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Racial and Ethnic Differences Over Time in Outcomes of Infants Born Less Than 30 Weeks' Gestation.

ABSTRACT: OBJECTIVES:To examine changes in care practices over time by race and ethnicity and whether the decrease in hospital mortality and severe morbidities has benefited infants of minority over infants of white mothers. METHODS:Infants 22 to 29 weeks' gestation born between January 2006 and December 2017 at a Vermont Oxford Network center in the United States were studied. We examined mortality and morbidity rate differences and 95% confidence intervals for African American and Hispanic versus white infants by birth year. We tested temporal differences in mortality and morbidity rates between white and African American or Hispanic infants using a likelihood ratio test on nested binomial regression models. RESULTS:Disparities for certain care practices such as antenatal corticosteroids and for some in-hospital outcomes have narrowed over time for minority infants. Compared with white infants, African American infants had a faster decline for mortality, hypothermia, necrotizing enterocolitis, and late-onset sepsis, whereas Hispanic infants had a faster decline for mortality, respiratory distress syndrome, and pneumothorax. Other morbidities showed a constant rate difference between African American and Hispanic versus white infants over time. Despite the improvements, outcomes including hypothermia, mortality, necrotizing enterocolitis, late-onset sepsis, and severe intraventricular hemorrhage remained elevated by the end of the study period, especially among African American infants. CONCLUSIONS:Racial and ethnic disparities in vital care practices and certain outcomes have decreased. That the quality deficit among minority infants occurred for several care practice measures and potentially modifiable outcomes suggests a critical role for quality improvement initiatives tailored for minority-serving hospitals.

SUBMITTER: Boghossian NS

PROVIDER: S-EPMC6813804 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Racial and Ethnic Differences Over Time in Outcomes of Infants Born Less Than 30 Weeks' Gestation.

Boghossian Nansi S NS Geraci Marco M Lorch Scott A SA Phibbs Ciaran S CS Edwards Erika M EM Horbar Jeffrey D JD

Pediatrics 20190812 3

<h4>Objectives</h4>To examine changes in care practices over time by race and ethnicity and whether the decrease in hospital mortality and severe morbidities has benefited infants of minority over infants of white mothers.<h4>Methods</h4>Infants 22 to 29 weeks' gestation born between January 2006 and December 2017 at a Vermont Oxford Network center in the United States were studied. We examined mortality and morbidity rate differences and 95% confidence intervals for African American and Hispani ...[more]

PMID: 31405887

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Project description:Abstract Objectives The association between poor growth and neurodevelopmental impairment (NDI) among preterm infants is well-established whether due to inadequate nutrition, adverse events or both. The present study assessed the diagnostic accuracy of 36-week anthropometric measures, including corresponding < 10th and < 3rd percentile cut points to predict NDI in preterm infants. Methods This study included data from the PreM Growth Cohort Study for preterm infants < 30 weeks of gestational age (GA) and birth weights < 1500 grams. The accuracy with which measured weight, length and head circumference z-scores can predict cognitive impairment (Bayley-III Cognitive Composite score < 80) at 21 months corrected age (born in 2005–2014) and intellectual impairment (Wechsler Preschool and Primary Scale of Intelligence-3rd and 4th Edition (Intellectual test) score < 70) at 3-years corrected age (born in 2001–2014) was determined by the area under the receiver operating characteristic curve (AUROC). Results At 21 months 98/621 (15.8%) of infants had low Bayley scores and 57/613 (9.3%) had low Intellectual test scores at 3 years. None of the AUROCs exceeded 0.6 and none were significantly different from 0.5. Sensitivities and specificities for the 10th and 3rd percentile cut points were equally poor, with most not exceeding 70% (Figures). The findings were similar between the Fenton 2013 and INTERGROWTH 2015 growth charts. The addition of morbidities increased the accuracy of predicting cognitive impairments except for infants with cerebral palsy, other morbidities had relatively marginal associations with impairment. Conclusions Preterm infant measures of weight, length, and head circumference z-scores at 36 weeks, including corresponding < 10th and < 3rd percentile cut points, are not accurate as predictors of NDI. This study confirms previous findings that preterm infants show some “catch up” in weight relative to growth references between 37–44 weeks GA. ClinicalTrials.gov Identifier: NCT03064022 Funding Sources Canadian Foundation for Dietetic Research. Supporting Tables, Images and/or Graphs

Project description:BACKGROUND:Preterm infants born 30 to 33?weeks' gestation often require early support with intravenous fluids because of respiratory distress, hypoglycemia or feed intolerance. When full feeds are anticipated to be reached within the first week, risks associated with intravenous delivery mode and type must be carefully considered. Recommendations are for parenteral nutrition to be infused via central venous lines (because of the high osmolarity), however, given the risks associated with central lines, clinicians may opt for 10% glucose via peripheral venous catheter when the need is short-term. We therefore compare a low osmolarity peripheral intravenous parenteral nutrition (P-PN) solution with peripheral intravenous 10% glucose on growth rate in preterm infants born 30 to 33?weeks' gestation. METHODS:In this parallel group, single centre, superiority, non-blinded, randomised controlled trial, 92 (P-PN 42, control 50) infants born 30+?0 to 33+?6 weeks' gestation, were randomised within 24?h of age, to receive either P-PN (8% glucose, 30?g/L amino acids, 500?IU/L heparin and SMOFlipid®) or a control of peripheral intravenous 10% glucose. Both groups received enteral feeds according to hospital protocol. The primary outcome was rate of weight gain from birth to 21?days of age. RESULTS:The rate of weight gain was significantly increased in P-PN infants compared with control (P-PN, n?=?42, 18.7, SD 6.6?g/d vs control, n?=?50, 14.8, SD 6.0?g/d; adjusted mean difference 3.9?g/d, 95% CI 1.3 to 6.6; P?=?0.004), with the effect maintained to discharge home. Days to regain birthweight were significantly reduced and length gain significantly increased in P-PN infants. One infant in the P-PN group had a stage 3 extravasation which rapidly resolved. Blood urea nitrogen and triglyceride levels were significantly higher in the P-PN group in the first week of life, but there were no instances of abnormally high levels. There were no significant differences in any other clinical or biochemical outcomes. CONCLUSION:P-PN improves the rate of weight gain to discharge home in preterm infants born 30 to 33?weeks gestation compared with peripheral intravenous 10% glucose. TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry ACTRN12616000925448 . Registered 12 July 2016.

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Racial and Ethnic Differences Over Time in Outcomes of Infants Born Less Than 30 Weeks' Gestation.

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Racial and Ethnic Differences Over Time in Outcomes of Infants Born Less Than 30 Weeks' Gestation.

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