Observational Study

. 2019 Apr:207:130-135.e2.

doi: 10.1016/j.jpeds.2018.11.025. Epub 2019 Jan 4.

Black Race Is Associated with a Lower Risk of Bronchopulmonary Dysplasia

Rita M Ryan¹, Rui Feng², Catalina Bazacliu³, Thomas W Ferkol⁴, Clement L Ren⁵, Thomas J Mariani⁶, Brenda B Poindexter⁷, Fan Wang⁸, Paul E Moore⁹; Prematurity and Respiratory Outcome Program (PROP) Investigators

Collaborators, Affiliations

Collaborators

Prematurity and Respiratory Outcome Program (PROP) Investigators:
Claire Chougnet¹⁰, James M Greenberg¹⁰, William Hardie¹⁰, Alan H Jobe¹⁰, Karen McDowell¹⁰, Aaron Hamvas¹¹, Mark R Holland¹², James Kemp¹², Philip T Levy¹², Christopher McPherson¹², Phillip Tarr¹², Gautam K Singh¹², Barbara Warner¹², Philip L Ballard¹³, Roberta A Ballard¹³, David J Durand¹⁴, Eric C Eichenwald¹⁵, Amir M Khan¹³, Leslie Lusk¹³, Jeffrey D Merrill¹⁶, Dennis W Nielson¹³, Elizabeth E Rogers¹³, Judy Aschner¹⁷, Candice Fike¹⁸, Scott Guthrie¹⁹, Tina Hartert²⁰, Nathalie Maitre²⁰, Marshall Summar²¹, Carl T D'Angio²², Vasanth Kumar²², Gloria Pryhuber²², Anne Marie Reynolds²², Kristin Scheible²², Timothy Stevens²³, C Michael Cotten²⁴, Kim Fisher²⁴, Jack Sharp²⁵, Judith A Voynow²⁶, Stephanie Davis²⁷, Scarlett A Bellamy²⁸, Jonas Ellenberg²⁹, Melissa Fernando²⁹, Howard Panitch²⁹, Pamela A Shaw²⁹, Barbara Schmidt²⁹, Lynn M Taussig³⁰, Carol J Blaisdell³¹

Affiliations

¹ Department of Pediatrics, Medical University of South Carolina, Charleston, SC. Electronic address: ryanr@musc.edu.
² Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA.
³ Department of Pediatrics, University of Florida, Gainesville, FL.
⁴ Department of Pediatrics, Washington University, St. Louis, MO.
⁵ Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University, Indianapolis, IN.
⁶ Department of Pediatrics, University of Rochester, Rochester, NY.
⁷ Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
⁸ Department of Molecular Cardiology, Lerner Research Institute, The Cleveland Clinic, Cleveland, OH.
⁹ Department of Pediatrics, Vanderbilt University, Nashville, TN.
¹⁰ Cincinnati Children's Hospital Medical Center.
¹¹ Washington University School of Medicine; Northwestern University Feinberg School of Medicine.
¹² Washington University School of Medicine.
¹³ University of California-San Francisco.
¹⁴ University of California-San Francisco; Children's Hospital and Research Center Oakland, Oakland, CA.
¹⁵ University of California-San Francisco; University of Texas Health Science Center- Houston, Houston, TX.
¹⁶ University of California-San Francisco; Alta Bates Summit Medical Center, Berkeley, CA.
¹⁷ Vanderbilt University; Albert Einstein College of Medicine, Bronx, NY.
¹⁸ Vanderbilt University; University of Utah.
¹⁹ Vanderbilt University; Jackson-Madison County General Hospital, Jackson, TN.
²⁰ Vanderbilt University.
²¹ Vanderbilt University; Children's National Health System, Washington, DC.
²² University of Rochester; University at Buffalo.
²³ University of Rochester; University at Buffalo; Indiana University; Medical University of South Carolina.
²⁴ Duke University.
²⁵ Duke University; Texas Children's Hospital.
²⁶ Duke University; Virginia Commonwealth University.
²⁷ Indiana University.
²⁸ University of Pennsylvania, DCC; Drexel University.
²⁹ University of Pennsylvania, DCC.
³⁰ Drexel University; University of Denver.
³¹ Drexel University.

