Morbidities more common in black, Hispanic preemies

Last Updated: 2018-09-11

By Will Boggs MD

NEW YORK (Reuters Health) - Neonatal morbidities are much more common among black and Hispanic very-preterm infants, compared with their white peers, researchers report.

"Clinicians should be aware of the sizeable increased risk of these important very-preterm morbidities among black and Hispanic women and strive for optimal prevention and treatment strategies to reduce the burden on black and Hispanic infants and their families," Dr. Teresa Janevic from Icahn School of Medicine at Mount Sinai, in New York City, told Reuters Health by email.

Previous research on racial/ethnic disparities in severe morbidities among preterm infants has yielded inconsistent findings. This may result from bias created when infants are stratified on birthweight or gestational age.

Dr. Janevic and colleagues estimated racial/ethnic differences in four severe neonatal morbidities: necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD). They used both a conventional approach and the fetuses-at-risk (FAR) approach designed to address biased paradoxical associations.

In fully adjusted conventional models, among very-preterm infants, black infants compared with white infants had a significantly increased risk of BPD and a borderline increased risk of NEC; Hispanic infants had a borderline increased risk of NEC; and Asian infants had a significantly increased risk of ROP, the team reports in JAMA Pediatrics, online September 10.

Results were considerably different using FAR denominators. In fully adjusted FAR models, black infants compared with white infants had a 4.4-fold increased risk of NEC, a 2.73-fold increased risk of IVH, a 4.43-fold increased risk of BPD and a 2.98-fold increased risk of ROP.

Similarly, Hispanic infants compared with white infants had a 2.52-fold increased risk of NEC, a 2.12-fold increased risk of IVH, a 2.18-fold increased risk of BPD and and 99% increased risk of ROP. Very-preterm Asian infants were 2.43-fold more likely to have ROP. All these risk increases were statistically significant.

"Reports on racial/ethnic disparities from select populations of very preterm births are misleading and can lead to the erroneous belief that black and Hispanic infants are at a lower or similar risk of severe morbidities, which detracts from the magnitude of the problem," Dr. Janevic said.

"We hope in future research to pinpoint specific points of intervention to reduce disparities, as well as conduct further investigation how these very preterm birth morbidity disparities contribute to inequalities in health and development in childhood and beyond," she said.

SOURCE: https://bit.ly/2NwPtNA

JAMA Pediatr 2018.