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 In the study of 7,177 very preterm infants born at 39 hospitals
citywide, 28 percent of the babies died or experienced serious
complications. Compared to white infants, however, black preemies
were almost twice as likely to die or have severe health issues,
while the odds were about 50 percent higher for Hispanic babies.
This disparity is due at least in part to the fact that white
children have a better chance of being born at hospitals that take
better care of preemies, researchers report in JAMA Pediatrics.
“Nearly 40 percent of the black-white disparity and nearly a third
of the Hispanic-white disparity can be attributed to hospital of
birth,” said Dr. Elizabeth Howell, director of the Women’s Health
Research Institute at the Icahn School of Medicine at Mount Sinai in
New York City.
“Hospital quality is an important and modifiable cause of
racial/ethnic disparities in neonatal outcomes,” Howell said by
email.
Pregnancy normally lasts about 40 weeks, and babies born after 37
weeks are considered full term. The study focused on the most
vulnerable preterm infants, delivered from 24 to 31 weeks’
gestation.
During the weeks immediately after birth, preemies often have
difficulty breathing and digesting food. They can also encounter
longer-term challenges such as impaired vision, hearing and
cognitive skills, as well as social and behavioral problems.
While black newborns in the U.S. have long had higher mortality
rates than white infants, much of this disparity has been attributed
to the fact that black women are more likely to have preemies,
Howell noted.
For the study, Howell and colleagues examined data for infants born
in New York City from 2010 to 2014.
Over this time, about 8 percent died within four weeks of birth or
within one year if they were continuously hospitalized. Almost 23
percent of the babies experienced serious medical complications.
Babies were more likely to die or suffer serious health issues when
their mothers were born outside the U.S. or had diabetes or high
blood pressure.
Outcomes varied widely by hospital, with mortality and complication
rates ranging from about 10 percent to almost 58 percent.
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When researchers sorted hospitals into three groups from the lowest
to highest death and complication rates, they found black and
Hispanic babies were more likely to be born at the worst-performing
hospitals.
About 43 percent of black preemies and 34 percent of Hispanic
preemies were born at the hospitals with the worst mortality and
complication rates, compared with 23 percent of white preemies, the
study found.
The study wasn’t a controlled experiment designed to prove whether
or how racial or ethnic disparities might develop among preemies.
Researchers also lacked data on some factors that can influence
outcomes for these babies, such as neighborhood poverty or exposure
to environmental toxins.
“Before we make any further inferences, we need to know what is the
cause of where these women are delivering,” said Ciaran Phibbs, a
researcher at the Stanford University School of Medicine and the VA
Palo Alto Health Care System in California, who wrote an editorial
accompanying the study.
“Once we understand the problem, we can try to take steps to correct
it,” Phibbs said by email.
Expectant mothers can still try when possible to research the
performance of hospitals and choose one that does well for these
vulnerable infants, Phibbs advised.
“Most deliveries are low-risk, and delivery hospital has no effect,”
Phibbs said. “The issue for high-risk deliveries is that they have a
limited time of advanced notice.”
SOURCES: http://bit.ly/2A7msNN and http://bit.ly/2A7ljpv JAMA
Pediatrics, online January 2, 2018.
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