Study finds significant racial inequities in high-risk infant follow-ups

A study uncovered significant racial inequities in high-risk infant follow-up programs for extremely low birth weight infants, according to findings published in Pediatrics.

Co-author Yarden S. Fraiman, MD, MPH, is a member of the department of neonatology at Beth Israel Deaconness Medical Center in Boston.

“My work all centers on thinking about and researching racial and ethnic inequities in neonatology,” Fraiman said. “A specific thing I think about is how are inequities that we know about in prematurity and neonatology connected to inequities over time? We started thinking about the health service utilization of extremely low birth weight (ELBW) in preterm infants, and the inequities that may exist there.”

Fraiman and colleagues used data from the Vermont Oxford Network, a nonprofit collaboration of more than 1,400 hospitals that collected data on 19,503 ELBW infants born between 2006 and 2017 at 58 hospitals across the country, 44.7% of whom were seen in a high-risk infant follow-up program.

They found that Black infants (n = 6,346) were 27% less likely to participate in these programs compared with white infants (n = 9,477; adjusted OR = 0.73; 95% CI, 0.64-0.83).

“What we found is that there are racial and ethnic inequities that exist in high-risk and quick follow-up participation across the entire population,” Fraiman said. “That wasn't too unexpected, given what we know about inequities in this country. But what I think was surprising is that there was also an incredible amount of between hospital variation, and within that, inequity.”

Fraiman said “racial and ethnic inequities exist in preterm birth, and in the neonatal morbidities and mortalities associated with preterm birth” but that “those inequities also exist after ... extremely low birth weight infants leave the NICU.”

“We need to be thinking at multiple levels, at the individual level and the hospital level, about strategies to begin to dismantle a system that continues to uphold inequity,” Fraiman said.

“This work is really centered on extremely low birth weight infants, and this specific high-risk infant follow-up clinic,” he continued. “But realizing that [there are] inequities we see early in life, and inequities to get services for our highest risk babies, may be a critical step in [ending] the chain of inequity that affects the health and well-being of children in this country.”