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. 2024 Dec 2;7(12):e2451707.
doi: 10.1001/jamanetworkopen.2024.51707.

Racial and Ethnic Differences in Outcomes of Neonates Born at Less Than 30 Weeks' Gestation, 2018-2022

Nansi S Boghossian  1 , Marco Geraci  1   2 , Erika M Edwards  3   4   5 , Jeffrey D Horbar  3   5
Affiliations

Racial and Ethnic Differences in Outcomes of Neonates Born at Less Than 30 Weeks' Gestation, 2018-2022

Nansi S Boghossian et al. JAMA Netw Open. .

Abstract

Importance: Previous research has examined outcomes among very preterm newborns by the birthing parent's race and ethnicity, but knowledge about these trends during the COVID-19 pandemic is limited.

Objective: To examine trends in outcomes among Black, Hispanic, and Asian preterm newborns compared with White preterm newborns.

Design, setting, and participants: This cohort study (2018-2022) took place at 774 neonatal intensive care units in the Vermont Oxford Network. Participants were newborns born at 22 to 29 weeks' gestation.

Exposure: Race and ethnicity.

Main outcomes and measures: The primary outcomes were mortality and complications, including respiratory distress syndrome, necrotizing enterocolitis (NEC), early-onset sepsis, late-onset sepsis (LOS), severe intraventricular hemorrhage (sIVH), severe retinopathy of prematurity, chronic lung disease, pneumothorax, and complication-free survival.

Results: Among 90 336 newborns (47 215 male [52.3%]; 43 121 female [47.7%]; mean [SD] gestational age, 26.4 [2.1] weeks), 4734 (5.2%) were born to Asian, 20 345 (22.3%) to Hispanic, 31 264 (34.3%) to non-Hispanic Black, and 33 993 (37.3%) to non-Hispanic White birthing individuals. Rates of in-hospital mortality (4831 Black newborns [15.6%]; 3009 Hispanic newborns [14.9%]; and 4886 White newborns [14.4%]), NEC (2374 Black newborns [7.8%]; 1359 Hispanic newborns [6.9%]; and 2137 White newborns [6.5%]), LOS (3846 Black newborns [13.5%]; 2258 Hispanic newborns [12.3%]; and 3575 White newborns [11.5%]), and sIVH (2919 Black newborns [10.3%]; 1673 Hispanic newborns [9.2%]; and 2800 White newborns [9.1%]) were highest among Black and lowest among White newborns. Chronic lung disease and pneumothorax rates were lowest among Black and highest among White newborns. Over the study period, mortality rate differences were slightly higher for Black than White newborns, with no differences by 2022. NEC and LOS rates were consistently higher among Black than White newborns. By 2022, Black newborns had higher rates of NEC (rate difference, 1.3 percentage points; 95% CI, 0.46-2.2 percentage points) and LOS (rate difference, 2.7 percentage points; 95% CI, 1.4-4.0 percentage points). sIVH rates were higher for Black newborns in some years, whereas severe retinopathy of prematurity rates were lower. Hispanic newborns had mortality and complication rates similar to those of White newborns. Black and Hispanic newborns had lower respiratory complication rates and higher complication-free survival than White newborns.

Conclusions and relevance: In this cohort study, there were no differences in mortality rates between Black and White newborns, but Black newborns had higher rates of NEC and LOS. Continued quality improvement and addressing social determinants of health are critical for promoting health equity in hospital outcomes and beyond.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Edwards reported receiving grants from Vermont Oxford Network to the University of Vermont during the conduct of the study. Dr Horbar reported receiving a salary from Vermont Oxford Network for serving as chief executive office and being an unpaid member of the board of directors of the Vermont Oxford Network during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Rates of In-Hospital Care Practices by Birth Year Among Black, Hispanic, and White Newborns
Shading represents 95% CIs.
Figure 2.
Figure 2.. Rate Differences in Mortality and Complications by Birth Year for Black and Hispanic vs White Newborns
Shading represents 95% CIs. EOS indicates early-onset sepsis; LOS, late-onset sepsis; NEC, necrotizing enterocolitis; sIVH, severe intraventricular hemorrhage; sROP, severe retinopathy of prematurity.
Figure 3.
Figure 3.. Rate Differences in Respiratory Complications and Complication-Free Survival by Birth Year for Black and Hispanic vs White Newborns
Shading represents 95% CIs. CLD indicates chronic lung disease; RDS, respiratory distress syndrome.
See this image and copyright information in PMC

References

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