PMID: 30612812
PMCID: PMC6458591
DOI: 10.1016/j.jpeds.2018.11.025

Observational Study

Black Race Is Associated with a Lower Risk of Bronchopulmonary Dysplasia

Rita M Ryan et al. J Pediatr. 2019 Apr.

. 2019 Apr:207:130-135.e2.

doi: 10.1016/j.jpeds.2018.11.025. Epub 2019 Jan 4.

Authors

Collaborators

Prematurity and Respiratory Outcome Program (PROP) Investigators:
Claire Chougnet¹⁰, James M Greenberg¹⁰, William Hardie¹⁰, Alan H Jobe¹⁰, Karen McDowell¹⁰, Aaron Hamvas¹¹, Mark R Holland¹², James Kemp¹², Philip T Levy¹², Christopher McPherson¹², Phillip Tarr¹², Gautam K Singh¹², Barbara Warner¹², Philip L Ballard¹³, Roberta A Ballard¹³, David J Durand¹⁴, Eric C Eichenwald¹⁵, Amir M Khan¹³, Leslie Lusk¹³, Jeffrey D Merrill¹⁶, Dennis W Nielson¹³, Elizabeth E Rogers¹³, Judy Aschner¹⁷, Candice Fike¹⁸, Scott Guthrie¹⁹, Tina Hartert²⁰, Nathalie Maitre²⁰, Marshall Summar²¹, Carl T D'Angio²², Vasanth Kumar²², Gloria Pryhuber²², Anne Marie Reynolds²², Kristin Scheible²², Timothy Stevens²³, C Michael Cotten²⁴, Kim Fisher²⁴, Jack Sharp²⁵, Judith A Voynow²⁶, Stephanie Davis²⁷, Scarlett A Bellamy²⁸, Jonas Ellenberg²⁹, Melissa Fernando²⁹, Howard Panitch²⁹, Pamela A Shaw²⁹, Barbara Schmidt²⁹, Lynn M Taussig³⁰, Carol J Blaisdell³¹

Affiliations

¹ Department of Pediatrics, Medical University of South Carolina, Charleston, SC. Electronic address: ryanr@musc.edu.
² Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA.
³ Department of Pediatrics, University of Florida, Gainesville, FL.
⁴ Department of Pediatrics, Washington University, St. Louis, MO.
⁵ Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University, Indianapolis, IN.
⁶ Department of Pediatrics, University of Rochester, Rochester, NY.
⁷ Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
⁸ Department of Molecular Cardiology, Lerner Research Institute, The Cleveland Clinic, Cleveland, OH.
⁹ Department of Pediatrics, Vanderbilt University, Nashville, TN.
¹⁰ Cincinnati Children's Hospital Medical Center.
¹¹ Washington University School of Medicine; Northwestern University Feinberg School of Medicine.
¹² Washington University School of Medicine.
¹³ University of California-San Francisco.
¹⁴ University of California-San Francisco; Children's Hospital and Research Center Oakland, Oakland, CA.
¹⁵ University of California-San Francisco; University of Texas Health Science Center- Houston, Houston, TX.
¹⁶ University of California-San Francisco; Alta Bates Summit Medical Center, Berkeley, CA.
¹⁷ Vanderbilt University; Albert Einstein College of Medicine, Bronx, NY.
¹⁸ Vanderbilt University; University of Utah.
¹⁹ Vanderbilt University; Jackson-Madison County General Hospital, Jackson, TN.
²⁰ Vanderbilt University.
²¹ Vanderbilt University; Children's National Health System, Washington, DC.
²² University of Rochester; University at Buffalo.
²³ University of Rochester; University at Buffalo; Indiana University; Medical University of South Carolina.
²⁴ Duke University.
²⁵ Duke University; Texas Children's Hospital.
²⁶ Duke University; Virginia Commonwealth University.
²⁷ Indiana University.
²⁸ University of Pennsylvania, DCC; Drexel University.
²⁹ University of Pennsylvania, DCC.
³⁰ Drexel University; University of Denver.
³¹ Drexel University.

