Exploring Racial Disparities in Preterm Neonatal Outcomes in the Neonatal Intensive Care Unit (NICU) [21K

Abstract

INTRODUCTION: Racial disparities exist in pregnancy outcomes and infant mortality. We explored whether in-hospital morbidity or mortality differed by race for preterm neonates admitted to a single academic institution's NICU. METHODS: Retrospective cohort analysis of preterm infants, under 37 weeks, within NIS-3 database from 1994-2009. Anomalies and aneuploidy were excluded. Primary outcome was death before discharge. Secondary outcomes were respiratory distress syndrome (RDS), interventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Planned sub-analysis of very preterm (VPT) infants, under 28 weeks, was performed. Four racial groups were compared with odds ratio compared to Caucasian neonates (CN). Logistic regression was performed with P-value less than 0.05 significant. RESULTS: 4,802 neonates were included. There was no difference across racial groups (RGs) in death before discharge (p=0.106). Mixed neonates had a 60% increased risk of in-hospital death (IHD) compared to CNs [OR 1.60 (1.05-2.40), p=0.026]. There was a significant reduction in RDS for all three RGs compared to CNs (p=0.004). There was no difference between RGs for IVH (p=0.280) or NEC (p=0.099). In the VPT cohort IHD, RDS and NEC did not differ across RGs (p=0.151, p=0.538, p=0.905, respectively). There was a significant increase in IVH across VPT RGs (p=0.038). Asian neonates accounted for majority of IVH morbidity compared to CNs [OR 3.21 (1.09-9.07), p=0.029]. CONCLUSION: IHD does not differ across RGs in preterm neonates admitted to the NICU. CNs have a higher rate of RDS than other RGs.