant women should be discussing their status with their obstetrician and learn about the signs and symptoms of early labor,” Howell said. “There are a number of important practices and medications that can be used within this setting that can improve outcomes for very premature babies.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.

Infants of black or Hispanic race/ethnicity born very prematurely are more likely to be born in hospitals with higher morbidity and mortality rates and, subsequently, have higher rates of adverse outcomes when compared with white infants, according to findings published in JAMA Pediatrics.

“We knew that this was a trend regarding neonatal mortality, but researchers had not looked at serious morbidities,” Elizabeth A. Howell, MD, MPP, director of the Women's Health Institute at the Icahn School of Medicine at Mount Sinai, told Infectious Diseases in Children. “It is interesting because in the last 10 to 20 years, we have made strides in the quality of NICU care, which has really improved overall outcomes. In this setting of improvement, it was interesting to look at whether these old patterns of care are still true today."

To assess the rates of neonatal morbidity and mortality in very preterm infants of non-Hispanic black, Hispanic and non-Hispanic white race/ethnicity, as well as the role of the site of delivery, the researchers conducted a population-based retrospective cohort study born within 39 New York City hospitals. All infants included were born between 2010 and 2014 at 24 to 31 gestational weeks. Howell and colleagues gathered data from linked discharge abstracts and birth certificates.

To compute the risk-adjusted neonatal morbidity and morality rates in this demographic for each hospital, the researchers used mixed-effects logistic regression that included a random hospital-specific intercept. Once this was completed, Howell and colleagues ranked the hospitals and later assessed the disparities between very preterm infants with different racial/ethnic backgrounds.

Additionally, the researchers created a composite of neonatal or in-hospital mortality up to 1 year or severe morbidity in neonates, including bronchopulmonary dysplasia, severe necrotizing enterocolitis, retinopathy of prematurity stage 3 or greater or intraventricular hemorrhage grade 3 or greater.

Of the 7,177 very preterm infants included, 28% experienced morbidity or mortality. The likelihood of morbidity or death was most prevalent in black (32.2%) and Hispanic (28.1%) neonates (2-tailed P = .001). When very preterm infants were born in hospitals with the highest rates of morbidity and mortality, the risk of these conditions were twice as great (0.40; 95% CI, 0.38-0.41) when compared with births within hospitals with the lowest rates of morbidity and mortality (0.16; 95% CI, 0.14-0.18).

White infants were less likely to be born in hospitals with high morbidity and mortality rates (22.9%) when compared with black (43.4%) and Hispanic (34.4%) very preterm infants (2-tailed P <.01; black-white difference, 20%; 95% CI, 18%-23%; Hispanic-white difference, 11%; 95% CI, 9%-14%). Although a significant amount of the observed disparity was contributable to differences in infant health risks among the races/ethnicities included in the study, 40% of the disparity between black and white infants and 30% of the disparity between Hispanic and white infants was supported by birth hospital.

“I think this research raises awareness and reminds us that pregnant women should be discussing their status with their obstetrician and learn about the signs and symptoms of early labor,” Howell said. “There are a number of important practices and medications that can be used within this setting that can improve outcomes for very premature babies.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.