638 Differences in management of care and survival of extremely premature babies by maternal race

Abstract

The purpose of our study was to examine racial differences in newborn care and survival of extremely premature babies born to women who delivered by cesarean section between 22 and 24 weeks of gestation in the United States. We conducted a retrospective cohort study using the Center for Disease Control’s Period Linked Birth-Infant Death Data Files from 2008-2017. We identified all singleton livebirths between 22 and 24 weeks of gestation without congenital anomalies delivered by cesarean section. We categorized them by maternal race and evaluated newborn management (ventilation, surfactant use, and Neonatal Intensive Care Unit [NICU] admissions) and infant survival. Multivariate logistic regression analysis was used to compare the management of care between racial groups, while adjusting for payment source. There were 28,377 newborns with extreme prematurity, of which 35.6% were born to White Non-Hispanic women, 35.2% to Black Non-Hispanics, 23.3% to Hispanics, and 5.9% were born to women of other races. NICU admissions were similar for all races, with the exception of being slightly lower for Hispanics (OR 0.79, 95%CI 0.73-0.86). Among these deliveries, newborns born to Black Non-Hispanic mothers (OR 0.75, 95%CI 0.71-0.80) and those born to Hispanic mothers (OR 0.60, 95%CI 0.56-0.64) were less likely to receive assisted ventilation relative to newborns of White Non-Hispanic women. Similarly, surfactant use was lower in newborns of Black Non-Hispanic mothers (OR 0.66, 95%CI 0.62-0.71) and Hispanic mothers (OR 0.51, 95%CI 0.47-0.55). In spite of these differences, babies born to Black Non-Hispanics (OR 1.20, 95%CI 1.13-1.28), Hispanics (OR 1.11, 95%CI 1.04-1.18), and mothers of other races (OR 1.16, 95%CI 1.04-1.29) were more likely to survive than babies born to White Non-Hispanic mothers. In the US, surfactant use and assisted ventilation were more often administered to extremely premature neonates of White Non-Hispanic women. However, their survival rate was slightly lower than the rates observed for Black Non-Hispanic, Hispanic, and neonates of other races.