Preterm infant survival without major morbidity declines in safety net hospitals
Click Here to Manage Email Alerts
Key takeaways:
- Rates of preterm infant survival without major morbidity stabilized in 2015 in non-safety net hospitals.
- Rates in safety net hospitals rose until 2017, then fell again to below 60%.
Although rates of survival without major morbidity have improved since 2008 among infants with very low birth weight, they have declined since 2017 for those cared for at safety net hospitals, according to findings published in Pediatrics.
“Although we in California and others have observed improving survival and survival without major morbidity over time among infants born very preterm, it is not clear whether this benefit extends equitably across race and ethnicity groups,” Jessica Liu, PhD, MPH, a biostatistician at the California Perinatal Quality Care Collaborative (CPQCC) at Stanford University, and colleagues wrote. “Similarly, to what extent these positive trends are observed for children cared for in safety net hospital NICUs, which treat predominantly low-income and underserved populations, is also unclear.”
Liu and colleagues tracked the outcomes of 66,786 infants (51.9% boys; mean gestational age, 28.3 weeks) born earlier than 29 weeks’ gestation or less than 1,500 g between Jan. 1, 2008, and Dec. 31, 2021, at California hospitals that are part of the CPQCC. The primary outcome for infants was survival without major morbidity up to 1 year after birth. The researchers compared trends in outcomes among racial and ethnic groups and in safety net hospitals vs. non-safety net hospitals.
Overall, 45.1% of infants were Hispanic, 24.6% were non-Hispanic white, 13% were Black (any ethnicity), 12.1% were Asian, 0.8% were Native Hawaiian/Pacific Islander and 3.4% were Native American/Alaskan Native or another race or ethnicity.
Out of 146 NICUs, 34 (23.3%) were safety net NICUs. A larger proportion of Hispanic infants (39%) and Black infants (34%) were cared for in safety net NICUs than non-Hispanic white infants (20%).
Liu and colleagues found that survival without major morbidity rose from 62.3% (95% CI, 60.5%-63.9%) in 2008 to 67.5% (95% CI, 65.8%-69.3%) in 2018. That rate decreased to 66.1% (95% CI, 64.3%-67.9%) by 2021.
They noted there has been little improvement in the last 5 years (P = .08). The authors cited several possible reasons, including “reaching the limit of available therapies, the need to optimize available interventions and the need to address social determinants of health.” The COVID-19 pandemic may have had an effect as well, Liu and colleagues wrote.
Black and Native Hawaiian/Pacific Islander infants experienced the largest improvements in survival without major morbidity, the researchers wrote. Rates among Black infants increased from 62.1% (95% CI, 57.7%-66.8%) in 2008 to 68.2% (95% CI, 63.4%-73.3%) in 2021, and survival rates for Native Hawaiian/Pacific Islander infants rose from 57.9% (95% CI, 31.3%-82.4%) in 2008 to 64.9% (95% CI, 43.9%-85%) in 2021. Hispanic infants had the lowest rates of survival without major morbidity of all racial and ethnic groups over the last 3 years, according to Liu and colleagues.
At safety net hospitals, rates of survival without major morbidity were an average of 7.9 percentage points lower than non-safety net hospitals at every time point, Liu and colleagues wrote. Non-safety net hospitals saw improvements from 64.5% (95% CI, 62.5%-66.5%) in 2008 to 69.6% (95% CI, 67.6%-71.6%) in 2015 with stable rates since then, whereas survival rates at safety net hospitals increased from 57.6% (95% CI, 54.5%-60.8%) in 2008 to 64.2% (95% CI, 60.7%-67.5%) in 2017, and fell to 59.7% by 2021.
Infants in all racial and ethnic groups had lower rates of survival without major morbidity in safety net hospitals compared with non-safety net hospitals. In safety net hospitals, Hispanic infants were the only group that experienced a decrease in rates over the last 5 years (P = .03).
“In our future work, we will examine whether differences in socioeconomic status among mothers delivering in safety net NICUs may account for any of these disparities; however, these disparities also indicate a greater need for services to help overcome these socioeconomic differences,” the researchers wrote.
Collapse
Read more about
Click Here to Manage Email Alerts