PMID: 30612812
PMCID: PMC6458591
DOI: 10.1016/j.jpeds.2018.11.025

Abstract

Objective: To use a large current prospective cohort of infants <29 weeks to compare bronchopulmonary dysplasia (BPD) rates in black and white infants.

Study design: The Prematurity and Respiratory Outcome Program (PROP) enrolled 835 infants born in 2011-2013 at <29 weeks of gestation; 728 black or white infants survived to 36 weeks postmenstrual age (PMA). Logistic regression was used to compare BPD outcomes (defined as supplemental oxygen requirement at 36 weeks PMA) between the races, adjusted for gestational age (GA), antenatal steroid use, intubation at birth, and surfactant use at birth.

Results: Of 707 black or white infants with available BPD outcomes, BPD was lower in black infants (38% vs 45%), even though they were of significantly lower GA. At every GA, BPD was more common in white infants. The aOR for BPD was 0.60 (95% CI, 0.42-0.85; P = .004) for black infants compared with white infants after adjusting for GA. Despite the lower rate of BPD, black infants had a higher rate of first-year post-prematurity respiratory disease (black, 79%; white, 63%).

Conclusions: In this large cohort of recently born preterm infants at <29 weeks GA, compared with white infants, black infants had a lower risk of BPD but an increased risk of persistent respiratory morbidity.

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Figures

**Figure 1.**
Percentage of babies with bronchopulmonary dysplasia by race and gestational age in PROP cohort of babies <29 weeks gestation. Data were collected for 707 newborn infants born at <29 weeks gestation for whom both race and BPD outcome were known. For race based on maternal self-report, and using the modified Shennan definition of BPD (supplemental oxygen at 36 weeks postmenstrual age), the rate of BPD was lower for Black babies at each week of GA at birth. The odds ratio for BPD was **0.60** (95% confidence interval 0.42-0.85, P=0.004) for Black infants compared with White infants after adjusting for gestational age, intubation at birth, antenatal steroid use, surfactant use within 72 hours after birth, and sibling correlations.

**Figure 2.**
Percentage of infants with BPD by race and GA in the PROP cohort of infants born at <29 weeks of gestation. Data were collected for 707 newborn infants born at <29 weeks of gestation in whom both race and BPD outcome were known. For race based on maternal self-report, and using the modified Shennan definition of BPD (ie, supplemental oxygen at 36 weeks postmenstrual age), the rate of BPD was lower for black infants at each week of GA at birth. The OR for BPD was 0.60 (95% CI, 0.42-0.85; P = .004) for black infants compared with white infants after adjusting for GA, intubation at birth, ANS use, surfactant use within 72 hours after birth, and sibling correlations.

See this image and copyright information in PMC

Comment in

Re-conceptualizing Associations between Race and Morbidities of Extreme Prematurity.
Burris HH, Hwang SS, Collins JW Jr, Kirpalani H, Wright CJ. Burris HH, et al. J Pediatr. 2019 Apr;207:10-14.e1. doi: 10.1016/j.jpeds.2018.12.052. Epub 2019 Feb 2. J Pediatr. 2019. PMID: 30723017 No abstract available.

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Black Race Is Associated with a Lower Risk of Bronchopulmonary Dysplasia

Collaborators

Affiliations

Black Race Is Associated with a Lower Risk of Bronchopulmonary Dysplasia

Authors

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Affiliations

Abstract

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