Maternal and neonatal characteristics of extremely low birth weight infants who die in the first day of life

Pont, Molly; Carter, B. S.

doi:10.1038/jp.2008.112

Cited by 3 publications

(2 citation statements)

References 30 publications

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“…The theme of worse care in minorityserving hospitals recurs throughout this review. * Although these findings could be secondary to other confounders such as socioeconomic differences in influencing disparate outcomes, [39][40][41][42][43]45,46 we also found racial and/or ethnic disparities across processes 9,21,22,24,[27][28][29][30][31]33,37 that disadvantage infants of color. This indicates that disparities may be under the control of providers and amenable to improvement by using available QI tools.…”

Section: Discussionmentioning

confidence: 70%

“…Three articles were focused on overall morbidity or mortality, revealing contradictory trends. In 2 articles, 42,43 the researchers indicated a disadvantage for infants of color. Jacob et al 42 found that Alaskan Native infants had higher rates of NEC, retinopathy of prematurity (ROP), and chronic lung disease compared with non-Native infants.…”

Section: Overall Morbidity or Mortalitymentioning

confidence: 99%

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Racial/Ethnic Disparities in Neonatal Intensive Care: A Systematic Review

et al. 2019

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CONTEXT: Racial and ethnic disparities in health outcomes of newborns requiring care in the NICU setting have been reported. The contribution of NICU care to disparities in outcomes is unclear. OBJECTIVE: To conduct a systematic review of the literature documenting racial/ethnic disparities in quality of care for infants in the NICU setting. DATA SOURCES: Medline/PubMed, Scopus, Cumulative Index of Nursing and Allied Health, and Web of Science were searched until March 6, 2018, by using search queries organized around the following key concepts: “neonatal intensive care units,” “racial or ethnic disparities,” and “quality of care.” STUDY SELECTION: English language articles up to March 6, 2018, that were focused on racial and/or ethnic differences in the quality of NICU care were selected. DATA EXTRACTION: Two authors independently assessed eligibility, extracted data, and cross-checked results, with disagreements resolved by consensus. Information extracted focused on racial and/or ethnic disparities in quality of care and potential mechanism(s) for disparities. RESULTS: Initial search yielded 566 records, 470 of which were unique citations. Title and abstract review resulted in 382 records. Appraisal of the full text of the remaining 88 records, along with the addition of 5 citations from expert consult or review of bibliographies, resulted in 41 articles being included. LIMITATIONS: Quantitative meta-analysis was not possible because of study heterogeneity. CONCLUSIONS: Overall, this systematic review revealed complex racial and/or ethnic disparities in structure, process, and outcome measures, most often disadvantaging infants of color, especially African American infants. There are some exceptions to this pattern and each area merits its own analysis and discussion.

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Section: Discussionmentioning

confidence: 70%

Section: Overall Morbidity or Mortalitymentioning

confidence: 99%

Racial/Ethnic Disparities in Neonatal Intensive Care: A Systematic Review

et al. 2019

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Addressing bias and disparities in periviable counseling and care

Edmonds

Schmidt

Walker

2022

Seminars in Perinatology

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Withholding or withdrawing life-sustaining treatment in extremely low gestational age neonates

Dworetz

Natarajan

Langer

et al. 2020

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo identify sociodemographic and clinical factors associated with withholding or withdrawing life-sustaining treatment (WWLST) for extremely low gestational age neonates.DesignObservational study of prospectively collected registry data from 19 National Institute of Child Health and Human Development Neonatal Research Network centres on neonates born at 22–28 weeks gestation who died >12 hours through 120 days of age during 2011–2016. Sociodemographic and clinical factors were compared between infants who died following WWLST and without WWLST.ResultsOf 1168 deaths, 67.1% occurred following WWLST. Withdrawal of assisted ventilation (97.4%) was the primary modality. WWLST rates were inversely proportional to gestational age. Life-sustaining treatment was withheld or withdrawn more often for non-Hispanic white infants than for non-Hispanic black infants (72.7% vs 60.4%; 95% CI 1.00 to 1.92) or Hispanic infants (72.7% vs 67.2%; 95% CI 1.32 to 3.72). WWLST rates varied across centres (38.6–92.6%; p<0.001). The centre with the highest rate had adjusted odds 4.89 times greater than the average (95% CI 1.18 to 20.18). The adjusted odds of WWLST were higher for infants with necrotiing enterocolitis (OR 1.77, 95% CI 1.21 to 2.59) and severe brain injury (OR 1.98, 95% CI 1.44 to 2.74).ConclusionsAmong infants who died, WWLST rates varied widely across centres and were associated with gestational age, race, ethnicity, necrotiing enterocolitis, and severe brain injury. Further exploration is needed into how race, centre, and approaches to care of infants with necrotiing enterocolitis and severe brain injury influence WWLST.

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Maternal and neonatal characteristics of extremely low birth weight infants who die in the first day of life

Cited by 3 publications

References 30 publications

Racial/Ethnic Disparities in Neonatal Intensive Care: A Systematic Review

Racial/Ethnic Disparities in Neonatal Intensive Care: A Systematic Review

Addressing bias and disparities in periviable counseling and care

Withholding or withdrawing life-sustaining treatment in extremely low gestational age neonates

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